Oesophageal Disease

Question 1

Acute oesophagitis is more common than chronic oesophagitis. True/False?

Answer 1

False

Question 2

What are some causes of acute oesophagitis?

Answer 2

Chemical abuse -> corrosion

Infection (herpes, candidiasis)

Question 3

What is the main cause of chronic oesophagitis?

Answer 3

Reflux disease [reflux oesophagitis]

Question 4

Define “reflux oesophagitis” (GORD)

Answer 4

Inflammation of the oesophagus due to reflux of acid from the stomach

Question 5

What are the 3 main causes of GORD?

Answer 5

Incompetent LOS
Poor oesophageal motility/clearance
Impaired mucosal barrier

Question 6

What is the dominant immune cell that accompanies acid abuse?

Answer 6

Eosinophils

Question 7

Name 3 complications of reflux oesophagitis

Answer 7

Ulceration/bleeding
Stricture formation due to scarring
Barrett’s Oesophagus

Question 8

Define “Barrett’s Oesophagus”

Answer 8

Replacement of stratified squamous epithelium -> columnar epithelium [metaplastic change]

Question 9

How is Barrett’s Oesophagus pre-malignant?

Answer 9

Mucosa becomes unstable, and persistent acid insult increases risk of developing dysplasia and carcinoma

Question 10

What is allergic oesophagitis?

Answer 10

Immune-mediated oesophagitis caused by reaction to food

Eosinophilic infiltrates present

Question 11

Benign oesophageal tumours are rarer than malignant tumours. True/False?

Answer 11

True

Question 12

What is the most common benign oesophageal tumour?

Answer 12

Squamous papilloma

Question 13

What are the two main types of malignant oesophageal tumour?

Answer 13

Squamous cell carcinoma

Adenocarcinoma

Question 14

Squamous cell carcinoma of oesophagus is commoner in males. True/False?

Answer 14

True

Question 15

Where is adenocarcinoma of the oesophagus most likely to develop? Why?

Answer 15

Lower 1/3 of oesophagus

Reflux insult is greatest here

Question 16

What are the 3 main mechanisms of metastasis of oesophageal tumours?

Answer 16

Direct invasion
Lymphatic spread
Haematogenous spread

Question 17

Give examples of symptoms of GORD

Answer 17

Heartburn
Waterbrash (hyper-salivation)
Dysphagia, odynophagia
Reflux
Chest pain

Question 18

What are the main investigations for GORD?

Answer 18

Endoscopy
Barium swallow
Manometry (pressure) studies
Nuclear imaging

Question 19

Name the ALARM Symptoms

Answer 19

Anaemia
Loss of weight
Anorexia
Recent progressive symptoms
Malaena or haematemesis
Swallowing difficulty

Question 20

Antacids provide symptomatic relief and heal oesophagitis in GORD. True/False?

Answer 20

False

Provide symptom relief but no healing or preventative qualities

Question 21

H2 receptor antagonists mainly provide symptomatic relief of GORD; give an example of one

Answer 21

Ranitidine

Question 22

Proton pump inhibitors provide symptomatic relief and heal oesophagitis. True/False?

Answer 22

True

*omeprazole

Question 23

When is surgery indicated for GORD?

Answer 23

To repair LOS

When PPIs ineffective (cheaper doing surgery than being on PPI for 7+ years)

Question 24

Which investigations are indicated for diagnosing oesophageal cancer?

Answer 24

Endoscopy
Barium meal
CT scan

Question 25

Name some contraindications to surgery for treating oesophageal cancer

Answer 25

Invasion of adjacent structures
Widespread metastasis
Poor health/lack of fitness