oesophageal disorders Flashcards
what are the three features of the lower oesophageal sphincter ?
high resting pressure in distal smooth muscle
striated muscle of right crud of the diaphragm
mucosal rossette formed by acute angle at GOJ
what drugs/foods can cause oesophageal dyspepsia ?
alcohol
smooth muscle relaxants
nicotine
dietry
xanthines
what should we enquire about in dysphagia ?
type of food
pattern
associated features (weight loss, regurgitation,cough)
location - oropharyngeal or oesophageal
what are the causes of dysphagia ?
benign stricture
malignant stricture
motility disorders
eosinophilic oesophagitis
extrinsic compression (lung cancer)
what investigations can we do for oesophageal dysphagia ?
oesophagi gastro duodenoscopy (OGD)
upper GI endoscopy (UGIE)
contrast barium swallow
oesophageal pH metry
manometry
what is hypermotility ?
diffuse oesophageal spasm with severe episodic chest pain +/- dysphagia
how do we treat hypermotility ?
smooth muscle relaxants
describe hypomotility ?
failure of LOS mechanism leading to heartburn
associated with connective tissue diseases (diabetes,neuropathy)
what is the appearance of hypermotility on a barium swallow ?
corkscrew appearance
what is achalasia ?
functional loss of myenteric plexus ganglion in the distal oeosphagus causing failure of LOS muscle to contract and open
- build up of food and acid in the oesophagus
who is most likely to get achalasia ?
30-50 yrs
men and women
incidence 1-2/100,000
what are the features of achalasia ?
progressive dysphagia for solids and liquids
weight loss
chest pain (30%)
regurgitation and chest infection
what is the treatment of achalasia ?
pharmacological (smooth muscle relaxants nitrates and CCB)
endoscopic botulinum toxin
pneumonic balloon dilatation
myotomy (laproscopic)
what are the complications of achalasia ?
aspiration pneumonia and lung disease
increased risk of squamous cell oesophageal carcinoma
what are the symptoms of GORD ?
some do not recieve any symptoms
heartburn, cough, waterbash, sleep disturbance
what are the risk factors for GORD ?
pregnancy, obesity, smoking , alcoholism, hypomotility, drugs lowering LOS pressure
who is most affected by GORD ?
men
caucasia>black>asian
when do we perform an endoscope for GORD ?
when they are >55 or have alarm features such as dysphagia, weight loss, vomiting
what are the causes of GORD without abnormal anatomy ?
increased transient relaxation of the LOS
hypotensive LOS
delayed gastric and oesophageal emptying
decreased oesophageal acid clearence
decreased tissue resistance to acid/bile
what kind of hernias can be present in GORD ?
sliding
paraoesophageal
risk increased by age and obesity
what is the pathology of GORD ?
mucosa exposed to acid-pesin and bile
increased cell loss and regenerative activity (inflammation)
erosive oesophagitis
what are the complications of GORD ?
ulceration
stricture
glandular metaplasia
carcinoma
what is barrett’s oesophagus ?
intestinal metaplasia related to prolonged acid exposure in the distal oesophagus
change from squamous to mucous secreting simple columnar which is a precursor to dysplasia/adenocarcinoma
cancer rate 0.3%
what does the cancer rate increase to in high grade dysplasia in barrett’s oesophagus ?
6%
what is the treatment for high grade dysplasia in barrett’s oesophagus ?
endoscopic mucosal resection (EMR)
radio-frequency ablation (RFA)
oesophagectomy (10% mortality so rare)
what is the treatment for GORD ?
lifestyle measurements
alginates (gaviscon)
H2RA (ranitidine)
proton pump inhibitor (omeprazole)
if symptoms proceed after investigation then anti-reflux surgery (fundoplication full or partial)
where are squamous carcinomas common ?
world except western europe and USA
proximal and middle third of oesophagus
smoking and alcohol related
where are adenocarcinomas common ?
western europe /USA
distal oeosphagus
barrett’s and obesity related
what is the presentation of oesophageal cancer ?
progressive dysphagia
anorexia and wight loss
chest pain
cough
pneumonia
where does oesophageal cancer metastasise ?
liver /nodes
hepatic, brain, pulmonary, bone
what is the prognosis for oesophageal cancer ?
5yr survival <10%
what are the investigations for oesophageal cancer ?
endoscopic biopsy
CT, endoscopic ultrasound, PET scan
what is the treatment for oesophageal cancer ?
oesophagectomy if localised disease, no co-morbidities and <70yrs of age with adjuvant/neoadjuvant chemotherapy
palliation - combined radiochemotherapy with stent, PEG, brachytherapy
what is eosinophilic oesophagitis ?
immune/allergen conditon where eosinophils infiltrate the epithelium (>15 per microscopic field) which mediated an allergen enviroment
common in asthma, hay fever and younger adults
what is the presentation of eosinophilic oesophagitis ?
dysphagis and food bolus obstruction
circular rings in and endoscope (like trachea )
what is the treatment of eosinophilic oesophagitis ?
topical/swallowed corticosteroids
dietry elimination
endoscopic dilatation
