Esophageal Disorders Flashcards
Most common cause of infectious esophagitis
Candida
Transmural rupture of the distal esophagus due to straining or vomiting is known as …
Boerhaave syndrome
Risk factors for esophageal adenocarcinoma
White male
GERD/Barrett’s esophagus
Obesity
This class of GERD medications can develop tachyphylaxis within 2-6 weeks
Histamine 2 receptor antagonists (famotidine/pepcid)
Premature, rapid contractions of the distal esophagus are suggestive of this condition
Diffuse/Distal esophageal spasm
After noting esophageal cancer on endoscopy, what is the next test?
CT of chest and abdomen to assess extent of disease and look for metastases
This medication is known to cause esophagitis
Minocycline
(tetracycline antibiotic used for acne)
Purpose of barium swallow in diagnosing esophageal disorders
Can identify subtle narrowings and motility disorders
Two common symptoms with achalasia
Slowly progressive dysphagia
Regurgitation
Purpose of metoclopramide in treatment of GERD
Prokinetic agent - enhance gastric clearance
A rosary bead or corkscrew appearance on barium swallow is suggestive of this condition
Diffuse/distal esophageal spasm
Esophageal cancer diagnosis methods
Barium swallow will show obstruction but won’t tell you the cause
X-ray may show irregular borders/sharp angles
Endoscopy best test, shows nodules protruding into lumen
Best initial diagnostic test in a patient complaining of chronic GERD
Endoscopy
This diagnostic test is often performed first in diffuse/distal esophageal spasm
Endoscopy
Gold standard test for esophageal motility disorder diagnosis
Esophageal manometry
Most common esophageal foreign body objects
Kids: coins
Adults: meat/other food
Treatments for infectious esophagitis
Mild = clotrimazole
Severe = fluconazole or amphotericin B
Test for tracking acid levels throughout a day
Ambulatory 24-hour esophageal pH monitoring
Most common type of esophageal cancer
Squamous cell carcinoma
Which type of esophageal cancer is more common in white men?
Adenocarcinoma
Most common age range for esophageal foreign bodies
6 months to 3 years
90% of patients with this autoimmune condition
Scleroderma
Form of calcium supplementation to use in patient on chronic PPI
Calcium citrate
(doesn’t require acid for absorption)
Two main medications to know for nutcracker esophagus
Nitrates, calcium channel blockers
Which esophageal disorders will have slowly progressive difficulty swallowing?
Benign lesions
Achalasia
Raised white plaques seen in the throat that resemble cottage cheese is suggestive of …
Infectious candida esophagitis
How to differentiate diffuse/distal esophageal spasm from nutcracker esophagus?
Both are non-progressive, disordered spasm of esophagus
DES: Esophagus contracts too early
Nutcracker: contracts on time, but too forcefully
Risks associated with PPI use
Clostridium difficile (no acid in stomach to stop proliferation)
Magnesium malabsorption (leads to neuromuscular excitability initially and long QT/torsades if severe)
Fractures (need acid to absorb calcium)
Dietary B12 malabsorption
Degeneration of the inhibitory neurons impairing relaxation of the esophagus causing a slowly progressive dysphagia is known as …
Achalasia
Two most common symptoms in diffuse/distal esophageal spasm
Dysphagia and chest pain
Initial diagnostic test for new onset GERD
PPI trial
A patient complaining of GERD who failed a PPI trial and with negative endoscopy should get this test to identify a possible motility disorder cause of reflux
Manometry
Three diagnostic studies for achalasia
Endoscopy - usually done initially
Esophageal manometry - gold standard
Barium swallow - dilated esophagus ending in bird’s beak
Symptoms of GERD
Uncomfortable, burning sensation often radiating up throat
Causes of nutcracker esophagus
Excessive excitatory neuronal activity/smooth muscle hypertrophy
Best procedures for achalasia treatment
Pneumatic dilation therapy
Surgical myotomy (cuts lower esophageal sphincter)
Botulinum injection into lower esophageal sphincter
Important method to manage cessation of PPIs
Must taper (50% each week) if patient has been on PPI for more than 6 months
Gold standard diagnostic test for diffuse/distal esophageal spasm
Esophageal manometry
If a patient with GERD fails BID H2RA therapy/has erosive esophagitis/has severe GERD, start these drugs
PPIs
Diagnosis method for Barrett’s esophagus
Endoscopy with biopsy
Describe benign esophageal stricture causes
Like scar tissue in the esophagus
(Can be caused by ingesting foreign bodies, history of candida, radiation to chest for cancer)
Difference between dysphagia and odynophagia
Dysphagia = difficulty swallowing
Odynophagia = pain/discomfort swallowing
This stomach condition sometimes co-occurs with GERD
Hiatal hernia
Mechanism of action of PPI drugs
Inhibition of hydrogen potassium ATPase pump
Which esophageal disorders will have rapidly progressive difficulty swallowing?
Malignant lesions
Medications for achalasia
Nitrates and calcium channel blockers
(although surgery or dilation procedures work better)
This condition is also called “hypercontractile esophagus”
Nutcracker esophagus
Which esophageal cancer is more likely in black or asian men?
Squamous cell carcinoma
Best treatment for infrequent GERD
Antacids (Tums)
Treatment for Boerhaave syndrome
Surgical debridement - (emergency)
Most common patient to get infectious esophagitis
Immunocompromised (HIV/AIDS)
A bird’s beak barium swallow is suggestive of this condition
Achalasia
Three best lifestyle modifications for GERD treatment
Elevate head of bed 4-8 inches
Avoid food 2-3 hours before bed
Dietary modification
Odd folds of the mucosa at the distal esophagus that cause non-progressive dysphagia (mostly with solid foods) is called …
Schatzki rings
Risk factors for esophageal squamous cell carcinoma
Black male
Smoking and alcoholism
Preserved foods, hot foods/drinks, achalasia
Medications for diffuse/distal esophageal spasm
Nitrates, calcium channel blockers, sildenafil
Diagnosis methods for Boerhaave syndrome
Chest/neck x-ray may show perforation
CT if x-ray fails to find it
(don’t give barium swallow, it will leak out)
Which esophageal disorder presents with intermittent, non-progressive episodes?
Schatzki ring
This esophageal is relieved by antacids and eliminated by PPIs
GERD
Which is more sensitive for identifying subtle mucosal lesions of the esophagus, barium swallow or endoscopy?
Endoscopy
