Oesophageal Disorders Flashcards
What sphincter is striated muscle of the right crus of the diaphragm?
Lower oesophageal sphincter
What are symptoms of oesophageal disease?
Heartburn
Often associated with waterbrash, cough
- Certain drugs/foods, (e.g. alcohol, nicotine, dietary xanthines) can reduce the LOS pressure resulting in increased reflux / heartburn
Persistent reflux and heartburn leads to gastro-oesophageal reflux disease (GORD) which can in turn cause long-term complications
Dysphagia
Odynophagia
What are the causes of oesophageal dysphagia?
benign stricture
- malignant stricture (oesophageal cancer)
- motility disorders (eg achalasia, presbyoesophagus)
- eosinophilic oesophagitis
- extrinsic compression (eg in lung cancer)
What are investigations for oesophageal disease?
- Oesophago-Gastro-Duodenoscopy (OGD)
- Upper GI Endoscopy (UGIE)
Contrast radiology - barium swallow
Oesophageal pH and manometry
When is endoscopy used in oesophageal disease?
In oesophageal disease used in investigation of dysphagia or reflux symptoms with alarm features
What is manometry used for?
Used in investigation of dysphagia / suspected motility disorder
What does manometry measure?
-assesses sphincter tonicity, relaxation of sphincters and oesophageal motility.
pH studies – used in investigation of refractory heartburn/reflux
What are the motility disorders of the oesophagus?
Hypermotility
Hypomotility
Achalasia
What portion of motility is controlled by the vagus nerve?
Contraction in the oesophageal body and relaxation of the LOS is mediated by the vagus nerve
What is the appearace of hypermotility on a barium swallow?
Corckscrew appearance on the barium swallow
What is hypermotility often confused with and why?
Often confused with angina/MI becaue there is severe episodic chest pain (with or without dysphagia)
What is hypomotility associated with?
Associated with connective tissue disease,
diabetes, neuropathy
Causes failure of the LOS and therefore causes reflux symptoms
What causes achalasia?
Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS
What is teh cardinal feature of achalasia?
failure of LOS to relax and therefore distal obstruction of the oesophagus
What are symptoms of achalasia?
- progressive dysphagia for solids and liquids
- weight loss
- Chest pain (30%)
- Regurgitation and chest infection
What is the treatment for achalasia?
Pharmacological - Nitrates,
Calcium Channel blockers
Endoscopic - Botulinum Toxin
Pneumatic balloon dilation
Radiological - Pneumatic balloon
dilation
Surgical - Myotomy
What are the complications of achalasia?
Aspiration pneumonia and lung disease
nIncreased risk of squamous cell oesophageal carcinoma
What causes GORD?
Presence of acid and bile exposure in the lower oesophagus
What are the symptoms of GORD?
Many may not experience any symptoms at all
Symptoms include: heartburn, cough, water brash, sleep disturbance
Waterbrash: a sudden flow of saliva associated with indigestion.
What are the risk factors for GORD?
Pregnancy, obesity, drugs lowering LOS pressure (alcohol, nicotine, dietary xanthines), smoking, alcoholism, hypomotility
Why is endoscopy a poor test for GORD?
Most patients (>50%) with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed
When must endoscopy be performed for GORD?
In the presence of alarm features eg dysphagia, weight loss, vomiting
What are the aetiologies of GORD with normal anatomy?
– Increasing Transient relaxations of the LOS
–Hypotensive LOS
–Delayed gastric emptying
–Delayed oesophageal emptying
– Decreased Oesophageal acid clearance
– Decreased Tissue resistance to acid/bile
What are the 2 main types of hiatus hernia?
Sliding and para-oesophageal
