GI tract disorders Flashcards
How does the oesophagus normally function (and what is the diagram that represents this)?
The upper oesophageal sphincter relaxes
Food enters and a peristaltic wave is triggered in the striated muscle
Lower oesophageal sphincter relaxes as swallow is initiated and food enters stomach
Seen below:
What are common oesophageal disorders?
Gastro-oesophageal reflux disease
Oesophageal motility disorders
Eosinophilic oesophagitis
Oesophageal cancer
What are different manifestations of GORD (gastro-oesophageal reflux disease)?
Oesophagitis
Barett’s oesophagus
Benign oesophageal stricture
What are symptoms of oesophageal disease?
COMMON
Dysphagia and odynophagia (difficulty and pain swallowing)
Heartburn
Acid regurgitation
Waterbrash
LESS COMMON
Chest pain
Food regurgitation
Food bolus obstruction
Cough
Altered voice- dysphonia
Globus (sensation of food being stuck but swallowing not affected)
Why can cough and altered voice in oesophageal disease?
Cough= when acid gets into respiratory system
Altered voice= irritated vocal chords
What are the different types of dysphagia?
What are the two main types of GORD (gastro-oesophageal reflux disease) and how are they different?
Transient lower relaxations= Usually acid is immediately cleared so no inflammation
Lower sphincter pressure decrease= inflammation due to chronic acid
What are the typical symptoms of GORD (gastro-oesophageal reflux disease)?
HEARTBURN= burning discomfort behind the breast bone spreading upwards
ACID REGURGITATION= often meal related or postural
WATERBRASH= hypersalivation secondary to gastro-oesophageal reflux
What are different investiagtions that can be done in oesophageal disease?
Endoscopy and biopsy
Barium swallow= x-ray after barium is swallowed.
Oesophageal function tests (Manometry, pH and Impedence monitoring)
CT, CT-PET scans or endoscopic ultrasound for tumours
What is a manometry test?
The manometry test senses the pressure and constriction of muscles in the esophagus as you swallow. It can detect patterns of muscle activity throughout the length of the esophagus, including contractions that are too weak or too powerful
What is impedence monitoring?
Esophageal 24-hour pH/impedance reflux monitoring measures the amount of reflux (both acidic and non-acidic) in your esophagus during a 24-hour period, and assesses whether your symptoms are correlated with the reflux.
What is oesopahgitis?
Inflammation of the oesophagus
Secondary to acid reflux
Can cause stricture
What is oesophageal stricture?
An esophageal stricture refers to the abnormal narrowing of the esophageal lumen; it often presents as dysphagia
What is Barrett’s oesophagus?
The squamous (oesophagus) is replaced by columnar (stomach) epithelium
Way for oesophagus to defend against large amounts of acid in chronic acid reflux
Often asymptomatic and commenest in obese men >50
If untreated can lead to adenocarcinomas
What is the treatment for Barrett’s oesophagus?
Barrets can be ablated (removed) so it does not become malignant. PPI are given long term (omeprazole ect)
What is the general treatment of gastro-intestinal reflux disease?
Lifestyle= smoking, alcohol, diet, weight
Mechanical= posture, elevate head in bed
Antacids
Acid supression= PPIs e.g. omeprazol, H2RA e.g. randitidine
Surgical- fundoplication (stomach wrapped around lower oesophagus)
What is an example of a oesophageal motility disorder?
Achalasia
What is achalasia and what does it present with?
Failure of the LOS relaxation together with absence of peristalsis
Degenerative lesion of oesophageal innervation
Typically presents in younger people with dysphagia to liquids and solids, weight loss, chest pain
What is the treatment for achalasia?
BoTox (paralyses LOS)
Endoscopic Dilatation
Surgical myotomy (surgeon cuts LOS)
POEM (Peroral endoscopic myotomy- cut without incision through skin)
What does achalasia look like on a barium swallow scan?
Dilated oesophagus, tight sphincter, ‘rat tail’
What is eosinophilic oesophagitis?
Eosinophilic esophagitis
is a chronic, immune/antigen-mediated esophageal inflammatory disease associated with esophageal dysfunction resulting from severe inflammation
What does eosinophilic oesoiphagitis present with?
Common presentation with Food bolus obstruction, dysphagia
Younger age, M>F, prevalence 50/100,000
History of atopy (asthma, hay fever)
What does an endoscopy of eosinophilic oesophagitis look like?
Endoscopy - furrows (lumps), rings, exudates, strictures
How is eosinophilic oesophagitis diagnosed?
Biopsy required for diagnosis