Esophagus@

Question 1

Name the steps of the belch.

Answer 1

1. Gastric distention –> TLESR
2. Cessation of phasic resp contraction of diaphragm
3. Esoph long muscle contracts and pulls LES proximally
4. Circular muscle relaxes

Question 2

T/F: H pylori tx leads to inc need for PPI higher dose.

Answer 2

False

Question 3

T/F: HP tx can lead to new onset reflux sxs.

Answer 3

False

Question 4

T/F: If pt w reflux sxs & HP +, tx of sxs easier if do not tx HP

Answer 4

True

Question 5

Barretts RFs

Answer 5

White, male, older age, prolonged reflux, erosive esoph on EGD

Question 6

Which type of achalasia best responds to pneumatic dilation?

Answer 6

T2 - pan esophageal pressurization, 100% fx swallows

Question 7

MC mechanism of GERD after meals?

Answer 7

TLESR

Question 8

Which type of pt benefits most from Nissen?

Answer 8

Typical reflux sxs, good PPI response

Question 9

What are some comorbidities/sxs that decrease chance of response to Nissen?

Answer 9

Psych DO, obesity, poorly defined sxs

Question 10

T/F: H&N rads inc risk of erosive esophagitis on EGD?

Answer 10

True

Question 11

Adjunct to PPI for reflux

Answer 11

Baclofen - inhibits TLESR

Question 12

T/F: MCTD can have similar GI findings like poor clearance as scleroderma 2/2 smooth muscle atrophy and fibrosis.

Answer 12

True

Question 13

When should pH monitoring ON PPI be considered?

Answer 13

When dx with reflux already and want to test PPI response

Question 14

T/F: Acute radiation injury to the esophagus is dose based and can be augmented with chemotx.

Answer 14

True

Question 15

Name the yearly CA risk in pts with Barretts and no to high dysplasia.

Answer 15

None - 0.5% over gen pop
HGD - 6%/yr
LGD - risk of prog to CA or HGD 0.5-13%/yr

Question 16

T/F: Histo is better than EUS for Barretts nodule and so EUS not needed prior to EMR.

Answer 16

True

Question 17

What are the criteria for type III achalasia?

Answer 17

Mean IRP > 15 mmHg

>20% premature contractions, no normal peristalsis

Question 18

What are criteria for DES?

Answer 18

Normal IRP ( < 15)
>20% premature contractions, DL < 4.5s, will have some normal peristalsis

Question 19

What will you see on manometry from lap band surgery?

Answer 19

Can see pseudoachalasia - High IRP, > 20% premature contractions due to shortened esophagus

Question 20

If pt with EOE on steroids gets odynophagia and evidence of candida, what should be done?

Answer 20

Empiric trial of fluticasone, do not stop steroid

Question 21

What do you see in hypercontractile esophagus?

Answer 21

Normal IRP
normal peristalsis
normal DL
DCI > 5000 but < 9000

Question 22

How does jackhammer esoph differ from hypercontractile?

Answer 22

JH DCI > 9000

HC DCI 5-9000

Question 23

Name the steps of physiologic belch

Answer 23

Gastric distention –> TLESR –> cessation of diaphragm contraction, esoph long muscle contraction & circ muscle relaxation

Question 24

T/F: If body HP+ and have reflux, response to tx is better if HP is NOT treated.

Answer 24

True

Question 25

T/F: Pts with Barretts esophagus tend to feel reflux events less.

Answer 25

True

Question 26

Name a condition that increases likelihood of erosive esophagitis in a patient.

Answer 26

Previous H&N rads - less saliva made and so less barrier protection

Question 27

If persisting regurg even though on PPI, which med should be considered.

Answer 27

Baclofen

Question 28

Which obesity surgery can improve reflux?

Answer 28

REY

Question 29

T/F: Inlet patch can be AW globus and endoscopic ablation can help with sxs.

Answer 29

True - inlet patch can secrete acid and cause sxs for pts

Question 30

How to diff inlet patch from Barretts?

Answer 30

Inlet patch has NO goblet cells on bx, Barretts does

Question 31

T/F: Radiation induced esophagitis is worse if rads+chemo is used instead of just rads.

Answer 31

True

Question 32

T/F: With EOE should do dilation at the time of starting swallowed budesonide in pts without full response to PPI?

Answer 32

False - do dilation only after failing PPI and steroid swallowed

Question 33

Barretts follow up if NO dysplasia found in how many years?

Answer 33

3-5 yrs

Question 34

What is best initial mgmt of achalasia type II?

Answer 34

Pneumatic dilation or myotomy

Question 35

What are diagnostic criteria of type III Achalasia? Criteria of DES?

Answer 35

T3A - Mean IRP > 15, >20% premature contractions, DCI > 450, DL < 4.5s DES - Nl IRP, > 20% premature contractions, DL < 4.5s

Question 36

T/F: You can get pseudoachalasia from lap band.

Answer 36

True

Question 37

Which should be done? Pt on steroid inhaler and with candida and odynophagia - tx with fluc or just stop inhaler?

Answer 37

Treat with fluc

Question 38

When see OP candida and pt with dysphagia/odynophagia - should just tx or scope then tx?

Answer 38

Just tx if can see candida

Question 39

Diagnostic criteria for hypercontractile esophagus?

Answer 39

Nl IRP, peristalsis, DL | DCI between 5000 and 9000

Question 40

How to tx hypercontractile esophagus?

Answer 40

SNRI or SSRI

Question 41

Esophagus whitish spots and odynophagia - what to think of first?

Answer 41

Candida more common than EOE