2.  Case1 :Esophageal Cancer  Diagnosis  Management  Case2 : Achalasia  Diagnosis  Management  Case3 : GERD  Diagnosis  Management

3. 65 years old complaining of dysphagia. How will approach him?

4.  History and clinical examination:

5.  onset  duration  site  progression  associated symptoms  Odynophagia  Cough  hoarseness

6.  Lymphadenopathy

7.  CBC  CXR  ECG

8. -Upper GI endoscopy

9.  Location  Size  Obstructing?  Biopsy

10.  Location  Size  Obstructing?

11. - TNM staging by doing CT (cap)

12. Conservative Surgical

13.  Adenocarcinoma  Squamous carcinoma

14.  Nutritional status support  Endoscopic dilatation &stenting  TPN  Gastrostomy tube  Chemo radiotherapy

15.  Esophagectomy:  Trans hiatal esophagectomy  Transthoracic esophagectomy

16. 30 years old complaining of dysphagia. How will approach him?

17. History and clinical examination:

18.  Onset  Duration  Site  Progression  Associated symptoms

19. Unremarkable

20.  Upper GI endoscopy

21. Bird’s beak or Rat’s tail Obstructing? Regular stricture edges

23.  Manometry study:  High LES pressure  Aperstalises  Fail of LES relaxation

24. Conservative Surgical

25.  Pneumatic dilatation  Calcium channel blockers  Botulinum toxin injection

26.  Laparoscopy or laparotomy and Heller myotomy

27. 30 years old complaining of heartburn and regurgitations. How will approach him?

28.  History and clinical examination:

29.  Onset  Duration  Associated symptoms  Has he treated before  Responding to medications

30.  Unremarkable

31.  Upper GI endoscopy

32.  Barium swallow:  Reflux of the material to the esophagus

33.  Ambulatory 24 h PH monitoring  Demester score >14.7

34.  Conservative  Surgical

35.  Changing life style  PPI

36.  Laparoscopy or laparotomy and Nissen fundoplication

37.  Esophagitis  Peptic stricture  Barrit esophagus :The most serious one as it consider as a pre malignancy (intestinal metaplasia in the lower esophagus).