lower esophageal sphincter disorders

Question 1

what are the names of these structures

Answer 1

Question 2

definition of GERD

Answer 2

troublesom symptoms or complications caused by reflux of gastric content into esophagus

Question 3

definition of barrets esophagus?

Answer 3

metaplasia of normal mucosa of lower esophagus from stratified squamous epethilum to columner epethilum

Question 4

what will happen if barret esoapagus is not treated?

Answer 4

if this condition is igonered later on it may change to esophageal adenocarcinoma

Question 5

what are the type of hiatel hernia in each figure?

Answer 5

Question 6

investigations for GERD

Answer 6

endoscopy

contrast study

24 PH monitring

• catheter
• wireless

manometry

Question 7

what is the gold standered investigation for GERD

Answer 7

PH monitring

Question 8

treatment of GERD

Answer 8

1- lifestyle modification (stop smoking, lose weight, stop coffee, stop eating before sleep by 3 hours, tilt the bed)

2- medical (PPI; long term use “20 years” have complication like osteoprosis, dementia, chronic renal damage)

3- endoscopic (stretta: electromagnatic waves, trans esophageal fundoplucation)

4- surgery

Question 9

indications for surgery of GERD

Answer 9

• failed optomim medical treatment
• non complince
• high volume reflux
• severe esophagitis
• benign stricture
• barrets esophagus
• non gastrointestinal indication

Question 10

what is the name of the surgical procedcure done for GERD and whats the mechanism?

Answer 10

Nissen fundoplication

release fundus of stomach from spleen

then folded aound esophagus

note: calibration tube is placed in esophagus to insure not tighting too much

Question 11

for patient with weak motility what surgery is prefered for GERD?

and for very weak motility patients? like patients who have achalasia

Answer 11

Toupet Fundoplication (anterior part of esophagus is visible)

dor fundoplication (only cover anterior part of esophagus)