Esophageal Disorders and GERD Clinical Flashcards
How do odynophagia and dysphagia differ?
odynophagia is pain on swallowing
dysphagia is a symptom resulting from the failure to move a food bolus from the mouth to the stomach - more of a discomfort than pain
In general, what are three factors that contribute to dysphagia?
- inadequate preparation (reduced saliva, imparied mental functoin)
- abnormal lunch strength or function (neuromusclar disorders or motility disturbances)
- esophageal passageway narrowed
What is dysphagia which includes difficulty initiating swallowing?
oropharyngeal dysphagia
What is dysphagia where food stops and “sticks” after swallowing is initiated?
esophageal dysphagia
What are some anatomical causes of oropharyngeal dysphagia?
postcricoid web
cervical osteophyte
hypopharyngeal diverticulum
head and neck tumors
What are some muscular diseases that cause oropharyngeal dysphagia?
oculopharyngeal muscle dystrphy
myotonic dystrophy
myasthenia gravis
What are some neurological disorders that can cause oropharyngeal dysphagia?
CVA poliolyelitis ALS parkinson's disease cerebral palsy tumors
What are the three main goals of treatment in oropharyngeal dysphagia?
protect the airway
maintain nutrition
relieve dysphagia
What are the 4 general therapeutic modalities for oropharyngeal dysphagia?
speach/swallowing therapy
esophageal dilation
surgical myotomy
NPO with nutrition support
What are some anatomic causes of esophageal dysphagia?
peptic strictures
rings and webs
caustic scars
cancer - either primary esophageal or extrinsic compression
What are some neuromuscular causes of esophageal dysphagia?
achalasia from chagas’ disease
other motor disorders
What is achalasia?
It’s basically where the lower esophageal sphincter is constantly constricted - they have ACh causing contraction, but they lose the inhibitory neurons that would secrete VIP and NO so you never get relaxation (or inappropriate relaxation)
How do most people with achalasia present?
with progressive lifelong dysphagia that starts with solids and then progresses to both solids and liquids.
How can we diagnose achalasia?
manometry to measure pressures - will show a non-relaxing LES and aperistalsis in the esophagus
barium swallow will show a bird’s-beak narrowing at the LES and a dilated esophagus
Why do you always get endoscopy after a barium swallow suggests achalasia?
carcinoma at the esophagogastric junction can mimic achalasia and you wouldn’t be able tot tell the difference on a barium swallow
How can we treat achalasia? Drugs and procedures….
calcium channel blockers and botulinum toxin, balloon dilation and esophagogastric myotomy
What happens in diffuse esophageal spasm?
you get different parts of the esophagus contracting simultaneously instead o f in a wave-like pattern like it’s supposed to. this means food doesn’t get pushed down
contractions can be severe and painful
make sure you rule out heart attack though!
What affect can systemic sclerosis from scleroderma have on the esophagus?
it basically paralyzes it such that they don’t get peristaltic contractions and there’s no tone in the LES. Basically the esophagus becomes a lead pipe and they’ll have constant reflux and dysphagia
What’s the most common cause of GERD?
transient LES relaxations
What are some other causes of GERD?
weak or failed esophageal peristalsis hypotensive LES at baseline gastroparesis duodenogastric reflux hiatal hernia
dysphagia for solids only, intermittent….
lower esophageal ring
dysphagia for solids only, progressive….
peptic stricture or cancer (esp if over 50)
Dysphagia for solids and liquids, intermittent…
diffuse esopahgeal spasm
NEMD
nutcracker
Dysphagia for solids and liquids, progressive…
achalasia or scleroderma
How ften do most people with GERD have symptoms?
monthly
What are some external factors that can contribut to the pathophysiology of GERD?
diet
high-fat foods
smoking
medications
What are the common esophageal symptoms of GERD?
heartburn
regurgitation
belching
water brash - increased salivary secretion
What are some atypical presentations of GERD to be aware of?
chest pain hoarseness/larygnitis loss of dental enamel asthma/chronic cough dyspepsia
What are some symptoms associated with COMPLICATIONS of GERD?
dysphagia from strictures
odynophagia and bleeding from inflammation and ulcers
What are the two mechanisms by which hiatal hernias may contribute to reflux?
no diaphragmatic support of the LES
the hernia acts as a reservoir for gastric contetns
Are diagnostic studies needed with a classic history of GERD?
he says rule out cardiac, otherwise no
What are some ways you can test for GERD
a barium sallow to see hiatal hernia or strictures, endoscopy to see lots of things, ambulatory pH monitoring, esophageal manometry to check LES and peristalsis
What are some lifestyle modifications you can make in GERD therapy?
elevate bed no food 3 hrs before bed modify diet (decrease fat and avoid peppermint, onions, cirtus, etc) avoid harmful meds OTC meds prn
What drugs are classic for decreasing LES pressure leading to GERD?
theophylline
anticholinergis
calcium channel blockers
nitrates
What drugs are classic for injurying the esophageal mucosa?
tetracyclines quinidine NSAIDS potassium tablets iron salts
What two groups of meds do we use to treat GERD?
H2 receptor antagonists
Proton pump inhibitors
What percentage of patients with GERD develop barrett;s
10-15%
Barrett;s esophagus is a risk factor for what cancer?
esophageal adenocarcinoma
What other complication can GERD cause in the esophagus contributing to dysphagia?
strictures - in aobut 10% of people with GERD
it’s ulceration that stimualtes fibrosis
