Diseases of the Upper GI: Pathophysiology of the Esophagus

Question 1

The medical term for swallowing is _____________.

Answer 1

deglutition

Question 2

What happens in the oropharynx while swallowing?

Answer 2

• Elevation of the palate
• Closure of the epiglottis
• Elevation of the posterior tongue

Question 3

How many times do we swallow per day?

Answer 3

600x

Question 4

The oral phase of deglutition is __________, while the pharyngeal phase (UES relaxation) is _____________.

Answer 4

voluntary; involuntary

Question 5

Transfer dysphagia can result from _______________.

Answer 5

neuromuscular (e.g., ALS, Parkinson’s, MS, stroke, muscle injury) or obstructive causes

Question 6

What are symptoms of oropharyngeal dysfunction?

Answer 6

• Aspiration pneumonitis
• Nasal regurgitation
• Airway obstruction (choking, cyanosis)

Question 7

What is Zenker’s diverticulum?

Answer 7

An outpouching of the oropharynx that leads to bacterial colonization

Question 8

____________ is the most helpful diagnostic tool of oropharyngeal dysfunction. Though _____________ and ___________ can help.

Answer 8

History and physical (always); barium swallowing; neurologic exam

Question 9

Achalasia results from failure of the _____________ to relax.

Answer 9

LES

Question 10

True or false: most achalasia presents in childhood.

Answer 10

False. The most common age is 25 - 60.

Question 11

The cardinal symptom of esophageal strictures/obstructive disorders is ______________.

Answer 11

dysphagia to solids earlier than liquids

Question 12

How do you diagnosis eosinophilic esophagitis?

Answer 12

Dysphagia in the absence of other causes with eosinophilic infiltrate

Question 13

What population has a higher incidence of eosinophilic esophagitis?

Answer 13

White males younger than 40 who have other atopic conditions

Question 14

The best drug treatment for eosinophilic esophagitis is ______________.

Answer 14

topical steroids

Question 15

Most patients with GERD have ______________ in their esophaguses.

Answer 15

nothing (i.e., most do not have pathologic findings)

Question 16

The highest estimates for the yearly likelihood of Barrett’s transitioning to cancer is __________.

Answer 16

0.5%

Question 17

Describe the three types of achalasia.

Answer 17

I: no change in esophageal pressure
II: simultaneous change in entire esophagus
III: spastic, random pressure changes in esophagus

Question 18

Calcium-channel blockers and sildenafil can treat type ______ achalasia.

Answer 18

III

Question 19

The three Ds can treat eosinophilic esophagitis: ______________.

Answer 19

• diet (avoiding allergens)
• drugs (corticosteroids)
• dilation (surgical expansion of strictures caused by EoE)

Question 20

Esophageal erosion can be prevented in ______ percent of patients with GERD if they take PPIs.

Answer 20

90