Esophageal Disorders & GERD - Erickson Flashcards
What is Odynophagia?
Pain on swallowing.
What is Dysphagia?
Symptom resulting from the failure to move a food bolus from the mouth to the stomach.
What factors contribute to Dysphagia?
- Inadequate preparation of what is being swallowed.
- Reduced saliva or mastication
- Neuromuscular disorders
- Impaired mental function
- Abnormal muscle strength/function
- Neuromuscular disorders
- Motility disturbances
- Esophageal passageway narrowed
- Mechanical obstruction
What are the goals of therapy in Oropharyngeal Dysphagia?
- Protect airway
- Maintain nutrition
- Relieve dysphagia
What are the causes of Dysphagia?
- Anatomic
- Benign: peptic strictures, rings and webs, caustic scars
- Cancer: primary esophageal and extrinsic compression
- (increasing incidence of adenocarcinoma)
- Neuromuscular
- Primary esophageal disease: achalasia, Chagas’ disease, other motor disorders
- Secondary
What is Achalasia?
Loss of inhibitory innervation to the LES
(lose NO/VIP => always contracting)
What organism causes Chagas’ disease?
Trypanosoma cruzi
What are the symptoms of Achalasia?
- Dysphagia
- Regurgitation
- Chest pain
- Weight loss
- Cough
What is secondary achalasia?
- Tumor on the other side of the Lower Esophageal Sphincter causing constriction
- (carcinoma at esophagogastric junction mimics achalasia)
MOA of Nifedipine
Calcium channel blocker
MOA of Botulinum Toxin
Prevents release of ACh at cholinergic nerve ending
What are the surgical treatments for Achalasia?
- Balloon Dilation
- Esophagogastric Myotomy
What is CREST syndrome?
- Multisystem connective tissue disorder.
- “CREST”:
- calcinosis
- Raynaud’s phenomenon
- esophageal dysmotility
- sclerodactyly
- telangiectasia
What questions should you ask a patient with likely esophageal dysphagia? What symptoms suggest particular diagnoses in Esophageal Dysphagia?
- Solids only? or Solids and/or Liquids?
- Intermittent or Progressive?
* If intermittent with solids only => Lower esophageal ring
* If progressive with solids only => Peptic stricture or cancer (esp. if >50 y.o.)
* If intermittent with solids and liquids => diffuse spasm NEMD nutrcracker
* If progressive with solids and liquids => Achalasia or Scleroderma
- Intermittent or Progressive?
What are the possible etiologies of GERD?
- Diminished Esophageal Clearance
- Peristalsis
- Body position
- Saliva
- Defective Anti-Reflux Barrier
- LES
- Crural Diaphragm
- Hiatal Hernia
- Gastric Factors
- Acid
- Bile Acid
- Gastric Emptying
- Gastric Distention
- External Factors
- Diet
- High-fat foods
- Smoking
- Medication
- Impaired Esophageal Mucosal Resistance
What is Zollinger Ellingson Syndrome?
- gastrin-secreting tumor of the pancreas
- stimulates the acid-secreting cells of the stomach (parietal cells) to maximal activity
- consequent gastrointestinal mucosal ulceration
What are the common symptoms of GERD?
- Heartburn
- Regurgitation
- Belching
- Water brash
What are the atypical presentations of GERD?
- Chest pain
- Hoarseness/laryngitis
- Loss of dental enamel
- Asthma/chronic cough
- Dyspepsia
What three symptoms are associated with complications of GERD?
- Dysphagia
- Odynophagia
- Bleeding
Are diagnostic studies needed when a patient presents with a classic history of GERD?
NO diagnostic studies needed. Start empiric treatment.
***RULE OUT cardiac etiology first though!
What is the best diagnostic study for evaluating mucosal injury and diagnosing esophagitis, Barrett’s epithelium, hiatal hernia, or strictures?
Endoscopy
What are the life-style modifications that have been effective in GERD therapy?
- Elevate head of bed while sleeping
- No food 3 hours before bedtime
- Stop smoking
- Modify diet:
- decrease fat and volume
- avoid peppermint, onions, citrus juice, coffee, and tomato products
- Avoid potentially harmful medications
- OTC medications PRN
What is Barrett’s Esophagus?
Columnar epithelium replaces squamous epithelium in distal esophagus.
What condition is a major risk factor for esophageal adenocarcinoma?
Barrett’s Esophagus → associated primarily with intestinal metaplasia
