Esophageal Disease

Question 1

What are 5 causes of esophagitis?

Answer 1

Pill, Infectious, Eosinophilic, Caustic, gErd/everything else.

Question 2

What meds often cause pill esophagitis?

Answer 2

Non-enteric coated nsaids, abx (tetracycline), biphosphonates, HAART

Question 3

Dx and Tx of pill esophagitis?

Answer 3

EGD + bx - if pill still there, remove, otherwise adminster PPI while still healing.

Question 4

Main causes of infectious esophagitis?

Answer 4

Candida, HSV, CMV, HIV

Question 5

Presentation of infectious esophagitis (Candida?):

Answer 5

Oral thrush, white plaques.

Question 6

Treatment of infectious esophagitis (candida)?

Answer 6

Nystatin swish/spit, or swish/swallow for oral candida, fluconazole for esophagitis.

Question 7

Presentation of infectious esophagitis (HSV?):

Answer 7

Oral lesions = painful vesicles w/ erythematous base. Ulcers at multiple stages of healing.

Question 8

TX of infectious esophagitis (HSV?):

Answer 8

Val/acylovir.

Question 9

Presentation of infectious esophagitis (CMV?):

Answer 9

No oral manifestations.

Question 10

Treatment of infectious esophagitis (CMV?):

Answer 10

val/a/ganciclovir.

Question 11

What is eosinophilic esophagitis?

Answer 11

allergic rxn to food/ingestion, causes allergic rxn in eso too. Seen in people w/ asthma, eczema, seasonal allergies, etc.

Question 12

Dx of eosinophilic esophagitis?

Answer 12

EGd + bx. > 15 esos per high powered field.

Question 13

TX of eosinophilic esophagitis?

Answer 13

Bc GERD can cause eosino-eso, give PPI. If rial fails, try aerosolized steroids.

Question 14

What is caustic esophagitis?

Answer 14

Burning of esophagus due to ingestion of very strong acid/base (drain cleaner etc), usually kid by accident or adult suicide attempt.

Question 15

Sx of caustic esophagitis?

Answer 15

Burning of larynx - hoarseness.
Burning of trachea - stridor. INTUBATE.
Eso burning - drooling.

Question 16

Dx of caustic esophagitis?

Answer 16

EGD + bx

Question 17

TX of caustic esophagitis?

Answer 17

NEVER TRY TO NEUTRALIZE PH. NEVER INDUCE EMESIS. Instead, NGT + lavage if early. If high severity (strictures, necrosis), NPO 72 hrs. If low, liquid diet/observe.

Question 18

What is GERD?

Answer 18

transiently weakened LES - regurg of acid up burns mucosa - ouch.

Question 19

Risk factors for GERD?

Answer 19

↑ intra-abdominal pressure (e.g., obesity, pregnancy), scleroderma, alcohol, caffeine, nicotine, chocolate, and fatty foods.

Question 20

Typical presentation of GERD?

Answer 20

Patients present with heartburn that commonly occurs 30–90 minutes after a meal, worsens with reclining, and often improves with antacids, sitting, or standing. Sour taste (“water brash”), laryngitis, dysphagia, and cough or wheezing.

Question 21

Atypical presentation of GERD?

Answer 21

nocturnal “asthma”.

Question 22

Diagnosis of GERD?

Answer 22

Dx with treatment - trial of PPIs AND lifestyle modification for 6 weeks. If doesn’t work, consider EGD + bx (esp if long-standard sx), or barium swallow to r/o hiatal hernia/esophageal manometry if considering surgery. 24 hr pH monitoring best test.

Question 23

When to go straight to EGD for GERD?

Answer 23

Alarm symptoms: n/v, anemia, weight loss.

Question 24

What may EGD + bx in the setting of GERD show?

Answer 24

Nothing: Gerd
Metaplasia of squamous –> columnar epithelium - Barret’s. Tx w/ PPI.
Dysplasia - local ablation + PPI.
Adenocarcinoma -> staging/resection/chemo/rads.

Question 25

What is the Nissen fundoplication

Answer 25

If someone cannot tolerate PPIs, nissen fundop wraps gastric tissue around LES. Too tight: Achalasia.

Question 26

What is achalasia?

Answer 26

Absence of myenteric plexus that inhibits LES contraction; LES cannot relax.

Question 27

Presentation of achalasia?

Answer 27

Sensation of knot/ball of food stuck mid-sternum.

Question 28

Dx of achalasia?

Answer 28

Barium swallow - birds beak.
Manometry - abnormal tone.
EGD w/ bx - rule out Ca.

Question 29

Treatment of achalasia?

Answer 29

Botulinum toxin - only if terrible surg candidate.
Dilation - perf risk
Myotomy - best. But too much –> Gerd.

Question 30

What is esophageal scleroderma?

Answer 30

Collagen deposition in LES, LES is too relaxes cannot contract.

Question 31

What is esophageal scleroderma associated with?

Answer 31

CREST (calcinosis, raynauds, esophag dysmotility, sclerodactyly, telangiectasias) - anti-centromere Ab or anti-scl70 or anti-topoisomerase.

Question 32

What is the treatment of esophageal scleroderma?

Answer 32

Only sx –> PPI.

Question 33

What is diffuse esophageal spasm?

Answer 33

contractions of esophagus, will look like an MI! retrosternal chest pain, releived by nitrates and CCBs.

Question 34

Dx of diffuse eso spasm?

Answer 34

Once MI ruled out:
Barium swallow - corkscrew esophagus
Manometry - random contraction
EGD - not necessary, maybe if unclear.

Question 35

treatment of diffuse esophageal spasm?

Answer 35

CCBs, nitrates PRN.

Question 36

What is Schatzki’s ring?

Answer 36

Ring at the GE junction, food gets stuck there.

Question 37

What is the buzzword for Schatzki’s ring?

Answer 37

Steakhouse dysphagia. Only w/ big bites of poorly masticated food.

Question 38

Treatment of Schatzki’s ring?

Answer 38

During EGD, lyse ring.

Question 39

What are esophageal webs? What syndrome?

Answer 39

Plummer-Vinson syndrome. Woman w/ dysphagia, iron deficiency anemia, risk of eso cancer.

Question 40

Dx of esophageal webs?

Answer 40

barium swallow.

Question 41

Treatment of esophageal webs?

Answer 41

Give iron, EGD bx to screen for cancer. NO prophylactic ESOPHAGECTOMY unless cancer DEVELOPS.

Question 42

What is Zenker’s diverticulum?

Answer 42

outpouching of mucosa in eso. Undigested food gets stuck there. halitosis! older man.

Question 43

Dx and tx of Zenker’s?

Answer 43

barium swallow, TX: surg repair.

Question 44

Two etiologies of esophageal cancer?

Answer 44

Squamous - upper 1/3 - etoh + tobacco

Adenocarcinoma - lower 1/3 - GERD.