Clinical Approach - Esophageal Dz Flashcards
How does serious disease of the gut easily elude diagnosis until advanced?
mucosa of esophagus has sensation and can feel pain but past that no sensation
What are the manifestations of systemic sclerosis in the esophagus?
weak or absent LES w poor esophageal motility
dysphagia and possible esophageal stricture
LES hypotension
How can achalasia be recognized?
LES won’t relax and poor peristalsis
dysphagia for BOTH liquids and solids
caused by t. cruzi in S. america
LES hypertension and simultaneous esophageal contractions –> aperistalsis
When is fundoplication used to treat GER?
when patients respond well to PPI to begin with
when gastric contents encroach on upper airway in spite of aggressive PPI therapy
What can make GER worse but does not cause it, and so is not an indication for surgery?
mere presence of hiatal hernia
What are the four structural complications of GER?
esophagitis
Barrett - biopsy surveillance every 3 yrs
stricture - heal w fibrotic peptic stricture in distal
mucosal rings - lower boundary of LES and symptomatic once lumen narrows to 13 mm, almost always seen on barium swallow above hiatal hernia
What is one possible way to treat Barrett?
ablate metaplastic mucosa and hopefully normal will grow back
may need multiple treatments but can prevent surgery
Why do lots of patients w strictures not know for a while?
line where they lose sensation moves higher so they don’t feel heartburn - don’t feel the stricture developing
What are ways to evaluate the esophagus based on symptoms?
EGD - for dysphagia, selected GERD, *odynophagia and bleeding
dysphagiagrams - look for oropharyngeal dysfunction causing dysphagia or aspiration
manometry - if achalasia or systemic sclerosis suspected
What are symptoms of eosinophilic esophagitis?
children - chest pain w muscle infiltration of eosinophils
adults - severe dysphagia
What are the risks of management of eosinophilic esophagitis?
clearing meat impactions can cause perf
systemic steroids are effective but have lots of side effects
What does dysphagia for solids vs. dysphagia for liquids represent?
solids - mechanical obstruction
liquids - motility disorder
