GI: Conditions of the Oesophagus

Question 1

What are the symptoms of oesophageal disease?

Answer 1

Dysphagia
Heartburn
Regurgitation
Painful swallow

Question 2

What is dysphagia?

Answer 2

DIFFICULTY swallowing

Question 3

What does a short history of progressive dysphagia first to solids and then liquids suggest? What is the most appropriate investigation?

Answer 3

Mechanical stricture
Urgent ODG (endoscopy)

Question 4

What does a long history of slow onset dysphagia to both solids and liquids suggest? What is the most appropriate investigation?

Answer 4

Motility disorder

Barium swallow

Question 5

What is heartburn?

Answer 5

Retrosternal/Epigastric burning sensation due to acid reflux.
Pain is made worse by lying down

Question 6

What is regurgitation? What conditions does it occur in?

Answer 6

Reflux of oesophageal contents into the mouth/pharynx

Occurs in reflux disease + oesophageal strictures

Question 7

What is odynophagia? What condition does it indicate?

Answer 7

Painful swallow

Oesphagitis caused by GORD/infection

Question 8

What is the major symptom of GORD?

Answer 8

Heartburn. May also present with regurgitation + odynophagia.

Question 9

How is the diagnosis of GORD made?

Answer 9

The history

Question 10

When is an endoscopy indicated?

Answer 10

In patients with new onset of heart burn over 55 years old or patients with ALARM Symptoms

Question 11

What are the ALARM Symptoms?

Answer 11

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malena or haematemesis 
Swallowing difficulty

Question 12

What non-pharmacological management is indicated in GORD?

Answer 12

Weight loss
Smoking cessation
Avoidance of aggravating foods + excess alcohol

Question 13

What is the first line treatment for mild GORD?

Answer 13

Antacids, e.g. gavascon

Question 14

What is the first line treatment for severe GORD or patients with complications?

Answer 14

PPIs e.g. omeprazole

Question 15

What do H2 receptor antagonists do?

Answer 15

Relieve the symptoms of GORD. e.g. ranitidine

Question 16

What are some of the complications of GORD?

Answer 16

Stricture formation
Barret oesophagus
Schatski ring

Question 17

How is an oesophageal stricture treated?

Answer 17

PPIs + endoscopic dilatation

Question 18

What is Barrets oesophagus?

Answer 18

Metaplastic change from squamous epithelium to columnar epithelium. It is an irreversible premalignant change

Question 19

How is Barrets oesophagus treated?

Answer 19

PPIs + endoscopic surveillance

Question 20

What is a schatski ring?

Answer 20

Localised mucosal stricture at the gastro-oesophageal junction

Question 21

What is achalasia?

Answer 21

Failure of the lower oesophageal sphincter to relax, preventing food from passing into the stomach

Question 22

What is the buzz word seen on a barium swallow for achalasia?

Answer 22

Birds beak oesophagus

Question 23

What else does a barium swallow show that indicates achalasia?

Answer 23

Dilatation of the oesophagus + no peristalsis

Question 24

What investigation confirms achalasia?

Answer 24

Oesophageal manometry

Question 25

What is the pathology behind achalasia?

Answer 25

Degeneration of the vagus nerve

Question 26

How do you treat achalasia?

Answer 26

NO CURE endoscopic dilation can improve symptoms but is contraindicated in frail, elderly patients Nitrates/Ca channel blockers (nifedipine) can be given to relax LOS

Question 27

What is an oesophageal spasm? | What is seen on a barium swallow?

Answer 27

Simultaneous contractions in the distal oesophagus | CORKSREW OESOPHAGUS

Question 28

What is a nutcracker oesophagus?

Answer 28

High amplitude peristaltic waves

Question 29

How do dysmotility disorders, e.g. oesophageal spasm, present?

Answer 29

Dysphagia + chest pain

Question 30

What is allergic eosinophilic oesophagits?

Answer 30

Inflammation of the oesophagus caused by reaction to food. Immune complex mediated + eosinophilic infiltrates present

Question 31

What causes oesophageal perforation?

Answer 31

Iatrogenic- after endoscopic dilatation | Traumatic- chest trauma or forceful vomiting

Question 32

How does oesophageal perforation present? How is it diagnosed?

Answer 32

``` Severe chest pain Fever Hypotension Emphysema Diagnosis: CXR + CT ```

Question 33

What are the most common malignant oesophageal tumours and where do they occur?

Answer 33

Squamous cell - usually middle 3rd of oesophagus | Adenocarcinoma- usually lower 3rd of oesophagus

Question 34

What are the risk factors for Squamous cell carcinoma?

Answer 34

Smoking, Alcohol, Achalasia, Coeliac disease

Question 35

What causes adenocarcinoma?

Answer 35

Barrets oesophagus. | Smoking + obesity are also risk factors

Question 36

How does oesophageal cancer present?

Answer 36

Progressive dysphagia to solids then liquids. | Weight loss

Question 37

How is oesophageal cancer diagnosed?

Answer 37

Endoscopy + tumour biopsy

Question 38

What is the treatment for oesophageal cancer?

Answer 38

Surgery

Question 39

Are benign oesophageal tumours common or rare?

Answer 39

Rare

Question 40

What is the most common benign oesophageal tumour?

Answer 40

Squamous papilloma