Oesoph & its disorders 2023-2024-2

Question 1

What are the intrinsic components of the lower oesophageal sphincter (LOS)?

Answer 1

• Oesophageal smooth muscle
• Oblique/sling fissures
• Fibres which form pinchcock lilke action

These components help prevent regurgitation and are responsive to cholinergic innervation.

Question 2

What is the Angle of His, and how is it developed in infants?

Answer 2

The Angle of His is poorly developed in infants, making a vertical junction with the stomach

This anatomical feature contributes to the commonality of reflux in infants.

Question 3

What factors in pregnancy contribute to gastro-oesophageal reflux disease (GORD)?

Answer 3

Increased abdominal pressure, pressure from the fetus, and descent of the uterus into the pelvis

These factors force gastric contents into the oesophagus.

Question 4

How is GORD investigated?

Answer 4

Low dose proton pump inhibitor (PPI) challenge, upper GI endoscopy, manometry, 24-hr ambulatory pH monitoring

These methods help confirm the diagnosis of GORD.

Question 5

What does 24-hr pH monitoring reveal about reflux in normal individuals?

Answer 5

Most normal individuals (non-refluxers) reflux on a daily basis

GORD implies reflux in excess of what non-refluxers experience.

Question 6

What are some factors that contribute to the severity of GORD?

Answer 6

• Weak or uncoordinated oesophageal contractions
• Prolonged contact duration of refluxed contents with the oesophagus
• Impaired gastric emptying
• Increased gastric acid secretion with bile presence
• Low resting LOS tone

These factors can lead to severe oesophageal damage.

Question 7

What is transient spontaneous LOS relaxation (tsr)?

Answer 7

Sudden and sustained relaxation of the LOS not induced by swallowing

This condition contributes to reflux in individuals with GORD.

Question 8

What is chronic oesophagitis, and what is its prevalence in GORD?

Answer 8

Chronic oesophagitis can be erosive or non-erosive, with a prevalence of 30%

It is often caused by the irritation from GORD.

Question 9

List some common symptoms of GORD.

Answer 9

• Heartburn
• Coughs
• Belching
• Regurgitation
• Dysphagia

Symptoms may vary in intensity and frequency.

Question 10

What lifestyle changes can help alleviate GORD symptoms?

Answer 10

• Avoid large meals
• Lose weight
• Avoid foods that increase gastric acidity
• Avoid lying down after meals
• Elevate the head of the bed

Identifying and avoiding symptom aggravators is crucial for management.

Question 11

What is the role of antacids in the treatment of GORD?

Answer 11

Neutralise gastric acid, increase pH of gastric lumen, inhibit peptic activity

However, magnesium salts can cause diarrhea, while aluminium salts can cause constipation.

Question 12

What is the function of alginates in GORD treatment?

Answer 12

Form a raft with saliva that floats on gastric contents and protects the oesophageal mucosa from reflux

Combining alginates with antacids enhances their protective effects.

Question 13

What is the structural composition of the oesophagus?

Answer 13

Fibromuscular tube (25cm) of striated squamous epithelium, lies posterior to the trachea

It begins at the end of the laryngopharynx and joins the stomach near the diaphragm.

Question 14

How is swallowing initiated?

Answer 14

Voluntary action to collect material on the tongue and push it backwards into the pharynx

This action triggers involuntary contractions that move food into the oesophagus.

Question 15

What are the potential long-term effects of GORD?

Answer 15

• Oesophagitis
• Oesophageal strictures
• Squamous cell carcinoma
• Barrett’s syndrome
• Oesophageal ulcer

These conditions can arise from chronic GORD.

Question 16

What is the normal pressure of the lower oesophageal sphincter (LOS)?

Answer 16

Normal pressure is about 15 mmHg, with relaxation allowing less than 10 mmHg

Pressure above 100 mmHg may indicate conditions like achalasia.

Question 17

What does oesophageal manometry evaluate?

Answer 17

The strength and coordination of muscle contractions in the oesophagus

It helps determine causes of symptoms like non-cardiac chest pain and swallowing difficulties.

Question 18

What is the role of the crural diaphragm in the lower oesophageal sphincter?

Answer 18

Encircles the LOS and forms a channel for the oesophagus, possessing a ‘pinchcock-like’ action

This action contributes to the anti-reflux function.

Question 19

What is the primary function of the oesophagus?

Answer 19

To convey food and fluids from the pharynx to the stomach

This process is facilitated by coordinated muscular contractions.

Question 20

What does the UOS/LOS contract and relax evaluation assess?

Answer 20

The strength of coordination of muscle contractions

This evaluation helps determine if the oesophagus is contracting and relaxing properly.

Question 21

What is considered a normal pressure for the Lower Oesophageal Sphincter (LOS)?

Answer 21

Pressure of LOS < 26 mm Hg

Pressures > 100 mm Hg indicate achalasia; > 200 mm Hg indicates nutcracker achalasia.

Question 22

What can low LOS pressure suggest?

Answer 22

GORD (Gastro-Oesophageal Reflux Disease)

GORD can also occur in individuals with normal LOS pressure.

Question 23

What prevents the reflux of gastric contents?

Answer 23

Anti-reflux barrier in the gastro-oesophageal junction

This barrier includes several mechanisms that help maintain the integrity of the junction.

Question 24

What effect does the diaphragmatic sphincter have on the lower oesophagus?

Answer 24

Pinchcock effect

This effect involves side-to-side compression between the two pillars of the crus.

Question 25

What is the function of the mucosal folds in the cardia?

Answer 25

Occludes the lumen of the gastro-oesophageal junction ## Footnote This action supports the anti-reflux mechanism.

Question 26

What is the role of sphincter muscles of UOS and LOS?

Answer 26

Act as valves ## Footnote They control the movement of the food mass aborally and prevent reflux.

Question 27

What are common symptoms of achalasia?

Answer 27

Dysphagia, vomiting/regurgitation, heartburn ## Footnote These symptoms arise from oesophageal dysmotility and food retention.

Question 28

What is a potential cause of heartburn in achalasia?

Answer 28

Retention of acidic food and gastric acid reflux ## Footnote Poor emptying and incomplete relaxation of LOS can contribute to heartburn.

Question 29

What is the aetiology of achalasia?

Answer 29

Disorders of motility or peristalsis, damage to innervation of oesophagus ## Footnote The initiating factor is often unknown but may be autoimmune or infection-triggered.

Question 30

What findings are associated with achalasia?

Answer 30

Impaired LOS relaxation, delayed opening of LOS, dilation of oesophageal body ## Footnote This can lead to a 'bird’s beak' appearance on an oesophagram.

Question 31

What is secondary peristalsis?

Answer 31

Repeated waves of peristalsis stimulated by food remnants in the oesophagus ## Footnote It ensures that ingested food reaches the stomach.

Question 32

What is oesophageal manometry?

Answer 32

A test that measures the pressure and pattern of muscle contractions in the oesophagus ## Footnote It is used to evaluate disorders of motility.

Question 33

What are potential long-term effects of untreated GORD?

Answer 33

Esophagitis, Barrett's esophagus, esophageal adenocarcinoma ## Footnote These complications arise from chronic exposure to stomach acids.

Question 34

What is oropharyngeal dysphagia?

Answer 34

Swallowing difficulty caused by inability of UOS to open or discoordination of timing ## Footnote This affects the pharyngeal push behind the ingested mass of food.

Question 35

What characterizes oesophageal spasm?

Answer 35

Abnormal oesophageal contractions preventing effective food passage ## Footnote This can lead to chest pain and swallowing difficulties.

Question 36

What is regurgitation?

Answer 36

Reflux of stomach acids into the oesophagus ## Footnote It is often associated with weak LOS and requires assessment of underlying causes.

Question 37

What should always be determined in cases of swallowing difficulties?

Answer 37

The causes of swallowing difficulties ## Footnote Identifying the underlying issue is crucial for appropriate management.

Question 38

What is the definition of achalasia?

Answer 38

Disorders of motility or peristalsis of the oesophagus ## Footnote It involves assessment of the motor function of the UOS, LOS, and oesophageal body.