Esophageal Dysphagia

Question 1

Esophageal Dysphagia is localized to what locations?

Answer 1

Neck/chest - lower esophagus

Question 2

With Esophageal Dysphagia, where do patients feel food sticking?

Answer 2

Mid to lower sternal area

Question 3

What is Schatzki’s Ring?

Answer 3

Distal smooth ring

- Associated with GERD and Hiatal Hernia

Question 4

Schatzki’s Ring - constant or progressive?

Answer 4

Constant

Question 5

Symptoms of Schatzki’s Ring?

Answer 5

Intermittent dysphagia with solids, reflux is common

Question 6

What is a possible complication with Schatzki’s Ring?

Answer 6

Food bolus impaction which can cause a perforation or ulcer

Question 7

Where are Esophageal Strictures common?

Answer 7

Gastroesophageal junction

Question 8

What usually causes an Esophageal Stricture?

Answer 8

Peptic stricture secondary to GERD

Question 9

Esophageal Strictures - constant or progressive?

Answer 9

Progressive

Question 10

Describe the progression of Esophageal Strictures

Answer 10

• Heartburn and weight loss
• Dysphagia with solids and then solids and liquids
• IMPROVEMENT/LESS heartburn!!!

Question 11

As an Esophageal Stricture progresses, the initial heartburn decreases. Why?

Answer 11

As the stricture grows, it acts as a barrier to the reflux

Question 12

What test is mandatory for Esophageal Strictures?

Answer 12

EGD to differentiate from esophageal carcinoma

Question 13

Barrett’s Esophagus

Answer 13

Columnar epithelium replaces stratified squamous epithelium at the distal esophagus

Question 14

With Barrett’s Esophagus, ____ epithelium replaces _______ epithelium at the distal esophagus

Answer 14

Columnar epithelium replaces stratified squamous epithelium

Question 15

What usually causes Barrett’s Esophagus?

Answer 15

Chronic GERD or Truncal obesity

Question 16

What patient population usually has Barrett’s Esophagus?

Answer 16

Obese, white >50 year old males who smoke

Question 17

Symptoms of Barrett’s Esophagus?

Answer 17

ASYMPTOMATIC

- GERD symptoms

Question 18

What can Barrett’s Esophagus progress to?

Answer 18

Esophageal Adenocarcinoma

Question 19

What can Barrett’s Esophagus progress to?

Answer 19

Esophageal Adenocarcinoma

Question 20

What will an EGD with biopsy show with Barrett’s Esophagus?

Answer 20

Orange goblet and columnar cells in distal esophagus

Question 21

Treatment for Barrett’s Esophagus?

Answer 21

Acid reduction and surveillance to monitor for adenocarcinoma

Question 22

Is surgical resection recommended for Barrett’s Esophagus?

Answer 22

NO

Question 23

Most common esophageal cancer in the world?

Answer 23

Squamous

Question 24

Most common esophageal cancer in the USA?

Answer 24

Adenocarcinoma

Question 25

Risk factors for Squamous esophageal cancer?

Answer 25

Smoking + Alcohol, esophageal disorders, injury

Question 26

Risk factors for Adenocarcinoma esophageal cancer?

Answer 26

Smoking, obesity, GERD -> Barrett's esophagus

Question 27

Symptoms of Squamous and Adenocarcinoma Esophageal Cancer?

Answer 27

PROGRESSIVE DYSPHAGIA - Weight loss, reflux, bleeding - Hoarseness, cough, odynophagia - Decreased iron

Question 28

Symptoms of Squamous and Adenocarcinoma Esophageal Cancer?

Answer 28

PROGRESSIVE DYSPHAGIA - Weight loss, reflux, bleeding - Hoarseness, cough, odynophagia - Decreased iron

Question 29

Test to order for Squamous esophageal cancer?

Answer 29

EGD with biopsy of middle 1/3

Question 30

Test to order for Adenocarcinoma esophageal cancer?

Answer 30

EGD with biopsy of lower 1/3 | squamous --> columnar

Question 31

Treatment for Squamous Esophageal cancer?

Answer 31

Surgery (esophagectomy) | -- poor survival

Question 32

Treatment for Adenocarcinoma Esophageal cancer?

Answer 32

Endoscopic Ablation

Question 33

Name 2 motility disorders?

Answer 33

Achalasia | Scleroderma

Question 34

Name 2 motility disorders?

Answer 34

Achalasia | Scleroderma

Question 35

What is Achalasia?

Answer 35

Loss of peristalsis because Lower Esophageal Sphincter does NOT relax

Question 36

LES not relaxing is?

Answer 36

Achalasia

Question 37

What causes the LES to not relax with Achalasia?

Answer 37

Denervation due to loss of nitric oxide producing inhibitory neurons in myenteric plexus

Question 38

What causes the LES to not relax with Achalasia?

Answer 38

Denervation due to loss of nitric oxide producing inhibitory neurons in myenteric plexus

Question 39

Achalasia can be secondary. What causes that?

Answer 39

Chagas Disease

Question 40

Achalasia - constant or progressive?

Answer 40

Progressive

Question 41

What is seen with Achalasia?

Answer 41

Bird's beak tapering of distal esophagus

Question 42

Symptoms of Achalasia?

Answer 42

Regurgitation, chest discomfort, adaptive maneuvers to eat successfully

Question 43

What are the extra symptoms of Secondary Achalasia?

Answer 43

Unilateral periorbital swelling (romana sign), fever, arrythmias

Question 44

What microbe causes Secondary Achalasia (due to chagas disease)?

Answer 44

Trypanosoma Cruzi

Question 45

What is Scleroderma?

Answer 45

Autoimmune disorder - smooth muscle fibrosis

Question 46

Scleroderma - constant or progressive?

Answer 46

Progressive

Question 47

Limited Scleroderma symptoms?

Answer 47

CREST - Calcinosis cutis - Raynauds - Esophageal dysmotility - Sclerodactyly - Telangiectasia

Question 48

Limited Scleroderma Symptoms?

Answer 48

CREST - Calcinosis cutis - Raynauds - Esophageal dysmotility - Sclerodactyly - Telangiectasia

Question 49

What is (+) with Limited Scleroderma?

Answer 49

Anti-centromere antibodies

Question 50

Diffuse Scleroderma symptoms?

Answer 50

Heartburn, strictures, BE Regurgitation, cough, hoarseness Dry mouth

Question 51

What is (+) with Diffuse Scleroderma?

Answer 51

Topoisomerase 1 Antibodies | scl-70