Disorders Of The Esophagus

Question 1

An EGD in a patient reveals nondysplastic, non-nodular Barrett’s esophagus - how do you manage this patient?

Answer 1

1. Optimize dose of PPI (start once daily or increase to BID)
2. Repeat EGD w/biopsies in 3-5 years.

Question 2

In a 45 year old patient presenting with dysphasia, GERD and NO alarm symptoms, what is your first step in management?

Answer 2

Trial of PPI

Question 3

What malignancy are patients with achalasia at risk for?

Answer 3

Esophageal squamous cell carcinoma

Question 4

What is the gold standard test for diagnosis of achalasia?

Answer 4

High resolution manometry +/- barium swallow. Impaired relaxation of the lower esophageal sphincter and abnormal peristalsis are diagnostic.

Question 5

What is the definition of Barrett’s esophagus?

Answer 5

Columnar intestinal meta plasma +/- goblet cells that extend > or = 1 cm proximal to the GE junction.

Question 6

In patients with Barrett’s esophagus and indefinite dysplasia, how do you manage further?

Answer 6

Optimize PPI therapy and repeat EGD in 3-6 months. If still indefinite, repeat EGD with biopsies in 1 year. Otherwise manage per new pathology.

Question 7

What is the first step in investigating for achalasia?

Answer 7

OGD

Question 8

What are the medications that can be used as second line therapy (after Botox injection) in the treatment of refractory achalasia, in people who are not surgical candidates?

Answer 8

Smooth Muscle Relaxants:
CCB (Nifedipine 10-30 mg SL TID)
Nitrates (ISDN 5 mg LD TID)

Question 9

Which conditions can cause eosinophilic esophagitis (7)?

Answer 9

GERD
Achalasia
Connective Tissue Disease
Hypermobility Syndromes
Pill Esophagitis
Pemphigus
Hyper IgE Syndrome

Question 10

Which 6 foods should be eliminated in unknown etiologies of eosinophilic esophagitis?

Answer 10

Eggs
Soy
Cow’s Milk
Wheat
Treat Nuts
Seafood

Question 11

When should PPIs be taken?

Answer 11

30-60 minutes before a meal