Oesophageal Disorders Flashcards
Define ‘dysphagia’ and state the appropriate history taking enquiries.
Subjective sensation of difficulty in swallowing foods and/or liquids.
History;
- Type of food
- Pattern
- Associated features
- Location
Explain the presentation of GORD.
Many are asymptomatic!
Symptoms;
- Heartburn
- Cough
- Waterbrash
- Sleep disturbance
List the causes of dysphagia.
- Benign stricture
- Malignant stricture e.g. oesophageal cancer
- Motility disorders e.g. achalasia, presbyoesophagus
- Eosinophilic oesophagitis
- Extrinsic compression e.g. lung cancer
Describe the treatment of GORD without ALARMS symptoms.
- Lifestyle measures
Pharmacological;
- Alginates (Gaviscon)
- H2 receptor antagonists (Ranitidine)
- PPIs (Omeprazole)
Describe the treatment of oesophageal cancer.
Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy.
Many present late stage so palliation is the priority.
Describe the use of endoscopy in the investigation of oesophageal disease.
Used in the investigation of dysphagia or reflux symptoms with ALARMS features.
Describe the use of barium swallow in the investigation of oesophageal disease.
Primarily used for investigating dysphagia (however endoscopy is preferred).
Describe the use and procedure of pH-metry swallow in the investigation of oesophageal disease.
Used in investigation of refractory heartburn/reflux.
Nasal catheter containing pH sensors is placed at both sphincters (UOS and LOS).
Describe the use of manometry swallow in the investigation of oesophageal disease.
Used investigation of dysphagia/suspected motility disorder (usually after endoscopy) by assessing sphincter and oesophageal motility and tonicity.
Describe the aetiology and symptoms of hypomotility disorders, and list associated conditions.
Aetiology: failure of LOS mechanism
Symptoms: heartburn and reflux.
Associated conditions;
- Connective tissue disease
- Diabetes
- Neuropathy
Describe the aetiology of achalasia.
- Degeneration of inhibitory neurones (ganglion cells) in myenteric plexus in distal oesophagus and LOS
- Often surrounded by lymphocytes (inflammatory aetiology suspected)
Explain the epidemiology of achalasia.
Incidence: 1-2/100,00
M=F
Onset: 3rd-5th decade
Describe the treatment of achalasia.
Pharmacological: nitrates, CCBs
Endosopic: botulinum toxin, pneumatic balloon dilation (can be X-ray guided)
Surgical: myotomy
State the complications of achalasia.
- Aspiration pneumonia and lung disease
- Increased risk of squamous oesophageal carcinoma
State the risk factors of GORD.
- Pregnancy
- Obesity
- Drugs lowering LOS pressure
- Smoking
- Alcoholism
- Hypomotility
Describe the diagnosis of GORD.
Diagnosed based on symptoms rather than testing.
> 50% with reflux have no visible abnormality seen through endoscopy (but must perform if ALARMS present).
Describe the aetiology of GORD without abnormal anatomy.
- Increase in LOS relaxation
- Delayed gastric/oesophageal emptying
- Decrease in oesophageal acid clearance
- Decrease in tissue resistance to acid/bile
Describe the methods of investigation and staging in oesophageal cancer.
Investigation;
- Endoscopy
- Biopsy
- Laparoscopy (only if suspicion of transcoloemic spread)
Staging;
- CT
- Endoscopic USS
- PET
- Bone scan
What is the description of eosinophilic oesophagitis?
Chronic immune/allergen-mediated condition defined clinically by;
- Oesophageal dysfunction
- Eosinophilic infiltration of oesophageal epithelium with no secondary causes of local/systemic eosinophilia
Describe the epidemiology of eosinophilic oesophagitis.
- Increasing incidence and prevalence
- More common in children and young adults
- M>F
Describe the treatment of eosinophilic oesophagitis.
- Topical/oral corticosteroids
- Dietary elimination
- Endoscopic dilation
Describe heartburn and name its associated features.
- Retrosternal pain or discomfort
- Associated with waterbrash, cough
- Consequence of gastric reflux
How long is the oesophagus?
25cm.
Where does the oesophagus begin?
At the lower level of the cricoid cartilage (C6).
Where does the oesophagus end?
At T11-12, where it enters the stomach.
Describe the muscle found in the oesophagus.
Upper 3-4cm is striated, the rest is smooth.
Describe the epithelium of the oesophagus.
Stratified squamous.
Describe the symptoms of hypermotility disorders and give an example of one.
- Severe, episodic chest pain +/- dysphagia
- Often confused with angina/MI
e.g. diffuse oesophageal spasm.
Describe the aetiology of hypermotility disorders.
Usually idiopathic.
Describe the investigation of hypermotility disorders and the positive findings.
- Ba swallow: corkscrew appearance
- Manometry: exaggerated, uncoordinated, hypertonic contractions
Describe the treatment of hypermotility disorders.
Smooth muscle relaxants.
Describe the presentation of achalasia.
Cardinal feature: failure of LOS to relax.
Result: functional obstruction of oesophagus.
Symptoms;
- Progressive dysphagia
- Weight loss
- Chest pain
- Regurgitation
- Chest infection
Describe the aetiology of GORD due to hiatus hernia.
Anatomical distortion of oesophagogastric junction.
Describe the treatment of GORD for refractory disease or symptoms following initial treatment.
Anti-reflux surgery (fundoplication).
Describe the presentation of oesophageal cancer.
- Progressive dysphagia
- Anorexia and weight loss
- Odynophagia
- Chest pain
- Cough
- Pneumonia (tracheo-oesophageal fistula)
- Vocal cord paralysis
- Haematemesis
