The Esophagus

Question 1

odynophagia

Answer 1

painful swallowing ranges from dull ache to stabbing pain

(usually represents a severe inflammatory process)

Question 2

zenker’s diverticula

Answer 2

approx. 85% occur in individuals >50

symptoms and sx:

fullness or gurgling in neck

coughing or aspiration

regurgitation of retained food

*dysphagia*

Question 3

achalasia

Answer 3

dilated esophagus with narrowed distal esophagus

“birds beak”

Question 4

what is the cause of achalasia?

Answer 4

unknown - believed to me defect in intramural innervation

Question 5

what are the symptoms of achalasia?

Answer 5

dysphagia to solids and liquids

chest pain

regurgitation

insidious onset

Question 6

how do we treat achalasia?

Answer 6

mainstay is surgery - endoscopic pneumatic dilatation of LES

can use smooth muscle relaxant - nitrates or Ca channel blockers

Botox injections

Question 7

what is the triad of findings in achalasia?

Answer 7

1. increased LES resting pressure
2. inability of the LES to relax
3. Absence of peristalsis in the body of the esophagus

Question 8

What is Schatzki’s ring?

Answer 8

Ring of mucosal tissue in the distal esophagus that can cause narrowing and dysphagia

Question 9

What is eosinophilic esophagitis?

Answer 9

allergic inflammatory condition that causes dysphagia and food impaction

Question 10

what is the epi of eosinophilic esophagitis?

Answer 10

children > adults

males > females

Question 11

what are three causative organisms of esophageal infections?

Answer 11

1. candida
2. herpes
3. CMV

Question 12

what are the most common agents in medication-induced esophagitis?

Answer 12

doxyccyline, iron, potassium, Vitamin C, aspirin, NSAIDs, alendronate

Question 13

what is a patient experiencing during esophageal spasm?

Answer 13

chest pain and dysphagia

due to abnormal contractions and ineffective peristalsis

(imposter of cardiac disease)

Question 14

what is the epi of GERD?

Answer 14

>25% of U.S. adults

7-10% have daily symptoms

20% have weekly symptoms

30-40% have monthly symptoms

male = female

60% of adults > 65% have monthly symptoms

Question 15

what are the possible complications of GERD?

Answer 15

bleeding

stricture

ulceration

Barrett’s epithelium

adenocarcinoma

Question 16

what do you do for the patient with typical symptoms of GERD and no coronary disease?

Answer 16

Nothing - they will take OTC medications

Question 17

what is esophageal mannometry useful for?

Answer 17

checking symptom etiology

monitoring medication effects

pre-operative evaluation (to tell how tight you need to wrap)

Question 18

How frequently do you see Barrett’s in GERD patients?

Answer 18

About 10%

Question 19

what is the epi of Barrett’s

Answer 19

males > females

history of GERD

Question 20

the risk of adenocarcinoma is ____ greater than in the general population in Barrett’s

Answer 20

40X

Question 21

what are the two types of esophageal cancer?

Answer 21

1. squamous cell (tobacco and alcohol)
2. adenocarcinoma (Barrett’s)