Oesophageal DIsorder Flashcards
What are the symptoms of Oesophageal Disease?
Heartburn
Dysphagia
State the causes of Oesophageal Dysphagia
-Usually Benign Stricture
- Malignant Stricture
- Motility Disorder
-Eosinophilic Oesophagitis
-Extrinsic Compression (in lung cancer)
State the investigations of Oesophageal Disease
Endoscopy
- Oesophageal Gastro Duodeoscopy
-Upper GI Endoscopy
Contrast Radiology
-Barium Swallow
Oesophageal Physiology
- pH metry
-Manometry
What is Hypermotility?
A type of motility disorder for example oesophageal spasm. on Ba swallow, it has a “corkscrew appearance.”
Presented with severe chest pain, +/- dysphagia.
Manometry shows hypertonic contractions.
What is Hypomotility?
It is associated with connective tissue disease, diabetes, and neuropathy. This type of motility disorder causes failure of the Lower Oesophageal Sphincter mechanism, leading to heartburn and reflux symptoms.
What is Achalasia?
it is the loss of myenteric plexus ganglion cells in the distal oesophagus and the Lower Oesophageal Sphincter. it is the failure of LOS to relax. Resulting in obstruction of the oesophagus.
State the symptoms of Achalasia
Weight Loss
Chest Pain
Regurgitation and chest infection
Progressive dysphagia for solids and liquids
State the pharmacological treatment for Achalasia
Nitrates, Calcium Channel Blockers
State the endoscopic treatment for Achalasia
Botulinum Toxin, Pneumatic Balloon Dilation
State the radiological treatment for Achalasia
Pneumatic Balloon dilation
State the surgical treatment for Achalasia
Myotomy
What are the complications that can occur with untreated Achalasia?
- Aspiration pneumonia and lung disease
- Increased risk of squamous cell oesophageal carcinoma
What is GORD?
Gastro-Oesophageal Reflux Disease. It is the commonest oesophageal disorder..
What are the symptoms of GORD?
Heartburn
Cough
Water brash
Sleep disturbance
What are the risk factors of GORD?
Anything which increases internal pressure such as:
Pregnancy
Obesity
Drugs lowing LOS pressure
Smoking
Alcoholism
Hypomotility
How can GORD be diagnosed?
It can be diagnosed on the basis of characteristic symptoms without diagnostic testing. ENdoscopy is a poor diagnostic test. However, endoscopy must be performed in the presence of alarming features that could suggest malignancy.
State the aetiology of GORD
Could be due to a hiatus hernia or happen without any abnormality of the anatomy.
Without abnormality of the anatomy:
- increased the relaxation of the LOS
-Hypotensive LOS
-Delayed Gastric Emptying
-Decreased Oeosphageal acid Clearance
- Decreased Tissue Resistance to acid/ bile
Due to Hiatus Hernia:
- Anatomical distortion of the oesophageal junction
Explain what happens in Hiatus Hernia
THe fundus of the stomach moves proximally through the diaphragmatic hiatus.
State the two types of Hiatus Hernia
Sliding and Para-oeosphageal
Explain the pathophysiology of GORD
The mucosa itself is exposed to acid-pepsin and bile. Which results in increased cell loss and inflammation. This causes erosive oesophagitis.
State the complications of GORD
Stricture (8-15%)
Ulceration (5%)
Barrett’s Oesophagus
Carcinoma
What causes Barrett’s Oeosphagus ?
It is caused by intestinal metaplasia related to prolonged acid exposure in the distal oesophagus.
How would you describe Barrett’s Oesophagus?
A change from squamous to mucin-secreting columnar epithelial cells in the lower oesophagus. It is also a precursor to dysplasia/ adenocarcinoma. it has a risk of developing into oesophageal cancer.
State the treatment for Barrett’s Oesophagus
- Usually endoscopic Mucosa Resection (EMR)
- Endoscopic Frequency Ablation
State the treatment for GORD
Lifestyle Measures
Pharmacological:
- Gaviscon (Alginates)
-Ranitidine (H2RA)
-Omeprazole, Lansoprazole (PPI)
Anti-reflux surgery
How can patients present with Oesophageal Cancer?
- Progressive Dysphagia (90%)
- Anorexia and Weight loss (75%)
-Chest pain
-Cough
-Odynophagia
-Pneumonia
-Vocal cord paralysis
-Haematemesis
Where does squamous cell carcinoma occur?
The proximal and middle third of oesophagus
What is the risk factor of squamous cell carcinoma?
Tobacco and alcohol
Where does adenocarcinoma occur?
In the distal oesophagus
What is squamous cell carcinoma associated with?
Achalasia, Caustic Strictures, Plummer Vinson Syndrome
What is adenocarcinoma associated with?
Barrett’s Oesophagus
Where can oesophageal cancer spread to?
Hepatic , brain, pulmonary ,bone
How can we diagnose Oesophageal Carcinoma?
Endoscopy and Biopsy
How do we stage oesophageal carcinoma?
Primarily CT Scan
Endoscopic Ultrasound
PET Scan
Bone Scan
The disease staging itself is TNM classification
State the treatment for oesophageal cancer
The only potential cure is by oesophagectomy. This is usually preceded by chemotherapy. Very occasionally adjuvant therapy may be required.
Nutritional Support
Most patients have incurable diseases so are offered palliative treatment
(treat their swallowing difficulty). This is done endoscopically by means of inserting a stent, allowing the oesophageal to open up.
What is Eosinophilic Oesophagitis?
A chronic immune condition. Symptoms of oesophageal dysfunction and pathologically by an eosinophilic filtration of the oesophageal epithelium.
How do patients present with Eosinophilic Oesophagitis?
Dysphagia and food bolus obstruction
What is the treatment of Eosinophilic Oesophagitis?
- Topical/ swallowed corticosteroids
- dietary elimination
- Endoscopic dilation
