Inflammatory Disorders of the Oesophagus

Question 1

can be ___ or ____ with acute being ____

Answer 1

acute, chronic , rare

Question 2

what are the three types of acute oesophagitis?

Answer 2

heartburn

corrosive following chemical ingestion

infections

Question 3

infections of the oesophagus are rare except in those who are ______

Answer 3

immunocompromised

Question 4

give three examples of the infective organisms of the oesophgus

Answer 4

candidiasis oesophagitis, herpes oesophagitis, CMV (cytomegalovirus) oesophagitis

Question 5

chronic oesophagitis is more common - what are the chronic inflammatory conditions 2

Answer 5

• reflux disease

- rare causes include crohn’s disease

Question 6

With chronic inflammation of any kind there is always an increased risk of _____

Answer 6

neoplasia

Question 7

reflux oesophagitis is inflammation of the oesophagus due to ______ ____ ____ ______ content.

Answer 7

This is inflammation of the oesophagus due to refluxed low pH gastric content.

Question 8

what may happen to the oesophagus if reflux is prolonged? 3

Answer 8

it may cause oesophagitis, benign oesophageal strictures (because of the scar formation) or barrett’s oesophagus (pre-malignancy)

Question 9

what are some of the causes of reflux oesophagitis? 4

Answer 9

• May be due to defective sphincter mechanism ± hiatus hernia
• Abnormal oesophageal motility
• Increased intra-abdominal pressure
• can have over-secretion of acid

Question 10

what things cause increased intra-abdominal pressure which can cause reflux oesophagitis? 3

Answer 10

• pregnancy
• more commonly in those who are overweight
• weight lifters

Question 11

what can cause oversecretion of acid which may be responsible for relux disease? 2

Answer 11

smoking and alcohol

Question 12

pathophysiology of reflux oesophagitis : Reflux causes cell damage to the _____ _____ ______. The cell loss causes compensatory _____ ____ ______ along with influx of intraepithelial _____,_____ and _______

Answer 12

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

Question 13

what are the symptoms of reflux oesophagitis? 4

Answer 13

• discomfort or pain retrosternally
• mimic cardiac symptoms because of oesophageal muscle spasm
• odontophagia
• reflux bronchitis causing a cough- if acid goes further up

Question 14

what are some characteristics of pain caused by reflux disease? 4

Answer 14

After meals, lying, stooping or straining and relieved by antacids

Question 15

what is odontophagia?

Answer 15

painful swallowing from oesophagitis or ulceration

Question 16

what are the complications of reflux oesophagitis? 4

Answer 16

• ulceration
• stricture
• iron-deficiency
• barrett’s oesophagus

Question 17

what is the commonest complication of reflux oesophagitis?

Answer 17

ulceration

Question 18

what are the 4 grades of ulceration in reflux oesophagitsi?

Answer 18

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%

Question 19

why do strictures develop in reflux oesophagitis?

Answer 19

from scar formation and contraction

Question 20

what is barrett’s oesophagus?

Answer 20

a metaplasia involving the repleacement of stratified squamous epithelium by columnar epithelium

Question 21

what tests are carried out in reflux oesophagitis?

Answer 21

Endoscopy

Barium swallow may show hiatus hernia

Question 22

when is an endoscopy performed in reflux oesophagitis?

Answer 22

Endoscopy if:

Symptoms >4 wks, persistent symptoms

weight loss

Question 23

what are the two treatment options in reflux oesophagitis?

Answer 23

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

Question 24

what are the options for acid block in reflux oesophagitis?

Answer 24

• H2 receptor antagonists
• PPI
• Antacids

Question 25

why are H2 receptor antagonists good in the short term but not the long term?

Answer 25

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

Question 26

PPIs - they are not just good for controlling ____ but are also useful _____ acid related _____. They need to be taken at ____ _____

Answer 26

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

Question 27

what are people on PPIs at slightly higher risk of?

Answer 27

gastroenteritis

Question 28

antacids only treat ____ so dont prevent ______

Answer 28

symptoms, complications

Question 29

barrett'soesophagus is a _____ response and may be due to differentiation from oesophageal ___ cells

Answer 29

protective, stem

Question 30

histologically what three basic patterns may be seen on the columnar epithelium in barrett's oesophagus ?

Answer 30

- Junctional (resembling gastric cardia) - Gastric fundic (including acid and pepsin-secreting cells) - Intestinal (with small intestinal type goblet cells)

Question 31

how is a diagnosis of barrett's made?

Answer 31

Mainly endoscopically but histopathology is used to make sure it has not become dysplastic

Question 32

what are the complications of barretts'

Answer 32

high risk that it will develop into dysplasia and carcinoma of the oesophagus mucosa requires surveillance

Question 33

allergic oesophagitis is also knwon as ______ oesophagitis

Answer 33

eosinophilic

Question 34

when should you suspect allergic oesophagitis

Answer 34

If patients don't get better from antireflux therapy or surgery then you have to think of another reason for the acid

Question 35

what is allergic oesophagitis associated with?

Answer 35

``` Atopy personal/family history of allergy Asthma Young people males> females ```

Question 36

in allergic oesophagitis the pH probe would be ___ for reflux, would have increased ____ in the blood and a ___ or _____ looking oesophagus

Answer 36

negative, eosinophils, corrugated or spotty

Question 37

what are the treatment options for allergic oesophagitis ?

Answer 37

steroids - dont really want to give these to kids cromoglycate montelukast