Esophageal Disease Lecture Powerpoint Flashcards
Oropharyngeal vs esophageal dysphagia
Difficulty with initiating swallow vs difficulty after initiating swallow with food stuck in the esophagus
Acute dysphagia
Typically foreign body impactation in the esophagus such as a food bolus, causes sensation of something stuck and inability to swallow saliva
Acute dysphagia treatment options (3)
- removal during endoscopy
- glucagon mg IV lower esophagus
- referral to gastro
Esophageal stricture/peptic stricture, how are they diagnosed (1)
Gradual progressive dysphagia for solids often due to chronic acid reflux or tumor,
-barium swallow
Most common esophageal cancer globally vs in the US
Globally is squamous cell, adenocarcinoma in the US
Clinical presentation of esophageal cancer (2)
- dysphagia often progressive
- unintentional weight loss
Esophageal cancer diagnostic studies (2)
- endoscopy and biopsy
- PET for mets
Esophageal cancer treatment options (3) and prognosis
- endoscopic mucosal resection (stage T1a)
- esophagectomy with lymphadenectomy (stage T1b)
- most of time palliative chemo, stents, brachytherapy, etc.
5 year survival rate only about 50% even without metastasis
Eosinophilic esophagitis and presentation
Chronic inflammation due to allergic process resulting in increased eosinophils in esophageal tissue, presents with reflux symptoms, solid food dysphagia, and impactation of food bolus, symptoms do NOT improve with acid suppression**
Eosinophilic esophagitis diagnosis (3)
- EGD with esophageal biopsy with pathology report showing >15 eosinophils per hpf not otherwise explained
- eosinophilia persists after trial of PPI
- characteristic tears on endoscopy
Eosinophilic esophagitis treatment options (3)
- first line inhaled corticosteroid (complication is candida, fluconazole might help)
- allergy testing
- esophageal dilation
Esophageal webs
-tissue membrane protruding into lumen most common in cervical esophagus, can be associated with iron deficiency anemia - plumme vinson syndrome
Triad of plummer vinson syndrome
Anemia
Cervical esophageal webs
dysphagia
Esohpageal rings
Concentric ring protruding into lumen that is typically in the distal esophagus and asymptmatic mostly but sometimes causees intermittent dysphagia for solids esp when the tube become <13 mm in diameter***
Esophageal web and rings diagnostic study (1)
-EGD
Esophageal webs and rings treatment options (3)
- rupture during EGD
- bougie dilation
- PPI daily x6 weeks
Zenker diverticulum and gold standard diagnosis (1) and treatment (1)
- Herniation of esophageal mucosa, rare typically in elderly populations who regurgitate undigested food stuffs
- barium swallow
- surgical technique if necessary
Nutcracker esophagus or hypertensive LES
Hypercontractility of the esophagus
Ineffective esophageal motility or hypotensive LES
Hypocontractility of the esophagus
Diffuse esophageal spasm (DES)
Discoordinated motility of the esophagus, can cause chest pain
Esoophageal motility disorders diagnostic studies (3)
- barium swallow
- EGD to rule out structural cause
- esophageal manometry
Up to __% of scleroderma patients with have esophageal involvement, resulting in…
90%, resulting in atrophy, sclerosis, absent peristalsis
Achalasia
Inadequate peristalsis in the lower esophagus due to a tight lower esophageal sphincter that leads to progressive dysphagia for solids and liquids***
Achalasia diagnostic studies (2)
- bird beak sign on barium esophogram
- EGD
Achalasia treatment options (3)
- surgical myotomy
- pneumatic dilation of LES (risky and loses efficacy over time)
- botox injections
Functional dysphagia
Sense of food lodging/sticking in esophagus with no evidence of cause, not many treatment options other than lifestyle change
Odynophagia
Painful swallowing, often medication induced esophagitis, pill becomes lodged and causes mucosal injury, can also be infectious
GERD
Reflux with or without mucosal injury, very very common
Alarm symptoms with GERD that indicate need for EGD to check for barrett’s esophagus (3)
- GI bleed
- new onset dyspepsia >60
- unexplained weight loss
GERD treatment options (step up therapy)
Step up from bottom
- Lifestyle mods
- PRN H2 blockers
- H2 blocker daily
- PPI gradual increase
-antacids and sucrlfate should be used prn for mild symptoms and pregnancy but not otherwise
Refractory GERD
GERD that has no response to once daily PPI therapy
Barrett’s esophagus
REplacement of stratified squamous epithelium in distal esophagus with metaplastic columnar epithelium, increases risk for esophageal cancer more than 30 fold, with short segment being more prevalent but long segment causing more severe reflux and risk for cancer
Barrett’s esophagus diagnosis (1)
Endoscopy with biopsy
Barrett’s esophagus screening
- no recommendation on screening in females
- only recommended if multiple risk factors exist
Barrett’s esophagus treatment options (3)
- indefinite PPI therapy
- ongoing surveillance
- radiofrequency ablation
Benign lesions of esophagus
- schwannomas (rare, typically present with dysphagia
- hemangiomas (rare incidental finding)
- glycogen acanthosis (uniform, celiac dz)
- esophagitis dissecans superficialis (sloughing entire mucosal epithelium)
Caustic esophageal injury common ingestions (4), what 2 things do you always do and what 2 do you NOT do?
- battery liquid
- drain cleaner
- hair relaxers
- bleaches
Preserve the airway and get a chest x ray, Do not induce vomiting this will cause more injury, do not do endoscopy if more than 24 hours to prevent perforation
Alkaline vs acidic caustic esophageal injury
Liequefactive necrosis with severe injury rapidly vs coagulation necrosis more limiting
