GI Conditions - Esophagus - Prof. Wall Flashcards
Esophagus
GERD

Return of stomach contents into esophagus (w/ symptoms)
Most Common D/O of Esophagus
Esophagus
GERD
Lower esophageal sphincter is weak or relaxes inappropriately

Esophagus
GERD
+
Hiatal Hernia
When the LES & Upper Stomach Portion move up into chest wall through small opening in diaphragm
Causes GERD more often

Esophagus
GERD
+
Epidemiology
- Affects 15-20% of population (report weekly heartburn)
- Caucasians & Pregnancy
- N. America & Europe
Esophagus
GERD
+
Signs & Symptoms
- Heartburn
- Odynophagia
- Dysphagia
- Regurg
- Bleching
- Nausea
- Anorexia/Weight Loss
Esophagus
GERD
+
Atypical Signs & Symptoms
- Sore Thorat
- Dental Caries
- Chronic Cough
- Asthma
- Hoarseness
- Recurrent Pneumonia
- Chest Pain
Esophagus
GERD
+
Diagnostics
- Empircally
- Upper endoscopy w/ bx (esophagogastroduodenoscopy)
- Barium Esophagogram
- Ambulatory esophageal pH monitoring
Esophagus
GERD
+
Complications
- Esophagitis
- Atypical symptoms
- Stricture - GE Junction
-
Barret’s Esophagus!
- Neoplastic changes
- Risk: 40-100x greater than general population
Esophagus
GERD
+
Management
- Repeat Endoscopy every 2 years w/ biopsy
- Surgical resection - if high grade dysplasia >25%
- Stay on Proton Pump Inhibitors FOREVER!
Esophagus
GERD
+
Treatment Goals
- Provide symptom relief
- Heal damage
- Prevent complications
Combo of Pharm & Non-Pharm Tmts
Esophagus
GERD
+
Non-Pharm Tmts
- Lifestyle!!!
- Avoid certain foods & drink
- Decrease portion size
- Lose weight
- Elevate head of bed
- Avoid eating 2-3 hours before bed

Esophagus
GERD
+
Pharm Tmts
-
Antacids
- Mg, Ca, Al
- *May cause constipation in elderly
-
Sialogogues
- Gum
-
H2 Receptor Agonists
- 30 min to work & last 8 hours
-
PPIs
- $$$
- Once daily dosing
Esophagus
GERD
+
Pharm Tmts
-
Antacids
- Mg, Ca, Al
- *May cause constipation in elderly
-
Sialogogues
- Gum
-
H2 Receptor Agonists
- 30 min to work & last 8 hours
-
PPIs
- $$$
- Once daily dosing
Esophagus
GERD
+
PPIs for Severe Disease!!!!
-
PPIs
- 1-2x daily
- Therapy course: 8-12wks
- Most pts relapse & continue with tmt
Esophagus
Esophageal Spasm
- Motility D/O
- Assc. w/
- Chest Pain
- Dysphagia
Esophagus
Esophageal Spasm
Nutcracker Esophagus
- Hypertensive Peristalsis
- Increased contraction pressure
- >180mmHg during Peristalsis

Esophagus
Esophageal Spasm
Treatment
- Nitrates
- CCBs
- Diltiazem
Diagnostics
Esophageal Manometry
Evaluates Peristalsis
Upper & Lower Esophageal Sphincters

Diagnostics
Esophageal Manometry
Examples
- Achalsia
- No Relaxation at LES
- Lack of Peristalsis
- Nutcrack Esophagus
- Hyper-contractile especially at LES

Esophageal Dysphagia Algorithm

- Solid Foods -
- Mechanical Obstruction
- Solid Food & Liquirds -
- Neuromsk Obstruction

Esophagitis
Inflammation of the Esophagus
Esophagitis
+
GERD
50% of those w/ GERD develop Esophagitis
Incidence increases with Age
Esophagitis
+
Risk Factors
- GERD
- Infectious
- Viral, fungal, bacterial, parasitic
- Pill/Med-Induced
- Abx, KCl, Bisphosphonates
Esophagitis
Signs & Symptoms
- Odynophagia
- Dysphagia
- Substernal Chest Pain
- Oral Thrush
- Herpes Labialis
- Retinitis (CMV)























