Esophageal Dysphagia - Erickson

Question 1

Using Dr.Erickson’s diagnosis tool:

A 35 year old woman comes into clinic with dysphagia. She began having trouble with both solids and liquids at the same time and the problem has gotten worse and worse.

She has also noticed problems with dry skin and mouth as well as arthritis

Answer 1

Sounds a lot like Scleroderma!

Their esophagus is just a non-functional lead pipe

Question 2

A patient complains of having difficulty swallowing both solid and liquid foods. Her first episode was drinking a glass of water. The problem has gotten progressively worse. The patient has had problems with regurgitation and has been losing weight. What would be the best treatment for this patient?

Answer 2

Sounds like the patient has achalasia.
(The lower esophagus is tightened up and refuses to dilate)

Tx: Ca channel blockers, Botulinum toxin, Balloon dilation, or Myotomy(knife)

Barium swallow will give bird-beak appearance

Question 3

Difference between dysphagia and odynophagia?

100% on the test

Answer 3

Odynophagia = pain on swallowing
Dysphagia = symptoms resulting from failure to move food bolus from mouth to stomach

Question 4

How do you tell the difference between oropharyngeal dysphagia and esophageal dysphagia?

Answer 4

Oropharyngeal:
difficulty initiating swallow

Esophageal:
food stops and “sticks” after swallow initiation

Question 5

If a patient has difficulty with solids and liquids and is having intermittent dysphagia, what is on your differential?

Answer 5

Diffuse spasm
NEMD
Nutcracker

All three of these are spastic motility problems.

Question 6

If patient started a few months ago having difficulty eating venison, but now his choking problems have increased to the point where he has problems with many other foods, what is on your differential for what might be causing his difficulties?

Answer 6

It sounds like a peptic stricture or cancer

Question 7

Let’s say a patient has intermittent problems with choking on solid foods. He says, “I don’t get it doctor, last Tuesday I ate a steak no problem. Then today I try to eat a burger and I’m choking like crazy! What’s going on with me?”

Answer 7

Intermittent dysphagia problems with solid foods most likely indicates a lower esophageal ring

Question 8

Give me the classic symptoms of GERD!

Answer 8

• Substernal burning
• Occurs post-prandial
• Position change aggravates
• Antacids relieve
• Regurgitation
• Belching

Question 9

Atypical presentations of GERD?

Answer 9

• Chest pain
• Hoarseness
• Loss of enamel
• Asthma, chronic cough
• Dyspepsia (impaired digestion)

Question 10

Name two ways that a hiatal hernia can contribute to GERD:

Answer 10

1 - LES has no support from diaphragm

2 - The hernia itself is a pocket that can be a reservoir for gastric contents

Question 11

Most accurate (maybe not easiest) study to confirm GERD:

Answer 11

Ambulatory pH monitoring

Question 12

life-style modifications to treat GERD?

Answer 12

• Elevate head while sleeping
• No food 3hrs before bed
• Stop smoking
• Decrease fat and volume of food
• Avoid peppermint, onions, citrus, coffee, and tomatoes
• Adjust meds if needed
• Good OTC meds

Question 13

What kinds of drugs might create or exacerbate GERD? Make sure to explain why!

Answer 13

Decrease LES pressure

• Theophylline
• Anticholinergics
• Ca channel blockers
• Nitrates

Injure Mucosa

• Tetracyclines
• Quinidine
• Aspirin/NSAIDS
• Potassium
• Iron salts

Question 14

2 kinds of meds that tx GERD?

Answer 14

H2 receptor antagonists:
Cimetidine
Ranitidine
Famotidine
Nizatidine

Proton Pump Inhibitors:
Omeprazole
Lansoprazole

Question 15

Barrets Esophagus is moajor risk factor for:

Answer 15

Esophageal Adenocarcinoma