Oesophageal Disorders Flashcards
What are typical symptoms of oesophageal disease?
Heartburn
Dysphagia
Odynophagia
What may be some causes of oesophageal dysphagia?
Benign Stricture Malignant stricture (cancer) Motility disorders (e.g. achalasia, presbyoesophagus) Eosinophilic oesophagitis Extrinsic compression
What investigations might be done in suspected oesophageal disorders?
Endoscopy
- Oesophago-gastro-duodenscopy/Upper GI endoscopy
Contrast radiography (barium swallow) Oesophageal pH and manometry
What are some different types of oesophageal motility disorders?
Hypermotility
Hypomotility
Achalasia
How might oesophageal hypermotility present?
Diffuse oesophageal spasm
Corkscrew appearance on barium swallow
Severe episodic pain +/- dysphagia
Manometry shows exaggerated, uncoordinated, hypertonic contractions
Give smooth muscle relaxants
How might oesophageal hypomotility present?
Associated with connective tissue disease, diabetes, neuropathy
Causes failure of lower oesophageal sphincter mechanism leading to heartburn and reflux symptoms.
What is achalasia?
Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS Cardinal feature = failure of LOS to relax Symptoms - progressive dysphagia - weight loss - chest pain - regurgitation - chest infection
Treated with nitrates/CCB, endoscopic botox, balloon (radiological or endoscopic), surgical myotomy
Complications include pneumonia, increased risk of squamous cell oesophageal carcinoma
What is the pathophysiology of GORD?
Mucosa exposed to acid, pepsin, bile
Increased cell loss and regenerative activity i.e. inflammation
Erosive oesophagitis
What are the risk factors and causes of GORD?
Prenancy Obesity Drugs lowering LOS pressure Smoking Alcoholism Hypomotility Men>Women Caucasian>Black>Asian
What are some non-anatomical causes of GORD?
Increased transient pressure of LOS Hypotensive LOS Delayed gastric emptying Delayed oesophageal emptying Decreased oesophageal acid clearance Decreased tissue resistance to acid/bilet
What are anatomical causes of GORD?
Hiatus hernia (sliding or paraoesophageal)
- anatomical distortion of the OG junction
- many patients have both
What are some symptoms of GORD?
Heartburn
Cough
Water brash
Sleep disturbance
Can cause Barrett’s oesophagus
What investigations might be done in suspected GORD?
Diagnosed based on characteristic symptoms rather than tests
Oesophageal pH and manometry
- pH <4 for 4.2%+ of day = pathological
Endoscopy is poor test - >50% no visible evidence
But must be performed in presence of alarm symptoms
What is the treatment for GORD?
Lifestyle measures
Alginates, ranitidine, PPI
Fundoplication - full/partial wrap
Treatment for barrett’s
- endoscopic mucosal resection
- RFA
- oesophagectomy - rare
What are complications of GORD?
Ulceration
Stricture
Glandular metaplasia (Barrett’s)
Carcinoma
Side effects of laparoscopic hernia repair/fundoplication
- dysphagia
- difficulty belching/vomiting
- gas bloating
- excess flatulence
- diarrhoea
