Oesophageal disease Flashcards
Eosinophilic Oesophagitis
Pathophysiology?
Oesphageal Eosinophilia
Th2 driven asthma like disease
? Food allergy
Eosinophilic Oesophagitis
Presentation
Young men with dysphagia and food impaction
Refractory GORD
Treatment of eosinophilic oesophagitis
PPIs
Elimination diet - requires 6 weeks of diet for symptoms to improve
Oeophageal motility disorders?
Achalasia
Zenker’s divericulum
–> outpouching in the cervical oesophagus
Diffuse oesophageal spasm
Cricopharyngeal spasm
–> bar of spasm in the cricopharyneal oesophagus
Definition of achalasia
Type 1:
- No peristasis
- No LOS relaxation
Type 2:
- No peristasis
- No LOS relaxation
- Pan oesophageal pressurization
NO LOS RELAXATION
Treatment of achalasia
Surgery - Heller myotomy
Botulinum toxin
Pathophysiology of refux disease
LOS dysfunction
Hiatus hernia
Defective oesphageal clearance
Delayed gastric emptying
Increased intra-abdominal pressure
Causes of low resting LOS
Gastric distension EToH Caffiene Fat CCK Smoking
Complications of reflux
Oesophageal metaplasia, ulceration and strictures
Motility disorders
Treatment of reflux
PPI and H2RA –> decreased acid –> less complications
Surgery - fundoplication
What is Barrett’s Oesophagus?
Metaplasia of oesophagus
Risk factors
Reflux >5yrs Male Smoking Central obesity Caucasian
Cancer risk
Barrett’s 0.2%/yr
Low grade dysplasia 0.7%/yr
High grade dysplasia 7%/yr
Barrett’s treatment
PPI life long
Surveillence Endoscopy every 3-5yrs
Ablation for dysplasia
Surveillence for dysplasia
Low grade = 6 months
High grade = 3 months
