Diagnostics

Question 1

GERD: Heartburn, worse after meals, relieved by antacids

What is the workup and diagnosis?

Answer 1

None, unless there are alarm symptoms
diagnosis: Clinical
tx: lifestyle modifications, PPI, H2 blockers

Question 2

infectious esophagitis: odynophagia or dysphagia in an immunocompromised patient

what is the work up, diagnosis and treatment?

Answer 2

• work up: endoscopy with biopsy/brushing
  diagnosis:EGD with biopsy
  tx: specific to type of infection: candida (fluconazole/ketoconazole); HSV (acyclovir), CMV (ganciclovir)

Question 3

Zenker’s diverticulum: reguritation of undigested food/liquids into pharynx hours after eating

what is the work up, diagnosis and treatment?

Answer 3

Work up: barium swallow, imaging, EGD
diagnosis: Barium swallow
tx: Surgery or nothing

Question 4

esophageal stricture/web: Dysphagia to solid foods, slow progression

what is the work up, diagnosis and treatment?

Answer 4

Work up: EGD (need biopsy), could also order barium swallow
Diagnosis: EGD
tx: dilation, resection if malignancy

Question 5

Achalasia: Episodic regurgitation, chest pain, global esophageal motor disorder in which peristalsis is decreased and LES tone is increased

Answer 5

workup: Barium swallow or EGD
diagnosis: MANOMETRY
tx: dilation, calcium channel blockers, botox