Oesophageal disease

Question 1

What is GORD?

Answer 1

GORD is reflux of acid in the stomach into the oesophagus

Question 2

What causes GORD?

Answer 2

• impaired lower oesophageal sphincter
• poor oesophageal clearance
• impaired barrier function
• external sphincter problems
• impaired peristalsis
• hiatus hernia

Question 3

What are the symptoms of GORD?

Answer 3

• heartburn
• waterbrash (excess saliva due to acid)
• regurgitation
• nocturnal cough or wheeze
• chest pain
• hiccoughs
• odynophagia (pain) or dysphagia
• weight loss

Question 4

What are the investigations for GORD?

Answer 4

• endoscopy

- oesophageal manometry and pH studies if concern - so if there is dysphagia, weight loss, anaemia or vomiting

Question 5

What is the management of GORD?

Answer 5

• Start with antacids
• Up to h2 receptor antagonists
• Up to proton pump inhibitors
• Surgery is an option for young patient and heals oesophagitis
• Prevent complications

Question 6

What are the complications of GORD?

Answer 6

Barrett’s oesophagus and adenocarcinomas

Question 7

What is Barrett’s oesophagus?

Answer 7

a premalignant condition where the lining of the oesophagus becomes columnar epithelium
It is irreversible intestinal metaplasia

Question 8

What causes Barrett’s and what are the risk factors?

Answer 8

• irritation by acid changes squamous epithelium to columnar epithelia
• risk factors for this include GORD, being old, being obese and being male

Question 9

What is the diagnosis of Barrett’s?

Answer 9

endoscopy will show pinker columnar cells and this is confirmed with biopsy

Question 10

What is the treatment for Barrett’s?

Answer 10

long term proton pump inhibitors
endoscopic mucosal resection
HALO ablation

Question 11

What is the main complication of Barrett’s?

Answer 11

adenocarcinoma

Question 12

What are the two types of hiatus hernia?

Answer 12

• sliding where it moves up

- paraoesophagheal where there is rolling up the side of the oesophagus

Question 13

What is gastroperesis?

Answer 13

delay in gastric emptying

Question 14

What are the causes of gastropersesis?

Answer 14

• neurological
• diabetes
• cannabis
• medication (opiates, anticholinergic)
• systemic disease

Question 15

What are the symptoms of gastroperesis?

Answer 15

• nausea
• feeling full
• vomiting
• weight loss
• upper abdominal pain

Question 16

What is the investigation for gastropersesis?

Answer 16

gastric emptying study with endoscopy

Question 17

What is the management of gastropersesis?

Answer 17

eat little and often
control diabetes
gastric pacemaker

Question 18

What is the most common cause of dysphagia?

Answer 18

stroke

Question 19

What cancers come in the oesophagus?

Answer 19

• squamous cell carcinoma

- adenocarcinoma if Barrett’s oesophagus has caused columnar epithelium to form

Question 20

What treatment do squamous cell carcinomas respond well to?

Answer 20

radiotherapy

Question 21

What are the causes of oesophageal cancer?

Answer 21

smoking
alcohol
vitamin deficiency

Question 22

What are the symptoms of oesophageal cancer?

Answer 22

Progressive dysphagia
Weight loss
Odynophagia 
Haematemesis
Hoarse voice
Recurrent chest infections

Question 23

What are the treatments for oesophageal cancer?

Answer 23

Endoscopic laser
Chemo-radiotherapy for squamous
Surgery