Oesophageal Disorders

Question 1

What is the length of oesophagus?

Answer 1

Approx 25cm in length

Question 2

Where does the oesophagus start and end?

Answer 2

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

Question 3

What is the type of epithelial lining in the oesophagus?

Answer 3

Stratified squamous epithelial lining

Question 4

What type of muscle is in the oesophagus?

Answer 4

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

Question 5

What is the function of the oesophagus?

Answer 5

Transport of food/liquid from mouth to stomach – active process.

Question 6

Explain oesophagus peristalsis

Answer 6

Oesophageal peristalsis produced by oesophageal circular muscles and propels swallowed materials distally into the stomach. Coordinates with lower oesophageal sphincter (LOS) relaxation

Question 7

Peristalsis and the relaxation of the LOS id mediated by which nerve?

Answer 7

vagus nerve

Question 8

What are the features of the LOS

Answer 8

• Physiological sphincter with a high resting pressure in distal smooth muscle
• Striated muscle of right crus of diaphragm
• “Mucosal Rosette” formed by acute angle (of His) at GOJ

Question 9

What is heartburn a consequence of?

Answer 9

Heartburn is a consequence of reflux of acidic &/or bilious gastric contents into the oesophagus

Question 10

What is heartburn associated with?

Answer 10

water brash and cough

Question 11

What is heartburn?

Answer 11

Retrosternal discomfort or burning

Question 12

What are the main symptoms of oesophageal disease?

Answer 12

heartburn, reflux, dysphagia

Question 13

What are the methods of investigating oesophageal disease?

Answer 13

endoscopy, barium swallow, manometry, pH metry

Question 14

What are the treatment options for achalasia?

Answer 14

Treatment options and complications of achalasia – treatment: pharmacological (CCB, nitrates), endoscopic (botulithum toxin and pneumatic balloon dilation), surgery (myotomy).

Question 15

What are the complications of achalasia?

Answer 15

Complications include aspiration, lung disease, increased risk of squamous cell carcinoma, GORD

Question 16

When do you investigate in cases of heartburn/GORD instead of empirical treatment

Answer 16

In the presence of alarm symptoms such as weight loss

Question 17

What is the treatment for GORD?

Answer 17

lifestyle measures (dietary changes), pharmacological (alginates – gaviscon, H2RA – rantidine, PPI – omeprazole).

Question 18

What is the long-term complications of untreated GORD?

Answer 18

Barrett’s oesophagus

Question 19

What is the management of dysplasia in Barrett’s oesophagus

Answer 19

endoscopic mucosal resection, radio frequency ablation, oesophagectomy rarely

Question 20

What is squamous cell carcinoma of the oesophagus?

Answer 20

Often large exophytic occluding tumours occurring proximal and middle third of the oesophagus preceded by dysplasia and carcinoma in situ.

Question 21

What is adenocarcinoma of the oesophagus?

Answer 21

occurs in distal oesophagus, associated with Barret’ oesophagus progress through dysplasia to cancer.

Question 22

What is the diagnostic investigation for oesophageal cancer

Answer 22

Diagnostic investigation includes endoscopy AND biopsy

Question 23

What is the staging of the esophageal cancer?

Answer 23

Staging includes CT scan, EUS, PET, bone scan. TNM classification is used.

Question 24

What is the curative treatment for esophageal cancer?

Answer 24

oesophagectomy +/- adjuvant or neoadjuvant chemotherapy

Question 25

What is the palliative treatment for esophageal cancer?

Answer 25

mainly to treat dysphagia, endoscopic stent, laser, PEG, chemotherapy, radiotherapy, brachytherapy

Question 26

What is the presentation of eosinophilic esophagitis?

Answer 26

dysphagia and food bolus obstruction, endoscopic findings.

Question 27

What is the treatment for eosinophilic oesophagitis?

Answer 27

topical/ swallowed corticosteroids, dietary elimination, endoscopic dilation.