Oesophageal disorders Flashcards
At what vertebral levels is the oesophagus present?
Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach
How long is the oesophagus?
25cm
What muscle type is present in the oesophagus?
Upper 3-4 cm striated skeletal muscle, remainder is smooth muscle
Which muscle of the oesophagus produces peristaltic movement?
Oesophageal peristalsis produced by oesophageal circular muscles and propels swallowed materials distally into the stomach
What can cause oesophageal dysphagia?
o Benign stricture
o Malignant stricture (oesophageal cancer)
o Motility disorders (eg achalasia, presbyoesophagus)
o Eosinophilic oesophagitis (inflammatory allergic disorder with intense eosinophil outflow into esophagus, common in children)
o Extrinsic compression (e.g. in lung cancer, mediastinal masses)
What is eosinophilic oesophagitis?
Inflammatory allergic disorder with intense eosinophil outflow into esophagus, common in children
List two motility disorders associated with dysphagia
Achalasia - inability to move food along gut
Presbyoesophagitis - degenerating motor function with age
What is odynophagia?
• Odynophagia: pain with swallowing (may accompany dysphagia)
How far down the GI tract can endoscopy examine?
Down to 2nd part of duodenum
What can cause corkscrew appearance on a barium swallow?
Diffuse oesophageal spasm (hyper motility)
What can cause hypomotility in the oesophagus?
connective tissue disease
diabetes
neuropathy
What can cause “rats tail” on barium swallow?
Achalasia - loss of inhibitory effect on contracted LOS, shows obstruction of oesophagus emptying into the stomach
What is found on manometry in achalasia?
High pressure in the LOS at rest (usually above 45mmHg, normal being 10mmHg)
Failure of LOS to relax following swallowing
Absence of peristalsis in lower oesophagus
What is used to treat achalasia?
Nitrates Calcium Channel blockers Botulinum toxin Pneumatic balloon dilatation Myotomy
What condition is linked to the development of squamous cell oesophageal carcinoma?
Achalasia
What are some risk factors for GORD?
Pregnancy obesity drugs lowering LOS pressure smoking alcoholism hypomotility
What are some complications associated with GORD?
Ulceration (5%)
Stricture (8-15%) – narrowing due to “reparative” inflammation and firbosis
Glandular metaplasia (Barrett’s oesophagus) – change from normal squamous epithelium -> red columnar epithelium similar to that of the stomach, very often linked to development of cancer
Carcinoma
How can you treat Barretts metaplasia surgically?
Endoscopic Mucosal Resection (EMR) – removes nodules Radio-Frequency Ablation (RFA) – removes epithelial layer Oesophagectomy rarely (mortality ~10%)
What drugs are used to treat GORD?
- Alginates (Gaviscon) – gel like layer prevents reflux
- H2RA (Ranitidine) – reduces gastric acid production
- Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole) – reduces gastric acid production
What surgery is used to treat GORD?
o Anti-reflux surgery
o Fundoplication – full / partial wrap around of top of stomach
How can people present with oesophageal cancer?
- Progressive dysphagia (90%)
- Anorexia and Weight loss (75%)
- Odynophagia
- Chest pain
- Cough
- Pneumonia (tracheo-oesophageal fistula)
- Vocal cord paralysis
- Haematemesis
What type of oesophageal carcinoma is most associated with which region of the oesophagus?
Squamous cell - Occur in proximal and middle third of oesophagus
Adenocarcinoma - Occurs in distal oesophagus
Common sites of metastases of oesophageal cancer
Hepatic, brain, pulmonary, bone
