Esophagus

Question 1

What are the LA class of esophagitis?

Answer 1

A: < 5 mm break that doesn’t span two mucosal fold
B: >5 mm break that doesn’t span two mucosal fold
C: spans two or more folds but <75%
D: >75% circumference break

Question 2

What’s manometry finding for achalasia? DES? Nutcracker? Scleroderma?

Answer 2

Achalasia: No peristalsis, high LES pressure, incomplete LES relaxation
DES: Frequent strong non-peristaltic unorganized contractions, normal LES relaxation
Nutcracker: High amplitude peristaltic contractions (>180), normal LES relaxation
Scleroderma: Low LES pressure and aperistalsis

Question 3

How do you treat achalasia? DES? Nutcracker? Scleroderma?

Answer 3

Achalasia: Balloon dilation + nitrates/CCB, Heller of lower esoph if failure
DES/Nutcracker: CCB/trazodone, Heller of entire esophagus if failure
Scleroderma: PPI/reglan, esophagectomy if severe