Esophageal Disorders/GERD - Erickson Flashcards
Define odynophagia
Pain on swallowing
Define dysphagia
Symptom resulting from the failure to move a food bolus from the mouth to the stomach
What are some factors that can contribute to dysphagia?
- reduced saliva/mastication
- Neuromuscular disorders
- Impaired mental function
- Motility disturbances
- Mechanical obstruction
What are symptoms of dysphagia?
- difficulty swallowing
- food stops/ “sticks” after swallowing is initiated
Difficulty initiating swallowing would indicate what type of dysphagia?
Oropharyngeal dysphagia
Food stops/or sticks after swallowing in initiated would indicate what type of dysphagia?
Esophageal Dysphagia
What are the 3 goals of treatment for oropharyngeal dysphagia?
- Protect Airway
- Maintain nutrition
- Relieve Dysphagia
What is achalasia?
Loss of inhibitory innervation to the LES (tonically contracted LES)
In what condition would you see a bird’s beak narrowing at LES, and a dilated esophagus on a barium swallow?
Achalasia
What are the 4 treatment options for Achalasia?
- Nifedipine (calcium channel blocker)
- Botulinum Toxin (blocks ACh release)
- Balloon Dilation
- Esophagogastric Myotomy
Esophageal dysphagia intermittent with solids only
Lower esophageal ring
Progressive esophageal dysphagia with solids only
Peptic Stricture
Cancer
Intermittent esophageal dysphagia with solids and liquids
Diffuse spasm
NEMD
Nutcracker
Progressive esophageal dysphagia with solids and liquids
Achalasia
Scleroderma
What is the classic symptom of GERD? Other common symptoms?
Heartburn = classic
Regurgitation
Belching
Water brash (regurgitation of excess saliva from lower esophagus often with lots of stomach acid)
What are 3 symptoms associated with complications of GERD?
Dysphagia
Odynophagia
Bleeding
What 2 ways do hiatal hernia contribute to reflux?
- No diaphragmatic support of LES
- HH is reservoir for gastric contents
Note: many hiatal hernias are not associated with reflux
What diagnostic studies should you order to diagnose GERD?
Trick questions!
Diagnostic studies are NOTneeded with classic history, start empiric treatment
What is the best initial diagnostic study for patients with reflux symptoms and dysphagia?
Barium Swallow
What is the best diagnostic study for evaluating mucosal injury? (like esophagitis, barrett’s epithelium, hiatal hernia, strictures)
Endoscopy
What is the best study to confirm GERD?
Ambulatory pH monitoring
What is the cornerstone of GERD therapy?
Life-style modifications!!
- elevate bed
- no food 3 hours before bed
- stop smoking
- modify diet
- check medications
- OTC med prn
What medications can decrease LES pressure?
Theophylline
Anticholinergics
Ca Channel blockers
Nitrates
What medications can injure mucosa?
Tetracyclines Quinidine NSAIDS K+ tablets Iron Salts
