Esophageal disorders Flashcards
What intervention can confirm the diagnosis of eosinophilic esophagitis?
Endoscopy and esophageal biopsy (> 15 eos/hpf)
Does eosinophilic esophagitis respond to GERD therapy (e.g. PPIs)?
Sometimes*, since 50% of patients do not respond to acid suppression therapy
What are the findings of eosinophilic esophagitis on upper endoscopy?
Trachealization of the esophagus and erythematous longitudinal furrows
What is the likely diagnosis in a patient with episodes of dysphagia, regurgitation, and chest pain with radiation to the back that is precipitated by emotional stress?
Diffuse esophageal spasm
Older patient with a 20 year history of GERD and new alarm symptoms (e.g. dysphagia/odynophagia) raises concern for______.
Next steps:
- Esophageal adenocarcinoma
- Endoscopy with biopsy, CT scan for staging
On a barium swallow x-ray, patients with diffuse esophageal spasm are seen to have:
A “corkscrew esophagus”
Risk factors
- Squamous cell carcinoma esophagus =
- Adenocarcinoma esophagus =
- irritants, alcohol, tobacco smoke, achalasia
- Obesity, GERD, and Barrett esophagus
Management of Barrett esophagus identified on EGD:
- No dysplasia:
- Low-grade dysplasia:
- High-grade dysplasia:
- Surveillance endoscopy q3-5 years
- Surveillance endoscopy q6-12 months
- Endoscopic radiofrequency ablation
Dysphagia and circumferential esophageal narrowing, together with normal histology findings, are consistent with ____ and the first-line treatment is:
- A Schatzki ring (esophageal ring).
- Mechanical dilation
What pharmaceutical therapy is recommended for prophylaxis of non-bleeding esophageal varices?
Non-selective β-blockers (e.g. propranolol, nadolol)
_____ may present with dysphagia, “gurgling” in the throat, regurgitation, foul-smelling breath and aspiration pneumonia
Zenker diverticulum
Bleeding esophageal varices are managed with IV fluids, octreotide, and antibiotics followed by:
Endoscopic band ligation
What is the initial management for a young patient with suspected GERD who has a bitter taste and substernal chest pain after meals?
PPI trial
What is the definitive diagnostic test for achalasia?
Esophageal manometry and it is characterized by high LES pressure
Achalasia may be treated initially with ______ or _____
- pneumatic dilation
- botulinum toxin injection
What is the treatment for Zenker diverticulum?
Cricopharyngeal myotomy
What is the likely diagnosis in a patient with alcohol use disorder/bulimia nervosa who presents with epigastric pain and hematemesis following multiple episodes of vomiting (normal X-ray)?
Mallory-Weiss tear
What is the treatment for a Mallory-Weiss tear?
- Without active bleeding =
- With active bleeding =
- PPIs
- Endoscopic repair
What procedure should be done prior to endoscopic treatment in patients with upper GI bleed who have a depressed level of consciousness and continued hematemesis?
Endotracheal intubation
