Oesophageal Disorders

Question 1

What is heartburn?

Answer 1

Retrosternal discomfort or burning sensation

Question 2

What other symptoms are often associated with heartbun?

Answer 2

Waterbrash (a sudden flow of saliva)
Cough

Question 3

What causes heartburn?

Answer 3

USually a consequence of reflux of gastric contents into oesophagus.
Can be induced by certain drugs and foods which reduce pressure in the LOS such as alcohol, nicotine and dietary xanthines.

Question 4

Define dysphagia and odynophagia?

Answer 4

Dys - Diffculty swallowing

Odyno - Pain on swallowing

Question 5

What questions should be asked about dysphagia?

Answer 5

• Solids or liquids
• Progressive or intermittent
• Location? (oropharyngeal or oesophageal
• Associated features such as weight loss, regurgitation of cough

Question 6

What can cause dysphagia?

Answer 6

A benign stricture
Malignant stricture
Motility disorder (E.g. Achalasia)
Eosinophilic Oesophagitis
Extrinsic compression (e.g. lung cancer)

Question 7

What type of endoscopy is there for oesophageal disorders?

Answer 7

OGD - Oesophago-Gastro-Duodenoscopy

Also called Upper GI Endoscopy (UGIE)

Question 8

What investigative tests can be done for oesophageal disorders?

Answer 8

Endoscopy (UGIE)
Contrast Radiology (barium swallow)
Oesophageal pH & Manometry

Question 9

When is a barium swallow used?

Answer 9

When an UGIE isnt possible, particularly when investigation dysphagia

Question 10

How is OEsophageal pH and manometry performed?

Answer 10

A probe with pressure and pH sensors is inserted through a naso-gastric catheter,
It measures muscle contraction and pH as you swallow

Question 11

What is the use of a oesophageal pH and manometry?

Answer 11

• Tells us about dysphagia and motility disorders
• Assesses sphincter tonicity
• pH helps investigate refractory (stubborn) heart burn

Question 12

Give an example of a hypermotility disorder?

Answer 12

Diffuse Oesophageal spasm
- Severe episodic chest pain (easily confused with angina)
- +/- dysphagia

Question 13

How would oesophageal spasm appear on tests?

Answer 13

Corkscrew barium swallow
Manometry shows exaggerated, uncoordinated, hypertonic contractions

Question 14

How do we treat oesophageal spasms?

Answer 14

Smooth muscle relaxants and wait for it end

Question 15

What conditions are related to hypomobility of the oesophagus?

Answer 15

• connective tissue disorders
• Diabetes
• Neuropathies

They cause the LOS to fail leading gastro-oesophageal reflux disease

Question 16

What is achalasia?

Answer 16

Unable to properly open the LOS due to functional loss of the myenteric plexus ganglion cells in the distal oesophagus.
Essentially causing a functional obstruction of the distal oesophagus

Question 17

What are the symptoms/complications of achalasia?

Answer 17

Progressive dysphagia
Weight loss
30% get chest pain
Regurgitation
Chest infection

Can also be complicated by aspiration pneumonia

Also raises risk of squamous cell carcinoma

Question 18

How do we treat achalasia?

Answer 18

Drugs - Nitrates, CCBs
Endoscopic - Botulinum toxin/Pneumatic balloon dilatation - Tend to relapse
Surgical - Myotomy - Definitive treatment

Question 19

What is Gastro-oesophageal Relfux Disease? (GORD)

Answer 19

Pathological acid and bile exposure to the lower oesophagus

Question 20

What are the symptoms of GORD?

Answer 20

Heartburn
Cough
Water Brash
Sleep Disturbance

Can often have no symptoms

Question 21

What are the risk factors for GORD?

Answer 21

Pregnancy
Obesity
Smoking & alcholism
Hypomotility
Drugs lowering LOS pressure

Men and caucasians are most affected

Question 22

How do we investigate/diagnose GORD?

Answer 22

Can diagnose on symptoms alone.
If there are any alarm features of malignancy an endoscopy is required (but will only show abnormalities 50% of the time)

Question 23

What are the alarm features of malignancy in GORD?

Answer 23

Dysphagia, Weight loss, Vomiting

Question 24

How does GORD occur?

Answer 24

One of two ways:
- Transient relaxation of the LOS
-> Delayed gastric emptying/oeosphageal emptying
-> Lower oesophageal acid clearance & acid regurg

Or

Hiatus hernia distorts the GO junction leading to reduced acid clearance and regurg

Either way the mucosa is exposed to acid, pepsin and bile leading to inflammation i.e. erosive oesophagitis

Question 25

What are the types of hiatus hernia and predisposing factors?

Answer 25

Sliding and para-oesophageal

Being old or fat

Question 26

How is GORD complicated?

Answer 26

Ulcers
Fibrotic strictures
Glandular metaplasia (Barret’s Oesophagus)
Carcinoma