Esophageal Disorders

Question 1

What are examples of mechanical obstructions causing dysphagia?

Answer 1

• Schatzki’s rings
• Peptic stricture
• Esophageal cancer
• Eosinophilic esophagitis

Question 2

What are motility disorders that cause dysphagia?

Answer 2

• Achalasia
• Diffuse esophageal spasm
• Scleroderma

Question 3

What is the main complaint of achalasia?

Answer 3

Substernal discomfort

Question 4

What is the diagnostic test for achalasia?

Answer 4

Esophageal manometry (showing absent peristalsis or incomplete LES relaxation)

Question 5

What does barium swallow show in achalasia?

Answer 5

Bird’s beak sign

Question 6

Treatment for achalasia

Answer 6

• Botox (for pts w/comorbidities who can’t do other tx)
• Pneumatic dilation (can cause perforation)
• Modified Heller cardiomyotomy of LES

Question 7

What is a complication of pneumatic dilation treatment of achalasia?

Answer 7

Perforation

Question 8

What is a “nutcracker” or “jackhammer” esophagus associated with?

Answer 8

Hypertensive peristalsis

Esophageal spasm

Question 9

Best diagnostic test for diffuse esophageal spasm?

Answer 9

Esophageal manometry

Question 10

Treatments for diffuse esophageal spasm?

Answer 10

• CCBs, Botox, Nitrates, TCAs

- Surgery (dilation, myotomy)

Question 11

What are the 2 forms of scleroderma?

Answer 11

• Progressive Systemic Sclerosis (PSS)

- CREST syndrome

Question 12

Describe progressive systemic sclerosis

Answer 12

• Diffuse scleroderma

- More fulminant form w/early involvement of internal organs

Question 13

Describe CREST sydnrome

Answer 13

• A variant of scleroderma

- Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasia

Question 14

Treatment of scleroderma

Answer 14

• PPI
• Prokinetic drugs (Reglan, erythromycin)
• Multiple small meals

Question 15

Complications a/w scleroderma

Answer 15

• Strictures
• Barrett esophagus
• Adenocarcinoma

Question 16

Describe infectious esophagitis

Answer 16

1. Candida (thrush)
2. CMV (single deep ulcer)
3. Herpes (multiple shallow ulcers)

Question 17

Describe Mallory Weiss tear

Answer 17

• Non penetrating
• 0.5 to 4.0 cm linear at GEJ
• Increased trans-abdominal pressure
• ETOHism is a risk
• Stabilize patient!

Question 18

Define esophageal webs

Answer 18

• Thin membranes of squamous mucosa
• Typically occur mid to proximal
• Congenital mainly

Question 19

Define Schatzki rings

Answer 19

• Smooth, circumferential

- Distal esophagus at squamocolumnar junction

Question 20

Most esophageal webs and rings are how big?

Answer 20

20+ mm diameter

Question 21

What are esophageal varices?

Answer 21

“Varicose veins of esophagus”

• Dilated submucosal veins
• Portal HTN patients (pressures over 10 mmHg)

Question 22

What is the MC cause of emergent UGI bleeding?

Answer 22

Esophageal varices

Question 23

Acute treatment of esophageal varices

Answer 23

• Resuscitation
• Avoid over transfusion of fluids (increases venous pressures)
• Correct coagulopathy
• Vasoactive drugs to reduce portal pressure

Question 24

Procedures to treat esophageal varices

Answer 24

• Balloon tamponade (initial control of bleeding)
• Acute endoscopic banding or sclerotherapy
• Portal decompression (TIPS)