Esophageal Diseases

Question 1

Scleroderma

Answer 1

90% of scleroderma ptn will have ⬇️ esophageal motility due to fibrosis

Question 2

What is achalasia?

Answer 2

Failure of relaxation of LES because of loss of inhibitory neurons

Question 3

What are the causes for achalasia?

Answer 3

Mostly Unknown

Rarely from Chaga’s disease, gastric carcinoma or lymphoma

Question 4

What are the S&S for achalasia?

Answer 4

1-progressive dysphagia to liquids >= solids

2- +/- regurgitaion of undigested food hours after eating

3- +/- wt loss

4-maybe nocturnal cough, chest pain

Question 5

What is the process to diagnose achalasia?

Answer 5

1-Barium swallow (birds peak) is best initial test followed by:

2-Manometry is the gold standard test

3- EGD is done for alarm symptomes or to find the cause

Xray has limitted value

Question 6

How can you 💊 achalasia?

Answer 6

1-Best 💊 is pneumatic ( balloon dilatation) done by endoscopy

2- surgery ( Heller myotomy ) done laparoscopically

3-Botox : for ppl refusing or can’t undergo surgery

4-PPI, CCB, nitrates can help

Question 7

What are the types of esophageal cancer and what causes them?

Answer 7

1- Sq. Cell carcinoma is ass. with 🍾and 🚬
it affect the proximal 2/3
> in 👦🏿 Men ( most common worldwide 🌍 )

2- adenocarcinoma is ass. with long standing reflux and barett esophagus,
It affect distal 1/3
( most common in 🇺🇸, Europe, 🇦🇺 )

Question 8

What are the S&S for esophageal cancer?

Answer 8

Dysphagia; Starts with meat then solids then liquids and finally saliva
rarely ass. with regurgation and halitosis, hoarseness

wt loss is always seen.

Maybe odynophahia, GERD, GI 🩸 & vomiting

+/- hypercalcemia (as in most cancers)

Question 9

How to diagnose esophageal cancer?

Answer 9

1-Barium swallow ( apple core) appearance done before endoscopy to prevent perforation

2-Endoscopy with biopsyis mandatory

3-Endoscopic- U/S for staging

4-Bronchoscopy detects local spread to bronchi

5-CT scan for metastasis and to assess operability

• Poor prognosis
• Esophageal cancer metastasizes early because esophagus lacks a serosa

Question 10

What’s the appropriate 💊 for esophageal cancer?

Answer 10

the only effective TTT is surgurey ,Only 25% are fit for surgery and 20% of them will die from the operation

alternative is 5-floruracil chamotherapy with radition to control locally metastatic disease

5 years survival is poor 5-15%

Pallation ttt: with endoscopy you can do laser or dilatation stenting

Question 11

What is scleroderma?

Answer 11

fibrosis & atrophy of esophageal mcs.➡️⬇️ motility( immobile open tube)

Question 12

What’s the S&S for scleroderma?

Answer 12

dysphagia + reflux (immobile open tube)

+ H/O scleroderma(the main clue to the diagnosis is reflux symptoms in scleroderma ptn )

Question 13

What’s the way to diagnose esophageal pb by scleroderma?

Answer 13

Do Motility study

Barium is unnecessary

Question 14

How to 💊 ptn with scleroderma?

Answer 14

Omeprazole

+/- Metoclopramide ( promotility effect )

Question 15

What is diffuse esophageal disease and nutcracker esophagus?

Answer 15

disorganized contractions that will NOT lead to flow of food or peristalsis

Both are the same disease the only difference maybe in manometric pattern

Question 16

What are the S&S for esophageal spasm disease and nutcracker?

Answer 16

Episodic chest pain (mimic MI) and dysphagia not ass. With exertion or food but ⬆️ by drinking cold liquids

Question 17

How to diagnose/differentiate between esophageal spasm and nutcracker disease?

Answer 17

Manometric studies

Barium shows ( corkscrew) at the time of spasm

Question 18

What’s the 💊 for esophageal spasm and nutcracker?

Answer 18

Calcium channel blockers ( nifedipine, nitrate)