Esophagus and GERD

Question 1

Odynophagia

Answer 1

pain on swallowing

Question 2

Dysphagia

Answer 2

symptom resulting from failure to move food from mouth to stomach

Question 3

Normal Swallowing

Answer 3

Transfer –> liquids/solids move from mouth to esophagus
Transport –> liquids/solids move length of esophagus
Emptying –> liquids/solids delivered to stomach

Question 4

Contributing factors to dysphagia?

Answer 4

• Inadequate preparation of swallowing –> saliva/mastication, neuromuscular disorder
• Abnormal muscle strength/function –> neuromuscular disorder
• Esophageal passageway narrowing –> mechanical obstruction

Question 5

Oropharyngeal dysphagia

Answer 5

difficulty initiating swallowing
Goals of therapy
- protect airway
- maintain nutrition
- relieve dysphagia
Therapies
- speech/swallowing therapy
- esophageal dilation
- surgical myotomy
- NPO with nutrition support

Question 6

Esophageal dysphagia

Answer 6

food stops/sticks after swallowing initiated

Question 7

Anatomic causes of dysphagia

Answer 7

Benign –> peptic strictures, rings/webs, caustic

Cancer –> primary esophageal, extrinsic compression

Question 8

Neuromuscular causes of dysphagia

Answer 8

Primary esophageal disease

• Achalasia
• Chagas’

Question 9

Achalasia

Answer 9

loss of inhibitory innervation to LES

• non-relaxing LES, esophageal aperistalsis
• bird’s-beak narrowing, dilated esophagus

Question 10

Treatment of achalasia

Answer 10

1. Nifidepine
2. Botulinum toxin
3. Balloon dilation
4. Esophageal myotomy

Question 11

Heartburn

Answer 11

Classic symptom of GERD

• substernal burning w/ or w/o regurgitation
• post-prandial
• aggravated by change in position
• prompt relief with antacids

Question 12

Therapy of GERD

Answer 12

LIFESTYLE MODIFICATIONS

• elevate head
• no food 3 hrs before bed
• modify diet –> decrease fat, volume, and acid

Question 13

Barrett’s Esophagus

Answer 13

columnar epithelium replaces squamous epithelium in distal esophagus (distal 1/3)

• occurs as a result of long-standing GERD in 10-15% patients
• major cancer risk for esophageal adenocarcinoma

Question 14

Peptic Esophageal Stricture

Answer 14

10% of patients who have reflux esophagitis

- ulceration stimulates fibrosis –> associated with NSAIDs

Question 15

Solids Dysphagia

Answer 15

Intermittent –> lower esophageal ring

Progressive –> peptic stricture or cancer

Question 16

Solids and Liquids Dysphagia

Answer 16

Intermittent –> diffuse spasm

Progressive –> achalasia or scleroderma

Question 17

Anatomical Disorders causing dysphagia

Answer 17

Postcricoid web
Cervical osteophyte
Hypopharyngral diverticulum
Head and neck tumors

Question 18

Muscular disorders causing dysphagia

Answer 18

oculopharyngeal muscular dystrophy
myotonic dystrophy
myasthenia gravis

Question 19

Neurological disorders causing dysphagia

Answer 19

cerebrovascular accidents
poliomyelitis
amyotropic lateral sclerosis
parkinson's
cerebral palsy
tumors