Disorders of the Esophagus

Question 1

Esophageal Achalasia:

• Pathophysiologic processes responsible
• Symptoms & Complications
• Diagnosis
• Treatment

Answer 1

-Patho: LES (lower esophageal sphincter) fails to relax properly- Exact cause unknown, Degeneration of the myenteric plexus, Loss of inhibitory neurons that dilate LES

-Symptoms: 
    Dysphagia
    Chest pain
    Regurgitation
-Complications:
    Stricture
    Obstruction
    Distortion of the esophagus

-Diagnosis:
Upper Endoscopy

-Treatment: Balloon dilatation or localized
botox injection (Both done during endoscopy)

Question 2

REFLUX ESOPHAGITIS (GERD)

• Pathophysiologic Processes Responsible
• Symptoms & Complications
• Diagnosis
• Treatment

Answer 2

Patho:
-Acid exposure recurrent —> esophageal mucosa injury (Can lead to esophagitis)

Symptoms & Complications:

• Heartburn (burning chest pain) [Often worse when laying down]
• Long-term: Dysphagia
• Stricture, obstruction
• Bleeding, rupture

Diagnosis
-Based on symptoms

Treatment: Proton Pump Inhibitor or Histamine 2 antagonist

Question 3

GERD Progression

Answer 3

1. Stricture
2. Obstruction
3. Perforation (a hole that develops through the wall of a body organ)
4. Barrett’s Esophagus
5. Cancer

Question 4

What leads to initial esophageal lesion? (GERD)

Answer 4

• Delayed Gastric Emptying
• Increased freq. of transient LES relaxations
• Increased acidity
• Loss of secondary peristalsis following transient LES relaxations
• Decreased LES tone

Question 5

Barrett’s Esophagus:

• Patho
• Modifiable risks
• Diagnosis
• Treatment

Answer 5

Patho:
-Epithelial metaplasia: Squamous to columnar cells
Metaplasia can lead to dysplasia [20 fold increased risk of esophageal adenocarcinoma]

Modifiable risks: Tobacco and alcohol use

Diagnosis: Upper Endoscopy

Treatment:

• Metaplasia:
  a. Prevent further acid damage (does not undo metaplasia)
  b. PPI, H2 Antagonist
  c. Lifestyle changes: Reduce tobacco/ alcohol use, don’t lay down after eating, don’t eat fatty or greasy foods
• Dysplasia:
  a. Esophagectomy
  b. Ablation of Dysplastic tissue

Question 6

Mallory- Weiss Tear

• Patho
• Symptoms
• Diagnosis
• Treatment

Answer 6

Patho: A tear in the mucosal layer at the junction of esophagus and stomach (caused by vigorous vomiting, retching or tearing)

Symptoms: Hematemesis (Vomit blood)

Diagnosis: Upper endoscopy

Treatment:

• Usually resolves quickly
• Local therapy if needed
• Maybe PPI