Diseases of the Upper GI: Pathophysiology of the Esophagus

Question 1

what are 4 Symptoms of Oropharyngeal Dysphagia:

Answer 1

• Difficulty initiating a swallow
• Nasal regurgitation
• Coughing with swallowing
• Laryngeal Penetration/Frank Aspiration

Question 2

Diagnosis of Oropharyngeal Dysphagia is made by:

Answer 2

• Good history (obviously)

- Modified Barium Swallow: serial X-rays of patient chewing and swallowing radio-opaque barium

Question 3

Oropharyngeal phase of swallowing consists of:

Answer 3

• Biting/grinding using teeth
• Chewing and saliva make a lubricated food bolus
• Tongue pushes food into the pharynx
• Pharyngeal contraction moves food into the esophagus
• Protection of airway and nasal passages

Question 4

what is the Treatment Oropharyngeal Dysphagia

Answer 4

• Treatment of underlying disease
• Speech therapy may be helpful
• Enteral feeding (gastrostomy tube feeding) may be required

Question 5

describe the endoscopic therapy for Achalasia

Answer 5

o Pneumatic Dilation: Inflation of rigid balloon across LES with resultant muscle tearing

o Per oral endoscopic myotomy (POEM): newer treatment, creation of a false tract (lumen) in wall of esophagus with endoscope then dissection down to LES and use of electrocautery to cut LES

Question 6

what are the causes of Esophageal Strictures:

May be benign or malignant

Answer 6

• Benign: GERD/reflux induced, radiation induced, caustic ingestions, congenital
• Malignant: esophageal cancer (adenocarcinoma or squamous cell carcinoma), rarely metastasis

Question 7

what is the Tx for esophageal strictures

Answer 7

Dilation and treat underlying cause is possible (IE acid suppressive therapy in GERD-induced stricture)

Question 8

what is Eosinophilic Esophagitis (EoE):

Answer 8

Chronic immune mediated allergic disease of the esophagus (related to food allergies)

Question 9

what occurs during Eosinophilic Esophagitis (EoE):

Answer 9

Causes esophageal inflammation (with eosinophils) and narrowing that leads to symptoms of esophageal dysfunction (dysphagia to solids and repeated episodes of food bolus impaction).

Question 10

Eosinophilic Esophagitis (EoE) is Frequenlyt concomitant other allergic diseases such as____ .

Answer 10

asthma,
allergic rhinitis,
food allergies,
eczema

Question 11

how is a diagnosis of Eosinophilic Esophagitis (EoE) made

Answer 11

Symptoms,
Endoscopy (typical endoscopic features),
Biopsies revealing esophageal eosinophilia that does not respond to PPI therapy

Question 12

what is the treatment of Eosinophilic Esophagitis (EoE)

Answer 12

Treatment =3 D’s,

Drugs: topical steroids, usually asthma formulations with patients instructed to swallow drug instead of inhale

Diet: Elimination diets (foods most likely to precipitate EoE are eliminated) and Elemental diet (diet free of allergens)

Dilation: Mechanical treatment of esophageal narrowing to improve symptoms. Does not treat inflammation.

Question 13

what are the Sx’s of GERD?

Answer 13

Heartburn and Regurgitation,
throat clearing,
cough,
chest pain

Question 14

5 Risk factors for Barrett’s Esophagus:

Answer 14

• Male
• Caucasian
• Central adiposity
• Advancing age (plateau in 60s)
• Chronic GERD

Question 15

what are the endoscopic treatments for Barret’s esophagus

Answer 15

o Ablation of Barrett’s tissue

o Endoscopic resection of visible lesions

Question 16

Squamous Cell Esophageal Cancer risk factors include

Answer 16

older age,
alcohol/tobacco (especially both).
Declining incidence is US and Europe.

Question 17

Adenocarcinoma esophageal cancer Risk factors include:

Answer 17

Barrett’s esophagus, 
GERD, 
older age, 
obesity, 
smoking. 
Usually located in distal esophagus/GE junction

Question 18

Describe the surgical treatment for Achalasia

Answer 18

Surgical (Heller) myotomy, laparoscopic surgery with incision of LES muscles and then usually combined with an antireflux surgery (fundoplication)