1.2 MTB Step 3 - Esophageal Disorders (Esophagitis & Mallory-Weiss)

Question 1

ESOPHAGITIS

“An HIV-positive man comes in with progressive dysphagia and Odynophagia. He has 75 CD4 cells but no history of opportunistic infections.”

What is the Next BEST Step in Management?

Answer 1

Fluconazole

When Odynophagia occurs in an HIV-positive patient, particularly when there are < 100 CD4 cells, the diagnosis is most likely Esophageal Candidiasis, and giving empiric Fluconazole is both Therapeutic and Diagnostic

Question 2

ESOPHAGITIS

PRESENTATION

How does Esophagitis Present?

Answer 2

Odynophagia

PAIN on Swallowing as the food rubs against the Esophagus

Question 3

ESOPHAGITIS

DIAGNOSIS

1. What is the Best INITIAL Management Step for Esophagitis in an HIV-_Negative_ patient?
2. What is the Best INITIAL Management Step for Esophagitis in an HIV-_Positive_ patient with < 100 CD4 cells?

Answer 3

1. Endoscopy
2. Fluconazole - only use endoscopy in these patients if there is NO response to this medication.

Question 4

ESOPHAGITIS

ETIOLOGY

What are the (3) Main Causes of Esophagitis?

Answer 4

1. Candida Esophagitis - causes > 90% of Esophagitis in HIV-Positive patients.
2. Pills - Doxycycline or Alendronate.
3. Eosinophilic Esophagitis - presents with swallowing difficulty, food impaction, and heartburn. Look for a patient with a history of Asthma and Allergic diseases and findings of Multiple Concentric Rings on Endoscopy

Question 5

ESOPHAGITIS

MANAGEMENT

1. What is the Best INITIAL Test for Eosinophilic Esophagitis?
2. What is the Most ACCURATE Test for Eosinophilic Esophagitis?

Answer 5

1. Endoscopy
2. Biopsy showing Eosinophils

Question 6

ESOPHAGITIS

MANAGEMENT

1. What is the Best INITIAL Therapy for Eosinophilic Esophagitis?
2. What is the Most EFFECTIVE Therapy for Eosinophilic Esophagitis?

Answer 6

1. Proton Pump Inhibitors (PPIs) and Eliminating Allergenic Foods
2. Steroid Inhalers

Question 7

MALLORY-WEISS TEAR

How does Mallory-Weiss Tear present?

Answer 7

Sudden Upper GI Bleeding

with

Violent Retching and Vomiting

+/- Hematemesis or Black Stool

Question 8

MALLORY-WEISS TEAR

What is the Best Diagnostic Test for Mallory-Weiss Tear?

Answer 8

1. Endoscopy
2. Epinephrine, if bleeding persists
   
   • Most cases resolve spontaneously