Oesophageal Disease

Question 1

Muscle type distribution in oesophagus?

Answer 1

Upper third - striated muscle
Middle third - mixed
Lower third - smooth muscle

Question 2

GORD causes increased exposure to which stomach chemicals of concern?

Answer 2

acid
pepsin
bile salts

Question 3

Risk factors for GORD

Answer 3

Age

Obesity, Pregnancy
Smoking, Alcohol

Hiatus Hernia,
Scleroderma
Asthma

H. Pylori (negative risk factor)

Question 4

Complications of GORD?

Answer 4

Ulcerations/ bleeding
Stricture/ Schatzki ring
Barret’s oesophagus, adenocarcinoma
pharyngeal reflux

Question 5

Diagnosis of GORD?

Answer 5

Clinical (Sx + response to anti-acids)

Endoscopy
- if atypical symptoms, other red flags/ issues

pH testing (of oesophageal fluid)

Question 6

Endoscopic classification of GORD system?

Answer 6

Los Angeles A,B,C,D

Question 7

Purposes of endoscopy in GORD?

Answer 7

classify
?barret’s
?malignancy
?other pathology - hernia, strictures, mimickers

Question 8

Meds that worsen GORD?

Answer 8

Decrease LOS function
- beta agonists, alpha antagonists
- theophylline
- diazepam
- tricyclic ant-depressants
- calcium channel blockers
- progesterone
- anticholinergics

Damage to mucous
- doxycycline
- aspirin
- bisphosphonates
- quinidine

Question 9

Complications of fundopilication

Answer 9

Serious Morbidity 0.4%, Mortality 0.1%

Inevitable complications
- increased flatulence
- initial dysphagia

Uncommon complications
- severe dysphagia
- inability to belch
- vomiting
- para-oesophageal hernia

Question 10

What is Barrett’s oesophagus really?

Answer 10

Metaplasia of the lower oesophagus
- to cardia/ gastric/ intestinal type

Question 11

Carcinoma increased with Barrett’s oesophagus/

Answer 11

adenocarcinoma

Question 12

RFs for Barrett’s oesophagus?

Answer 12

age
reflux (10% of reflux patients), increases with severity
male
caucasian

Question 13

RFs for adenocarcinoma of oesophagus?

Answer 13

Male
Caucasian
Age
Barrett’s oesophagus
Obesity
Smoking
GORD
Medications -> decreased LOS pressure

H.pylori (negative risk factor)

Question 14

Management of Barrett’s Oesophagus

Answer 14

Monitoring
No dysplasia: 3-5 years
Low grade dysplasia: 6 monthly
High grade: close surveillance or definitive management

Question 15

Management strategies for High Grade Barret’s Oeophagus

Answer 15

Oesophagectomy

Mucosal ablation + High dose acid suppression

Question 16

Presentation of Eosinophilic Oesophagitis?

Answer 16

dysphagia, food impaction

Often in young males

Associated asthma, atopy,

Question 17

Management of Eosinophilic Oesophagitis?

Answer 17

PPI steroids (fluticasone puffer or budesonide slurry)

Dilation

Diet
- Food elimination diet: wheat, egg, seafood, nuts, milk, soy
- elemental diet
- gradual re-introduction of food

Question 18

Ix/ Diagnosis of achalasia

Answer 18

Endoscopy
- need to exclude strictures (main rationale)
- food in the oesophagus
- tight LOS
- dilated oesophagus

CXR
- lack of gastric bubble, retro cardiac fluid level

Ba swallow
- rat tail/ bird beak

Manometry

Question 19

Management of Achalasia

Answer 19

Meds: GTN, CCBs

Balloon dilatation
- risk of perforation/ rupture
- can require repitition

Botox

Myotomy - surgical

POEM Procedure (per oral endoscopic myotome )

PEG,
Oedsophagectomy