Esophageal Conditions Flashcards
Esophageal Disorders: Red Flags
– Weight loss, mass, symptoms time worsening, abrupt onset after 50
– Other: muscle weakness,neurological signs, pain
Dysphagia
-Difficulty swallowing
-May say “food feels stuck”
-Liquids or colids
Causes of Dysphagia
NMS, obstruction of inflammation of esophagus
Odynophagia
-Pain with swallowing (often sharp)
-Usually associated with diffuse or severe inflammation
Pyrosis
Heartburn
In esophageal disorders, chest pain is often result of:
Motility issue which resembles heart
Regurgitation
Small amount of content comes up
Risk Factors of Dysphagia
-Older adults: Natural aging leads to decreased muscle tone*
-Neurological disorders/damage (ie. stroke)
Esophageal Disorders: Testing Procedures
-Palpation: lump, mass, hypertonic tissue
-Swallow (screening) test: pain, dysfunction
(Drinking water test)
Esophageal Disorders: Diagnostic Procedures
-Barium swallow (upper GI series)
-Endoscopic exam (upper GI endoscopy)
-CT, MRI
Functional vs. Pathological Swallowing Issues
-Functional: No evidence, globus hystericus
-Pathological: Evidence, most conditions
Oropharyngeal: Location, Symptoms
-Oral cavity to upper esophageal sphincter
Symptoms
• Trouble initiating swallowing*
• Nasal regurgitation
• Coughing, choking or gagging w/ attempts to swallow
• Halitosis
• Drooling
Oropharyngeal Conditions
• NMS
• Medications
• Oral conditions
• Structural
• Obstructive
Esophageal: Location
Upper to lower esophageal sphincter
Esophageal Conditions
• Mechanical
• Motility (DES/achalasia)
• Obstructive
• Inflammation/ infection
• Other: hiatal hernia, Barrett’s syndrome, etc
Esophageal: Main Symptoms
• Food “gets stuck” (patient may indicate mid to lower part of throat region)*
• Sternal pain/ heart burn (pyrosis)*
Oropharyngeal vs. Esophageal: Causes
-Oropharyngeal: muscle, nerve, structural
-Esophageal: mechanical, motility, obstructive
Globus Hystericus
• Sense of fullness or lump in throat
– Has no difficulty in swallowing
– No mass present
Globus Hystericus: Causes (3)
– No specific etiology
– May be due to pharyngeal muscle spasm
– May result from GERD
– May be symptom of certain mood disorders/stress
Globus hystericus can be confused with other disorders including:
Esophageal, GERD, skeletal muscle, mass lesions
Globus Hystericus: Diagnostic considerations
• Rule out true dysphagia conditions
-Consider other conditions: NMS, conditions causing post-nasal drip, psychosocial/stress
In Globus hystericus, a swallowing screen and palpation for neck masses will:
Come back normal
Diffuse Esophageal Spasm
Abnormal motility due to esophageal motor dysfunction
DES is more common in:
-Age: Mid 40s+
-More common in women
DES Symptoms
• Vague Sx
– Usually intermittent & variable
– May last minutes to hours
DES may evolve to:
Achalasia
DES is also called
Corkscrew esophagus or rosary bead
DES: Symptoms
-Retrosternal pain (may radiate to the back)
-Dysphagia
-Regurgitation
-May occur: at night or with exercise,
DES: Red Flags
Spasms can cause substernal pain w/o dysphagia
-Mimics angina pain*
DES: Other DDx (5)
Achalasia, esophagitis, GERD, diverticula, rings
DES: Diagnostic testing
-Barium swallow*
DES: Medication
-Ca channel blockers, nitroglycerin, antidepressants
-Botox injections
DES: Dietary Factors
-Small meals, pureed foods, quick swallow liquids
Achalasia
• Neurogenic esophageal motility disorder
A. Ineffective peristalsis of esophageal smooth muscle
B. Inadequate relaxation of lower esophageal sphincter
C. Results in functional obstruction of esophagus
Achalasia: Time of Onset
Slowly progressive over months or years
-Usually begins between 20-60
Achalasia is also known as
Esophageal aperistalisis
Achalasia: Symptoms
• Dysphagia (most common)
• Noctural regurgitation (33%)
• Chest pain possible
• Heartburn
• Weight loss:
– mild to moderate
– Rapid weight loss, may be secondary to tumor
Achalasia: Diagnostics
– Barium swallow preferred
Narrowing of the esophagus at lower esophageal sphincter
Bird beak
Esophageal dilation
Megaesophagus
Intrinsic Disorders of Esophagus
-Esophageal web
-Lower esophageal ring
-Esophageal tumors
Extrinsic disorders of esophagus
-Cervical bony exostosis
-Thoracic tumor
-Aortic aneurysm
Esophageal web
Obstructive disorder in upper esophagus
An esophageal web can develop with what disorder?
Untreated severe iron deficiency anemia
An Esophageal Web is also known as
– Plummer-Vinson Syndrome
– Sideropenic Dysphagia
Esophageal Web: Symptoms
-Dysphagia of solids
-Possible thoracic pain
-Fatigue
Esophageal Web: Diagnostic Testing
-Barium swallow (preferred)
-Labs: Related to IDA
Esophageal Web: Treatment
-Treat IDA: Iron supplement
-Determine/address cause of IDA
Esophageal Web should include a diet of:
Iron rich foods
Lower Esophageal Ring
-Mucosal structure causing narrowing at distal esophagus
-Causes obstruction of food passing into gastric making it difficult to swallow
-Probably congenital
When do symptoms usually begin for Lower Esophageal Ring
After 25
Lower Esophageal Ring: Symptom
Intermittent dysphagia of food
Lower Esophageal Ring: Diagnosis
-Barium
-X-Rays
Lower Esophageal Ring: Treatment
Dilation, chew food well
Other names for Lower Esophageal Ring
-Schatzki Ring or B ring
*GERD Vs. Acid Reflux
-Acid Reflux: Reflux is common but not frequently; may include heartburn
-GERD: Chronic reflux; Occuring more than 2x/week; Heartburn is most common symptom
GERD
Reflux of gastric content into esophagus
GERD is caused by:
Incompetency of LES
GERD: Causes of Incompetency of LES
Medication, food/diet, pregnancy, hiatal hernia, diabetes, tobacco, weight gain
GERD: Specific Populations
– Older adults: possible increase d/t coexisting diseases
– Infants: uncomplicated reflux
• Normal to have brief episodes of spitting up
• Disappear by 10 month though may last until 2 yo
• If GERD, may see slow weight gain
Contributor to GERD
Hiatal hernia
Chronic GERD can lead to (5)
– Esophagitis
– Esophageal ulcers
– Esophageal strictures
– Barrett’s esophagus
– Esophageal adenocarcinoma (rarely)
GERD Symptoms
• Heartburn* main sx
• Regurgitation
• Sour taste
• Dysphagia
• Sensation of lump in throat
• Chest pain
• Early satiety
• Abdominal fullness
• Bloating
GERD diagnosis is typically diagnosed through:
History
Esophagitis
Inflammation of the esophageal lining
Causes of esophagitis
-Reflux
-Infection: bacteria, virus (herpes), fungal (candida)
-Other irritants: vomiting, medications
Esophagitis: Risk Factors
Alcohol, smoking, diet (Similar to GERD)
Disorders that can lead to esophagitis
GERD & hiatal hernia
Esophagitis can lead to other problems including:
– Ulcers
– Scars and strictures
– Barrett’s esophagus
Esophagitis: Symptoms
• Heartburn (most common)
• Regurgitation
• Dysphagia
• Chest pain
• Epigastric discomfort
Esophagitis: Diagnostics (4)
– Endoscopy or biopsy
– Upper GI series or barium swallow
Esophagitis: When to refer
Because sx may look like other conditions like GERD, refer if :
• ER: chest pain lasting more than a few minutes or history of heart dx
• Other: when doesn’t improve after few days, doesn’t improve w/ meds.
Barrett’s Esophagus
• Abnormal cellular changes in lining of lower esophagus
Barrett’s Esophagus: Risk Factors
– Chronic acid reflux
– Increases with age
– Male, Caucasian
– Overweight, Smoking
Conditions causing Barrett’s Esophagus
– GERD
– Esophagitis
Barret’s Esophagus is associated with:
– increased risk in esophageal cancer
Barrett’s Esophagus: Symptoms
NONE
-May have history of GERD
Barrett’s Esophagus: Diagnostics
– Endoscopic
– Biopsy
Barrett’s Esophagus: Treatment/Prognosis
-Treat underlying reflux (GERD): Medication/lifestyle
-Ongoing surveillance to detect cancerous change*
Hiatal Hernia
• Stomach protrudes through diaphragmatic esophageal hiatus
Most common type of hiatal hernia (of 3 types)
Sliding (above diaphragm)
Hiatal hernia: Most common cause
– Increased abdominal pressure
• Coughing, vomiting, lifting
• Straining from bowel movement
• Pregnancy, obesity
Hiatal Hernia: Risk Factors
– Obesity, aging (70% in those older than 70) , smoking
– Chronic constipation related to low fiber diets
Hiatal Hernia is associated with:
GERD (<50%)
Complications of Hiatal Hernia
Heartburn, stricture, Barrett esophagus, esophageal cancer
(Complications from Reflux)
Hiatal Hernia: Possible Symptoms
• Most asymptomatic
Possible sx:
• Heartburn
• Regurgitation
• Dysphagia
• Chest pain
• GI bleed
– Ex: Mallory Weiss
Hiatal Hernia: Treatment
• Medication
– Treat GERD
– Tighten muscles
• Surgery
Mallory-Weiss Syndrome
• Nonpenetrating laceration in gastroesophageal junction region
Mallory-Weiss Syndrome: Causes
– Primary condition causes significant vomiting or vigorous coughing
– This causes a tear in the GE junction
– Leading to hematemesis
Mallory-Weiss Syndrome: Risk Factors
– Chronic alcohol abuse
– Bulimia
– Male
– Age: 40-60
Mallory-Weiss Syndrome: Associated Conditions
– Hiatal hernia (present up to 90% of patients)
– Esophagitis
– Gastritis
Mallory-Weiss Syndrome: Signs/Symptoms
• Hematemesis-100%
• Melena-10%
Mallory Weiss Syndrome: Diagnostics
– Endoscopy for definitive diagnosis (will see tear)*
– No specific labs
– May do CBC for bleeding
Esophageal Cancer is more common in:
Men
Esophageal Cancer: Proximal 2/3
Squamous Cell Carcinoma
Squamous Cell Carcinoma: Risk Factors
Alcohol, tobacco, achalasia, esophageal web
Esopheageal Cancer: Distal 1/3
Adenocarcinoma
Adenocarcinoma: Risk Factors
– Risk factors: Caucasian, smoking, Barrett’s esophagus, GERD
Esophageal Cancer: Symptoms
– Dysphagia-progressive
– Weight loss
Esophageal Cancer: Prognosis
Poor
Mallory Weiss: Symptoms d/t vomitting
– Light-headedness
– Dizziness
– Syncope
– Abdominal pain
– Dyspepsia
Esophageal: Other Symptoms
• Painful swallowing
• Regurgitation
• Coughing
• Sore throat
• Possible thoracic or upper abdominal pain
DES: Can be initiated by
-Initiated by hot, cold or carbonated drinks
