oesophageal disorders Flashcards
How is food moved through oesophagus
Oesophageal peristalsis produced by the circular muscles
What innervates the oesophageal peristalsis and relaxation of the lower oesophageal sphincter (LOS)
Vagus nerve
Describe how heartburn might feel
Retrosternal heartburn or discomfort
What causes heartburn
acid reflux
What does persistent reflux and heartburn lead to
Gastro-oesophageal reflux disease (GORD)
What is dysphagia
Difficulty swallowing foods
What can cause dysphagia
Benign stricture
Malignant stricture - oesophageal cancer
Motility disorder (achalasia)
Stricture is most common cause
How is oesophageal disease investigated
Endoscopy when patient has ALARM features
Describe hypermotility of oesophagus
Diffuse oesophageal spasm - corkscrew appearance on Ba swallow
Severe episodic chest pain with or without dysphagia
What is the treatment for hyper-motility of oesophagus
Smooth muscle relaxants
What is achalasia
Functional loss of the myenteric plexus ganglion in the distal oesophagus and lower oesophageal sphincter
Failure of LOS to relax which causes distal obstruction of oesophagus
What is the presentation of achalasia
Progressive dysphagia for solids and liquids
Weight loss
Chest pain - sometimes
Regurgitation and chest infection
What is the treatment of achalasia
Nitrates, calcium channel blockers
Botulinum toxin pneumatic balloon dilation
Surgical - myotomy
What does achalasia increase the risk of
Squamos cell oesophageal carcinoma
What are the symptoms of GORD
Heart burn
Cough
Water brash
Sleep disturbance
Risk factors for GORD
Pregnancy, obesity, drugs lowering LOS pressure, smoking, alcoholism, hypomotility
Who most commonly has GORD
Men > women
White > black > asian
How is GORD diagnosed
clinically from history or endoscopy if ALARM features suggest malignancy
What is hiatus hernia
Herniation of the stomach up into the chest through the oesophagus
What are the 2 types of hiatus hernia
Sliding and para-oesophageal
Which type of hiatus is worse
Para-oesophageal since the hiatus hernia is at risk of incarceration due to becoming trapped in the oesophagus
What happens in GORD
mucosa is exposed to the acid-pepsin and bile which causes cell loss and inflammation
Describe Barret’s oesophagus
Change from squamos to mucin secreting columnar
What is the treatment of barret’s oesophagus
Endoscopic mucosal resection -sucking up the abnormal area into a cap on the scope and then a rubber band is fired into the area which lifts the abnormal area of the oesophageal wall. Then resection can be done by a smear on the endoscope
What is the treatment of GORD
Lifestyle changes
Alginates - gaviscone
H2RA - ranitidine
PPI - omeprazole
What is the presentation of oesophageal cancer
Progressive dysphagia
Anorexia and weight loss
Chest pain
Cough
Pneumonia
Haematemesis
Where does squamos carcinoma of the oesophagus occur
upper 2/3
Where does adenocarcinoma occur in oesophagus
Distal 1/3 of oesophagus
Who is most at risk for adenocarcinoma
Obese male who are middle age and white
How is oesophageal cancer diagnosed
Endoscopy and biopsy
What is the treatment for oesophageal cancer
Only potential cure is surgical oesophagectomy with adjuvant or neoadjuvant chemotherapy - this is only given to localised disease cases who are under 70 and low co-morbidities
Symptom palliative care is often priority
What is the presentation of eosinophilic oesophagitis
Dysphagia and food bolus obstruction
What is the treatment for eosinophilic oesophagitis
Oral corticostreroids , dietary elimination or endoscopic dilatation
