Diseases of the Oesophagus Flashcards
What is GORD?
Inflammation of the oesophagus due to reflux of acid from the stomach
What does GORD lead to?
Leads to basal zone hyperplasia and elongation of papillae as cell type changes to deal with acid
Causes of GORD
Incompetent LOS, impaired oesophageal clearance/motility, defective mucosal barrier, hiatus hernia, pregnancy, obesity, large (fatty) meals, alcohol, CCBs, nitrates, stress
Symptoms of GORD
Heartburn - worse lying down, nocturnal cough, regurgitation of food and acid, waterbrash (excessive salivation)
Complications of GORD
Ulceration, bleeding, Barrett’s oesophagus, oesophageal cancer
Investigations into GORD
Endoscopy, manometry/pH studies if endoscopy is normal, barium swallow, nuclear imaging (rare)
Treatment of GORD
- Lifestyle changes
- PPI (omeprazole)
- Gaviscon, ranitidine
- Endoscopic fundoplication to repair LOS/if unresponsive to medication
What is Barrett’s oesophagus?
Metaplastic change - stratified squamous epithelium replaced by columnar epithelium
Pre-malignant condition where mucosa becomes unstable and can undergo dysplastic
Cause of Barrett’s oesophagus?
Persistent GORD/acid abuse
Complications of Barrett’s oesophagus?
Oesophageal carcinoma
What is the most common type of oesophageal cancer?
Adenocarcinoma
Investigation of Barrett’s
Endoscopic changes of epithelium and biopsy to screen for cancer
Treatment of Barrett’s
- PPI
- Argon
- Endoscopic mucosal resection
- Radio-frequency ablation
Intermittent dysphagia + impaired relaxation of LOS, dilated oesophagus, barium swallow bird-beak appearance
Achalasia
Oesophageal cancer development
Squamous papilloma –> squamous cell and adenocarcinomas
