Pathophys esophagus

Question 1

the etiology of dysphagia (difficulty swallowing) symptoms based on symptoms
Oropharyngeal vs Esophageal
Propulsive/Motility vs Obstructive

Answer 1

oropharyngeal obstruction- choking coughing nasal regurg aspiration

• cancer zenker diverticulum radiation
• barium swallow

oropharyngeal motility- Neurological (ALS, MS, Myasthenia gravis, parkinsons, stroke) muscular dystrophy
-barium swallow

Esophageal obstruction- dysphagia to solids, weight loss vomiting regurg, impaction
-stricture rings EoE cancer compression
esophogram, EGD

esophageal dysmotility-solid and liquid dysphagia chest pain
-acalasia, scleroderma, esophageal spasm

manometry, esophogram, EGD

Question 2

Achalasia

Answer 2

Achalasia = Primarily idiopathic abnormal peristalsis and failure of LES relaxation
Selective loss of inhibitory neurons in the myenteric plexus resulting in relatively unopposed excitatory neurons and hypertensive sphincter.
Rx: Meds (don’t work that well), repeated botox endoscopically, surgical myotomy (balloon to stretch and tear sphincter – complications are perforation and reflux), and per-oral endoscopic myotomy.

Esophageal strictures can be benign or malignant. Dysphagia to solids.

Question 3

Eosinophilic Esophagitis (EoE)

Answer 3

Eosinophilic Esophagitis (EoE) = causes luminal narrowing via inflammation and fibrosis (allergy to food). 
Concentric rings on endoscopy.

Question 4

Gastroesophageal Reflux Disease (GERD)

Answer 4

Gastroesophageal Reflux Disease (GERD) = heartburn
Reflux of gastric acid into esophagus due inappropriate relaxation of LES, hiatal hernia, etc.
Risk factors include obesity, tobacco, meds, pregnancy, scleroderma, ZE, etc.
Post-prandial and positional (lying down).
Usually relived by antacids or PPIs.
Complications include erosive esophagitis (5-10%) and Barrett’s (5%; salmon pink epithelium and a disease of old white men), which is a precancerous condition for adenocarcinoma, so patients may benefit from biopsy every 3-5 years.
Treatment for Barrett’s includes ablation or resection.

Question 5

Esophageal adenocarcinoma

Answer 5

Esophageal adenocarcinoma = Nearly always in distal esophagus (makes sense because it comes from chronic GERD).

Question 6

3 Ds for EoE

Answer 6

Diet drug therapy and dilation is the management of EoE

Question 7

Medical, endoscopic and surgical treatments for achalasia

Answer 7

Meds (don’t work that well), repeated botox endoscopically, surgical myotomy (balloon to stretch and tear sphincter – complications are perforation and reflux), and per-oral endoscopic myotomy.

Question 8

Endoscopic management of Barrett’s Esophagus and some esophageal cancers (confined to mucosa)

Answer 8

ablation

Question 9

Scleroderma =

Answer 9

multisystem disorder of fibrosis of multiple organs, including smooth muscle.
Weak peristalsis and dysphagia; stricture.

Question 10

Dysphagia Lusoria =

Answer 10

aberrant right subclavian artery that compresses the esophagus against the mediastinum.