Pathophys - Esophagus I&II

Question 1

What are the symptoms of Oropharyngeal vs Esophageal dysphagia?

Answer 1

Oropharyngeal: Inability to initiate a swallow or transfer food bolus into esophagus. Can present with nasal regurgitation, aspiration, cough after attempted swallows,

Esophageal: Inability to transport food and water from oropharynx to stomach

Question 2

What are the symptoms of Propulsive/Motility vs Obstructive dysphagia?

Answer 2

Propulsive/Motility: Dysphagia to BOTH solids and liquids, chest pain

Obstructive: choking, stridor, wheezing, cyanosis,

Question 3

What are the characteristics of Achalasia?

Answer 3

Greek for “No Relaxation”
Most important motility disorder of esophagus
Impaired relaxation of lower esophageal sphincter
Absence of normal peristalsis
Idiopathic
Both genders, all races, adults

Symptoms include: Dysphagia to solids AND liquids, weight loss, regurgitation

Question 4

What are the characteristics of Esosinophilic Esophagitis (EoE)?

Answer 4

Chronic immune/antigen-mediated esophageal disease. Often associated with other allergic diseases

Symptoms of esophageal dysfunction

Eosinophilic infiltrate in the esophagus with absence of other potential causes of esophageal eosinophilia

Symptoms: Dysphagia, food avoidance, and 50% of cases of acute food impaction. (In kids, symptoms are more non-specific and include feeding intolerance, failure to thrive and abdominal pain)

Question 5

What are the characteristics of Gastroesophageal Reflux Disease (GERD)?

Answer 5

Pathologic reflux of gastric juice acid, causing disruptive symptoms, esophageal injury, and/or increased cancer risk

Symptoms: Heartburn, Regurgitation with acidic taste, relieved with position or antacids or anit-secretory meds

Risk factors: Obesity, tobacco, medications, pregnancy, other illnesses (scleroderma, ZE, gastroparesis)

Question 6

What are the characteristics of Esophageal Adenocarcinoma?

Answer 6

Risk factors: older age, smoking, obesity, GERD, and Barrett’s Esophagus

Nearly always in distal esophagus or gastric cardia

Question 7

Tell me about the medical, endoscopic and surgical treatments for achalasia. please.

Answer 7

Medical: Nitrates (stimulate relaxation), Calcium channel blockers

Endoscopic: GE junction botox injection, Balloon dilation, Per-Oral Endoscopic Myotomy

Surgical: Heller myotomy

Question 8

What are the “3Ds” for EoE?

Answer 8

The treatments!

Drugs, Diet, Dilation

Drugs include steroids
Diet includes elemental diet (allergen free) in children and the 6 food elimination diet in adults (milk, eggs, wheat, soy, seafood, nuts)

Question 9

What is the endoscopic management of Barrett’s Esophagus and some esophageal cancers that are confined to mucosa?

Answer 9

Ablation of Barrett’s tissue and/or endoscopic resection of visible lesion

Question 10

*Examples of Obstructive Esophageal disease

Answer 10

Esophageal Strictures
Esophageal Rings
EoE
Extrinsic Compression 
Esophageal Cancer

Question 11

*Examples of Propulsive/Motility Esophageal disease

Answer 11

Achalasia
Esophageal spasm
Scleroderma

Question 12

*Examples of Obstructive Pharyngeal disease

Answer 12

Head and neck cancers
Zenker’s Diverticulum
Radiation Therapy

Question 13

*Examples of Propulsive/Motility Pharyngeal disiease

Answer 13

Neurological: Stroke, ALS, Parkinsons, MS, Polio

or

Muscular: myasthenia gravis, muscular dystrophy, muscle injury