Esophageal Disorders

Question 1

Diagnosis of Achalasia?

Answer 1

Barium Swallow

Mannometry

Question 2

Treatment of achalasia

Answer 2

• long acting nitrates
• calcium channel blockers
• pneumatic dilatation of LES

Question 3

What are symptoms of diffuse esophageal spasms and how do you diagnose?

Answer 3

• heartburn, chest pain or dysphagia often initiated by swallow
• barium swallow

Question 4

treatment for esophageal spasm

Answer 4

• long acting nitrates

- calcium channel blockers

Question 5

Which of the following studies are indicated for diagnosis of GERD?

• EGD
• Manometry
• 24 hour pH monitoring
• barium radiology

Answer 5

• 24 hour pH monitoring***: recommended to dx GERD in pts refractory to PPI or when dx in question
• EGD: used to dx complications of GERD
• Manometry: used in pre-op eval
• barium radiology: not recommended

Question 6

Approach to treating new onset GERD pt

Answer 6

• empiric trial of acid suppression therapy BID for 4-8 weeks
• if alarm symptoms obtain EGD

Question 7

What are potential risks associated with PPI?

Answer 7

• hypomagnesemia
• vit b12 deficiency
• C dif infection
• CAP (in short term use)

Question 8

Risk factors for Barrett’s

Answer 8

• men
• caucasian
• age > 50
• hiatal hernia
• increased BMI
• abdominal fat distribution
• cigarette smoking

Question 9

Is it likely that a tumor in the esophagus is cancer?

Answer 9

90% are cancerous

• squamous cell carcinoma more common, increased risk with heavy alcohol and tobacco use
• adenocarcinoma where GERD is a risk factor