Oesophageal Disorders

Question 1

How does GORD present?

Answer 1

Dyspepsia (related to meals and lying down); belching/regurgitation; odynophagia; acid taste; cough/wheezing.

Question 2

What are the causes of GORD?

Answer 2

Drugs e.g. NSAIDS, doxycycline, tricyclics, Ca2+ channel blockers; smoking; alcohol; coffee; obesity; big meals.

Question 3

What are the differential diagnoses of GORD?

Answer 3

Oesophagitis, infection e.g. CMV, peptic ulcer, malignancy, non-ulcer dyspepsia.

Question 4

What are the complications that can arise from GORD?

Answer 4

Oesophagitis, benign stricture, barrett’s oesophagus, oesophageal adenocarcinoma.

Question 5

How can you confirm the diagnosis of GORD?

Answer 5

24hr manometry whereby monitoring of pH is correlated to symptoms.

Question 6

How do you manage GORD?

Answer 6

Conservative: Lose weight, smaller meals, avoid hot drinks and alcohol, don’t eat <3hrs before bed, avoid drugs that affect oesophageal motility (nitrates, Ca2+ channel blockers) or that damage mucosa (NSAIDs, bisphosphonates).
Medical: Antacids for symptom relief, PPIs for long term acid reduction.
Surgical: For severe refractory GORD with pH monitoring evidence can do nissen fundoplication.

Question 7

What is Barrett’s Oesophagus?

Answer 7

Columnar gastric epithelium extends up into the oesophagus replacing the stratified squamous epithelium. It increases the risk of OESOPHAGEAL ADENOCARCINOMA.

Question 8

What is the management for Barrett’s Oesophagus?

Answer 8

PPIs, close monitoring, oesophageal resection (esp younger patients), mucosal ablation, photodynamic therapy.

Question 9

What is achalasia and what does it cause?

Answer 9

Failure of the lower oesophageal sphincter to relax. It causes dysphagia of both liquids and solids, regurgitation and weight loss.

Question 10

How is achalasia treated?

Answer 10

With endoscopic balloon dilation/botulinum injections, then PPIs.