Oesophageal disorders

Question 1

At what vertebral levels is the oesophagus present?

Answer 1

Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach

Question 2

How long is the oesophagus?

Answer 2

25cm

Question 3

What muscle type is present in the oesophagus?

Answer 3

Upper 3-4 cm striated skeletal muscle, remainder is smooth muscle

Question 4

Which muscle of the oesophagus produces peristaltic movement?

Answer 4

Oesophageal peristalsis produced by oesophageal circular muscles and propels swallowed materials distally into the stomach

Question 5

What can cause oesophageal dysphagia?

Answer 5

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)

Question 6

What is eosinophilic oesophagitis?

Answer 6

Inflammatory allergic disorder with intense eosinophil outflow into esophagus, common in children

Question 7

List two motility disorders associated with dysphagia

Answer 7

Achalasia - inability to move food along gut

Presbyoesophagitis - degenerating motor function with age

Question 8

What is odynophagia?

Answer 8

• Odynophagia: pain with swallowing (may accompany dysphagia)

Question 9

How far down the GI tract can endoscopy examine?

Answer 9

Down to 2nd part of duodenum

Question 10

What can cause corkscrew appearance on a barium swallow?

Answer 10

Diffuse oesophageal spasm (hyper motility)

Question 11

What can cause hypomotility in the oesophagus?

Answer 11

connective tissue disease
diabetes
neuropathy

Question 12

What can cause “rats tail” on barium swallow?

Answer 12

Achalasia - loss of inhibitory effect on contracted LOS, shows obstruction of oesophagus emptying into the stomach

Question 13

What is found on manometry in achalasia?

Answer 13

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

Question 14

What is used to treat achalasia?

Answer 14

Nitrates
Calcium Channel blockers
Botulinum toxin
Pneumatic balloon dilatation
Myotomy

Question 15

What condition is linked to the development of squamous cell oesophageal carcinoma?

Answer 15

Achalasia

Question 16

What are some risk factors for GORD?

Answer 16

Pregnancy
obesity
drugs lowering LOS pressure
smoking
alcoholism
hypomotility

Question 17

What are some complications associated with GORD?

Answer 17

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

Question 18

How can you treat Barretts metaplasia surgically?

Answer 18

Endoscopic Mucosal Resection (EMR) – removes nodules
Radio-Frequency Ablation (RFA) – removes epithelial layer
Oesophagectomy rarely (mortality ~10%)

Question 19

What drugs are used to treat GORD?

Answer 19

• Alginates (Gaviscon) – gel like layer prevents reflux
• H2RA (Ranitidine) – reduces gastric acid production
• Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole) – reduces gastric acid production

Question 20

What surgery is used to treat GORD?

Answer 20

o Anti-reflux surgery

o Fundoplication – full / partial wrap around of top of stomach

Question 21

How can people present with oesophageal cancer?

Answer 21

• Progressive dysphagia (90%)
• Anorexia and Weight loss (75%)
• Odynophagia
• Chest pain
• Cough
• Pneumonia (tracheo-oesophageal fistula)
• Vocal cord paralysis
• Haematemesis

Question 22

What type of oesophageal carcinoma is most associated with which region of the oesophagus?

Answer 22

Squamous cell - Occur in proximal and middle third of oesophagus

Adenocarcinoma - Occurs in distal oesophagus

Question 23

Common sites of metastases of oesophageal cancer

Answer 23

Hepatic, brain, pulmonary, bone