Oesophageal Disorders Flashcards
What is heartburn?
Retrosternal discomfort or burning associated with waterbrash/cough as a consequence of acid reflux
What are the causes of oesophageal dysphagia?
Benign stricture, malignant stricture, motility disorders (e.g. achalasia), eosinophilic oesophagitis and extrinsic compression (e.g. lung cancer)
What investigations can be done for dysphagia?
Upper GI endoscopy, contrast barium swallow, oesophageal pH and manometry
What are the signs of hypermotility?
Severe, episodic chest pain with or without dysphagia
How does hypermotility appear on manometry?
Exaggerated, uncoordinated, hypertonic contractions
How is hypermotility treated?
With smooth muscle relaxants
What are the causes of hypomotility?
Connective tissue disease, diabetes and neuropathy
What is the cause of achalasia?
Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS
What is the pathology of achalasia?
Failure of LOS to relax and functional distal obstruction of oesophagus
What are the symptoms of achalasia?
Progressive dysphagia, weight loss, chest pain, regurgitation and chest infection
What is the treatment of achalasia?
Pharmacological: nitrates and CCBs
Endoscopic: botulinum toxin and pneumatic balloon dilation
Radiological: pneumatic balloon dilation
Surgical: myotomy
What are the symptoms of GORD?
Heartburn, cough, water brash and sleep disturbance
What are the risk factors of GORD?
Pregnancy, obesity, drugs lowering LOS pressure, smoking, alcoholism and hypomotility
When is endoscopy indicated in GORD?
In the presence of alarm features
What are the complications of GORD?
Ulcerations, stricture, glandular metaplasia (Barrett’s oesophagus) and carcinoma
What is barrett’s oesophagus?
Intestinal metaplasia related to prolonged acid exposure in distal oesophagus - change from squamous to mucin secreting columnar cells
What is the treatment of Barrett’s oesophagus?
Endoscopic mucosal resection, radio-frequency ablation and oesophagectomy (rarely)
What is the treatment of GORD?
Lifestyle measures, alginates (gaviscon), ranitidine and PPIs (omeprazole) and anti-reflux surgery (fundoplication)
What histological types of oesophageal cancer are there?
Squamous cell or adenocarcinoma
What are the presentations of oesophageal cancer?
Progressive dysphagia, anorexia/weight loss, odynophagia, chest pain, cough, pneumonia, vocal cord paralysis and haematemesis
What are the risk factors for squamous cell carcinomas?
Tobacco, alcohol, diet, achalasia, caustic strictures and Plummer-Vinson syndrome
What are the risk factors for adenocarcinoma?
Obesity, male sex, middle age and caucasian
Where are the common sites from metastases from the oesophagus?
Hepatic, brain, pulmonary and bone
What is the prognosis for oesophageal cancer?
5yr survival less than 10%
What investigations are used in diagnosing oesophageal cancer?
Endoscopy and biopsy
What investigations are used to stage oesophageal cancer?
CT scan, endoscopic ultrasound, PET scan and bone scan
What is the treatment for oesophageal cancer?
Curative - surgical oesophaectomy +/- chemotherapy
Palliative: endoscopic, chemotherapy, radiotherapy and brachytherapy
What is eosinophilic oesophagitis?
Chronic immune condition defined clinically by symptoms of oesophageal dysfunction and pathologically by eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes
What is the presentation of eosinophilic oesophagitis?
Dysphagia and food bolus obstruction
What is the treatment of eosinophilic oesophagitis?
Topical/swallowed corticosteroids, dietary elimination and endoscopic dilatation
