Inflammatory Disorders of the Oesophagus Flashcards
can be ___ or ____ with acute being ____
acute, chronic , rare
what are the three types of acute oesophagitis?
heartburn
corrosive following chemical ingestion
infections
infections of the oesophagus are rare except in those who are ______
immunocompromised
give three examples of the infective organisms of the oesophgus
candidiasis oesophagitis, herpes oesophagitis, CMV (cytomegalovirus) oesophagitis
chronic oesophagitis is more common - what are the chronic inflammatory conditions 2
- reflux disease
- rare causes include crohn’s disease
With chronic inflammation of any kind there is always an increased risk of _____
neoplasia
reflux oesophagitis is inflammation of the oesophagus due to ______ ____ ____ ______ content.
This is inflammation of the oesophagus due to refluxed low pH gastric content.
what may happen to the oesophagus if reflux is prolonged? 3
it may cause oesophagitis, benign oesophageal strictures (because of the scar formation) or barrett’s oesophagus (pre-malignancy)
what are some of the causes of reflux oesophagitis? 4
- May be due to defective sphincter mechanism ± hiatus hernia
- Abnormal oesophageal motility
- Increased intra-abdominal pressure
- can have over-secretion of acid
what things cause increased intra-abdominal pressure which can cause reflux oesophagitis? 3
- pregnancy
- more commonly in those who are overweight
- weight lifters
what can cause oversecretion of acid which may be responsible for relux disease? 2
smoking and alcohol
pathophysiology of reflux oesophagitis : Reflux causes cell damage to the _____ _____ ______. The cell loss causes compensatory _____ ____ ______ along with influx of intraepithelial _____,_____ and _______
Reflux causes cell damage to the superficial squamous epithelium. The cell loss causes compensatory basal cell hyperplasia along with influx of intraepithelial neutrophils, lymphocytes and eosinophils
what are the symptoms of reflux oesophagitis? 4
- discomfort or pain retrosternally
- mimic cardiac symptoms because of oesophageal muscle spasm
- odontophagia
- reflux bronchitis causing a cough- if acid goes further up
what are some characteristics of pain caused by reflux disease? 4
After meals, lying, stooping or straining and relieved by antacids
what is odontophagia?
painful swallowing from oesophagitis or ulceration
what are the complications of reflux oesophagitis? 4
- ulceration
- stricture
- iron-deficiency
- barrett’s oesophagus
what is the commonest complication of reflux oesophagitis?
ulceration
what are the 4 grades of ulceration in reflux oesophagitsi?
1: tiny erosions - less than 5 mm
2: greater than 5mm in length
3: less than 75% of the circumference of the oesophagus is involved
4: over 75%
why do strictures develop in reflux oesophagitis?
from scar formation and contraction
what is barrett’s oesophagus?
a metaplasia involving the repleacement of stratified squamous epithelium by columnar epithelium
what tests are carried out in reflux oesophagitis?
Endoscopy
Barium swallow may show hiatus hernia
when is an endoscopy performed in reflux oesophagitis?
Endoscopy if:
Symptoms >4 wks, persistent symptoms
weight loss
what are the two treatment options in reflux oesophagitis?
Can physically repair the defect e.g. the valve can be tightened - solves the problem but there are risks with surgery
Can use acid blocking medication
what are the options for acid block in reflux oesophagitis?
- H2 receptor antagonists
- PPI
- Antacids
why are H2 receptor antagonists good in the short term but not the long term?
This is because gastrin and ACh also control acid production as well as histamine and so the body compensates for the histamine blockage by up regulating the ACh and gastrin mechanisms
If you then stop the H2 antagonists then acid production may be paradoxically high
PPIs - they are not just good for controlling ____ but are also useful _____ acid related _____.
They need to be taken at ____ _____
They are not just good for controlling symptoms but are also useful in preventing acid related damage
They need to be taken at specific times
what are people on PPIs at slightly higher risk of?
gastroenteritis
antacids only treat ____ so dont prevent ______
symptoms, complications
barrett’soesophagus is a _____ response and may be due to differentiation from oesophageal ___ cells
protective, stem
histologically what three basic patterns may be seen on the columnar epithelium in barrett’s oesophagus ?
- Junctional (resembling gastric cardia)
- Gastric fundic (including acid and pepsin-secreting cells)
- Intestinal (with small intestinal type goblet cells)
how is a diagnosis of barrett’s made?
Mainly endoscopically but histopathology is used to make sure it has not become dysplastic
what are the complications of barretts’
high risk that it will develop into dysplasia and carcinoma of the oesophagus
mucosa requires surveillance
allergic oesophagitis is also knwon as ______ oesophagitis
eosinophilic
when should you suspect allergic oesophagitis
If patients don’t get better from antireflux therapy or surgery then you have to think of another reason for the acid
what is allergic oesophagitis associated with?
Atopy personal/family history of allergy Asthma Young people males> females
in allergic oesophagitis the pH probe would be ___ for reflux, would have increased ____ in the blood and a ___ or _____ looking oesophagus
negative, eosinophils, corrugated or spotty
what are the treatment options for allergic oesophagitis ?
steroids - dont really want to give these to kids
cromoglycate
montelukast
