GI Reflux Diseases and Motility Disorders

Question 1

Oesophagus anatomy

Answer 1

upper, middle and lower oesophagus
upper oesophageal sphincter- C6
lower oesophagus sphincter- T11

Question 2

Oesophageal peristalsis

Answer 2

progressive contraction of circular muscles to push food bolus down to stomach
primary peristalsis - inititated by swallowing
secondary peristalsis- stimulated by oesophageal distension and involves oesophageal afferent fibres

Question 3

degultitive inhibition

Answer 3

preceeds peristaltic contractions
exitatory pathway- vagal preganglionic, stimulates postganglionic neurones containing ACh and substance P
inhibitory pathway- preganglionic vagal fibres, stimulates postganglionic inhibitory neurones containing NO, substance P and adenosine triphosphate

Question 4

symptoms of oesophageal problems

Answer 4

heartburn/reflux
dysphagia- difficulty swallowing
odonophagia
chest pain
regurgitation

Question 5

oesophageal physiology tests

Answer 5

high resolution manomentary test- tube place in oesophagus for 10 minutes to measure how well oesophageal muscles work

24hr Ph test- thin tube place in oesophagus and sends signal to recording box worn on shoulder for 24hr and measures Ph and food and drink

Question 6

achalasia

Answer 6

impaired smooth muscle peristalsis and relaxation of lower oesophageal sphincter in oesophagus
symptoms- dysphagia regurgitation, reflux symptoms, weight loss
treatment- diet changes, endoscopic treatment (botox injection, dilatation), surgical intervention

Question 7

gastro-oesophageal reflux disease (GORD)

Answer 7

problems contracting lower oesophageal sphincter which leads to acid reflux in the oesophagus
symptoms- reflux, odynophagia, nausea, cough
endoscopy used to assess complications such as cancer, strictures and barretts disease
treatment- lifestyle modifications, PPIs, H2 antagonists, surgery