Esophagus Flashcards
(128 cards)
1
Q
What TESTING should be done for DYSPHAGIA NOT explained by stenosis or esophagitis, CHEST PAIN not explained by heart disease or other extra-esophageal processes and PRE-OP for patients being considered for ANTI-REFLUX surgery?
A
ESOPHAGEAL MANOMETRY
2
Q
INADEQUATE LES RELAXATION is found in what ESOPHAGEAL disorder?
A
ACHALASIA
3
Q
UNCOORDINATED esopahgeal contractions are noted in what ESOPHAGEAL condition?
A
DIFFUSE ESOPHAGEAL SPASM
4
Q
HYPERcontraction of the ESOPHAGUS is noted in what esophageal disorder?
A
NUTCRACKER ESOPHAGUS (also in isolated hypertensive LES)
5
Q
HYPOcontraction of the ESOPHAGUS is found in what esophageal condition?
A
INEFFECTIVE ESOPHAGEAL MOTILITY
6
Q
What is considered NORMAL (basal) LES (EGJ) PRESSURE?
A
10-35 mmHg
7
Q
In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and 100% FAILED peristalsis (DCI <100 mmHg/cm/second) - should be >450 and <8,000?
A
ACHALASIA TYPE-I
8
Q
What is considered NORMAL EGJ RELAXATION with SWALLOW (Integrated Relaxation Pressure - IRP)
A
<15 mmHg
9
Q
Waht is considered NORMAL SPEED of PERILSTALSIS (Contractile Front Velocity - CFV) from UES to LES?
A
<9 cm/second
10
Q
What is considered a NORMAL DISTAL WAVE AMPLITUDE (mean Distal Contractile Integral - DCI)?
A
>450 and <8,000 mmHg/cm/second (the AMPLITUDE of PERISTALSIS)
11
Q
What is the DISTAL LATENCY in esophageal manometry?
A
The interval between the START of a SWALLOW and the Contractile Deceleration Point (CDP) - the point of transition from esophageal peristaltic clearance to esophageal emptying
12
Q
In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and 100% FAILED peristalsis (DCI <100 mmHg/cm/second) - should be >450 and <8,000 AND PANESOPHAGEAL PRESSURIZATION with ≥20% of SWALLOWS?
A
ACHALASIA TYPE-II
13
Q
In which ACHALASIA TYPE do you see an IRP (EGJ releaxation pressure) >15 mm Hg, and NO NORMAL peristalsis, SPASTIC CONTRACTIONS (DL <4.5 seconds) with DCI >450 mmHg/cm/second) - should be >450 and <8,000 with ≥20% of SWALLOWS?
A
ACHALSIA TYPE-III
14
Q
NORMAL IRP, 100% FAILED peristalsis (DCI <100 mmHg/cm/second)
A
ABSENT CONTRACTILITY
15
Q
NORMAL IRP, ≥20% PREMATURE CONTRACTIONS (DL <4.5 seconds), with DCI >450 mmHg/cm/second (some normal peristalsis mat be seen)
A
DISTAL ESOPHAGEAL SPASM
16
Q
NORMAL IRP, ≥20% SWALLOWS with DCI >8,000 mmHg/cm/second
A
HYPERcontractile (jackhammer esophagus)
17
Q
NORMAL IRP, ≥50% INEFFECTIVE SWALLOWS (FAILED DCI <100 or WEAK DCI <450 mmHg/cm/second)
A
INEFFECTIVE ESOPHAGEAL MOTILITY
18
Q
NORMAL IRP, ≥50% FRAGMENTED contractions (breaks >5 cm in 20 mmHg isobaric contour) with DCI >450 mmHg/cm/second
A
FRAGMENTED PERISTALSIS
19
Q
In this TYPE of ACHALASIA, swallowing results in NO CHANGE in the pressurization of the esophagus?
A
TYPE-I ACHALASIA
20
Q
In this TYPE of ACHALASIA, swallowing results in SIMULTANEOUS, LOW-AMPLITUDE PRESSURIZATION that spans the ENTIRE LENGTH of the esophagus?
A
TYPE-II ACHALASIA
21
Q
In this TYPE of ACHALASIA, swallowing results in PREMATURE SPASTIC CONTRACTIONS of the esophagus with a DCI >450 mmHg/cm/second?
A
TYPE-III ACHALASIA
22
Q
Modalities to treat achalasia work BEST in what TYPE of ACHALASIA (dilation, botox, POEM)?
A
TYPE-II ACHALASIA (don’t work well at all in type-III)
23
Q
In WHICH patients should BOTOX injection be used to treat ACHALASIA rather than PNEUMATIC DILATION (30 mm - 40 mm balloon) or HELLER MYOTOMY/POEM?
A
In those who are HIGH-RISK for more INVASIVE procedures
24
Q
Does ANY therapy available for ACHALASIA last long-term (>2 years)?
A
NO, most patients need further treatment thereafter
25
**ELEVATED** **IRP** (\>15 mmHg) with **NORMAL** **PERISTALSIS**, what is that condition called?
**EGJ OUTFLOW OBSTRUCTION** (EOE, cancer, stenosis)
26
What **MEDICATIONS** can **ELEVATE** the **IRP** and cause **HYPERcontraction** (elevated DCI) and **SPASM** with **SHORTENED DL**?
**OPIOIDS**
27
Pt presents with esophageal outlet obstruction (**elevated IRP**) and **SPASTIC** contractions, what should be ruled out **FIRST**?
**OPIOID** use
28
Episodes of **DYSPHAGIA** and **CHEST PAIN**, **TERTIARY** esophageal contractions on **IMAGING** and **PREMATURE**, **SPASTIC** contractions on **MANOMETRY**?
Distal Esophgeal Spasm (diffuse esophageal spasm) - **DES**
29
The **TIME** from **RELAXATION** of the **UES** to the **CDP** (contractile deceleration point) which is the point of transition from **ESOPHGEAL PERISTALTIC CLEARANCE** to **ESOPHAGEAL EMPTYING** is known as what?
Distal Latency (**DL**) - NORMAL is **\>4.5 seconds**
30
A condition associated with **GERD**, when **TWO** or **MORE** **SWALLOWS** (≥2) have a **DCI \>8,000** mmHg/cm/second
**HYPERcontractile** (jackhammer) esophagus (previusly nutcracker esophagus)
31
What condition is found in **\>80%** of patients with **SCLERODERMA** (also MCTD, RA, SLE) with **PREDISPOSITION** to **GERD** in which **≥50% of SWALLOWS** have a **CDI \<450** mmHg/cm/second?
Esophageal **HYPOcontraction** and **INEFFECTIVE ESOPHAGEAL MOTILITY**
32
What is considered **FAILED** **PERISTALSIS**?
**100%** of **SWALLOWS** have a **DCI \<100** mmHg/cm/second
33
What is considered **INEFFECTIVE ESOPHAGEAL MOTILITY**?
**≥50% SWALLOWS** have a **DCI \<450** mmHg/cm/second (CHICAGO classification)
34
What causes **NON-CARDIAC CP** in patients with **GERD**?
**SENSITIZATION** of the esophagus to even normal stimuli
35
If patient with **NON-CARDIAC CP** and **WITHOUT** **ALARM SYMPTOMS** (dysphagia, weight loss, bleeding) does **NOT** respond to **2 MONTHS** of **PPI** therapy, whats the **NEXT STEP**?
ESOPHAGEAL **MANOMETRY** (if POSITIVE, treat with TCAs, Trazodone or SSRI)
36
What is the **PREFERRED** treatment for **TYPE-III ACHALASIA** (episodic chest pain, dysphagia to BOTH liquids and solids, IRP \>15 mmHg, no normal peristalsis, **PREMATURE** **CONTRACTIONS** ie **SPASMS** with some **HYPERcontractility** (**DCI \>8,000**) involving the distal 2/3rds of the esophagus)?
**POEM** (with longer tunnel)
37
What should **ALWAYS** be done **BEFORE** evaluating for **ESOPHAGEAL** causes of **CP**?
**CARDIOLOGY EVALUATION**
38
**LONG**-standing, **INTERMITTENT**, **NON-PROGRESSIVE** dysphagia for **SOLID** foods **WITHOUT CP BETWEEN** episodes of dysphasia suggests what diagnosis?
**SCHATZKI RING**
39
What are the **TREATMENT** methods for **HYPERcontractile** **ESOPHAGUS** (distal esophgeal spasm) with **NORMAL** **IRP**, **DL \<4.5 seconds in ≥20% of swallows**?
**PEPPERMINT OIL**, **SILDENAFIL**, **CA-Channel Blockers**, **NITRATES**
40
How **LONG** is a **NORMAL** **EGJ** relaxation window (bottom of tracing before pressure increases again)?
**~10 SECONDS**
41
**IRP \>15 mmHg** with **NO PERISTALSIS** is what? What if there is **ANY PERISTALSIS**?
**NO PERISTALSIS** - **ACHALASIA**
**ANY PERISTALSIS** - **EGJ OUTFLOW OBSTRUCTION**
42
What are the **PREFERRED** treatment modalities for the different **TYPES** of **ACHALASIA**?
TYPE-I: Pneumatic Dilation or HELLER
TYPE-II: Pneumatic Dilation or HELLER
TYPE-III: POEM
43
A **SHORT** Distal Laency (**DL \<4.5 seconds**) indicates what type of esophageal condition?
**ESOPHAGEAL SPASM** (≥20% of swallows)
44
What is the esophageal condition in which **≥20% of contractions**, the **DCI \>8,000** mmHg/cm/second?
**HYPERcontractile** (Jackhammer) **ESOPHAGUS**
45
Esophageal motility where ≥50% of swallows are with a DCI \<450 mmHg/cm/s (if \<100, FAILED motility)?
**Ineffective** Esophageal Motility
46
What is the **MAJOR** mechanism of **GERD**?
**TRANSIENT LES RELAXATION** (**NOT** preceded by a swallow) and lasting **\>10 seconds** - this is also part of the **NORMAL** **BELCH** reflex
47
Which **GABAnergic** medication has been shown to **DECREASE** the frequency of the **TLESR** (transient LES relaxation) which is the predominant mechanism in **GERD**?
**BACLOFEN**
48
Patients with **LARGE HIATAL HERNIAS** almost **ALWAYS** also suffer from what condition?
**GERD**
49
Does Helicobacter Pylori cause **GERD**?
**NO**
50
This **CONDITION** presisposes us to **GERD**, **BARRETT's ESOPHAGUS**, **ESOPHAGEAL** **ADENOCARCINOMA** and **HIATAL HERNIA** by increased intra-gastric pressure?
**OBESITY** (high BMI)
51
Patients with **GERD** and **LA** grades **C&D** **ESOPHAGITIS**, how **LONG** is **PPI** therapy needed for?
**INDEFINITELY**
52
In patients with **GERD**, when is an **EGD** indicated?
**ALARM SYMPTOMS** (dysphagia, bleeding, anemia, wt loss, recurrent vomiting)
AND
If symptoms persist **AFTER 4-8 WEEKS** of **BID** **PPI** therapy
53
Age **≥50**, **MALE**, **WHITE**, **CHRONIC GERD**, **HIATAL HERNIA**, elevated **BMI** are all **RISK** factors for this condition requiring EGD for screening?
**BARRETT's ESOPHAGUS** and **ESOPHAGEAL ADENOCARCINOMA**
54
What can be **IMMEDIATELY** diagnosed if on **EGD**, **REFLUX ESOPHAGITIS** is found?
**GERD**
55
Are **LIFESTYLE** modifications efficacious for **GERD**?
**WEAK**
56
What **TREATMENT** is recommended to patients who have **MILD** and **INTERMITTENT** **GERD** symptoms?
**H2**-blockers (and as an addition to those on PPI therapy who have **NIGHTIME** breakthrough symptoms
57
Is there a **ROLE** for the use of **SUCRALFATE** in **GERD**?
**NO** (little)
58
Best **PROCEDURE** to treat **GERD** in those **NOT** morbidly **OBESE**?
Modern **FUNDOPLICATION**
59
**BEST PROCEDURE** to treat **GERD** in the **MORBIDLY OBSESE**?
**Roux-en-Y** Gastric Bypass
60
Which **BARIATRIC** surgery should be **AVOIDED** in patients with **GERD** who are **MORBIDLY** **OBESE**?
**SLEEVE GASTRECTOMY**
61
What is the **BEST PROCEDURE** for **GERD**, **REGURGITATION** and a **HIATAL HERNIA** **\<3 cm**?
**LINX** procedure
62
Which is the **ONLY** **ENDOSCOPIC** therapy which has shown to **TREAT GERD**?
**TIF**
63
The presence of troublesome, **RFLUX**-related symptoms in the **ABSENCE** of endoscopically visible mucosal breakes is called what?
**NERD** (non-erosive reflux disease)
64
When a patient undergoes **ESOPHAGEAL** pH monitoring and is found to indeed have an esophageal pH \<4 for \<5% of the time in a 24 hour period, they have **REFLUX** **HYPERSENSITIVITY** to even small amounts of acid and should be tested how?
Esophageal **IMPEDANCE** pH MONITORING
65
Whenever a **NON-GERD** esopahgeal disorder causes **HEARTBURN** (EOE, achalasia), what is the best **NEXT TEST**?
**EGD** with **BIOPSY** and esophageal **MANOMETRY**
66
When performing an **EGD** for a patient with **HEARTBURN**, and they have a **NORMAL**-appearing esophagus, what should be done and why?
**BIOPSY** esophagus for **EOE** (because this can cause HEARTBURN in the absence of GERD)
67
Would **EOE** (eosinophilic esophagtitis) be present on biopsies in a patient on **PPI** therapy?
**NO** (must be stopped for **SEVERAL WEEKS** before EGD)
68
In patients with **NERD**, what is found on esophageal **BIOPSIES** that can clue you in to the **REFLUX** etiology of their symptoms?
Dilated **INTRACELLULAR SPACES**, elongated papillae and thickened **BASAL** **ZONE**
69
In **esophageal pH monitoring**, a Symptom Index (**SI**) **≥50%** indicates what?
It indicates that \>50% of symptoms are indeed associated with acid **REFLUX** episodes (Symptom Associated Probability **SAP \>95%** also signifies the same thing)
70
When **NORMAL**, **PHYSIOLOGIC** episodes of **ACID REFLUX** cause symptoms of **HEARTBURN**, what is this called?
**REFLUX HYPERSENSITIVITY** (functional disorder) - TCAs, SSRIs
71
In patients in whom symptoms of **HEARTBURN DISAPPEAR** with **PPI** therapy, is esophageal pH monitoring necessary to establish the diagnosis of **GERD**?
**NO**
72
In patients with **PPI-resistant GERD** symptoms and a **POSITIVE SI** on pH manometry, **BESIDES** **SURGERY** (fundoplication, Roux-en-Y) what other medication can be tried?
**BACLOFEN** (reduces TLESR events)
73
As **PPIs** are not well known to treat LaryngoPharyngeal Reflux (**LRP**), when treating, what is **RECOMMENDED**?
**BID PPI** therapy for **8 WEEKS**
74
**WHEN** should an **H2**-blocker be used at **NIGHT** for breakthrough reflux?
When there is **BREAKTHROUGH** reflux at night while already on **BID PPI** therapy
75
What are the **EARLY** mucosal changes noted in **GERD**?
**T-lymphocyte** predominant inflammation of the esophagus and that **PROLIFERATIVE CHANGES** in the **SQUAMOUS** epithilium **PRECEDE** the development of **SURFACE CELL EROSIONS** (happen last)
76
What are **HISTOLOGIC** chnages seen in **GERD** (**NOT EARLY** stages)?
**DILATED INTRACELLULAR SPACES**
77
In a patient in whom **PPI** therapy worked well for a while but no longer does, what **SHOULD** be performed **NEXT**?
**ON PPI pH MONITORING** with **IMPEDANCE**
78
What is the **BEST** treatment for **REGURGITATION** that occurs in spite of **BID PPI** therapy?
**LINX** (magnets) - **MUST** rule out motility disorder first as **DYSPHAGIA** is an issue with this procedure (rule out with manometry)
79
Should you **ROUTINELY** check for **H.pylori** in patient's with **GERD**?
**NO** (because H.pylori causes LESS GERD by causing gastritis with less acid production)
80
What are the **BEST** therapeuric options for **Barrett's Esophagus** with **DYSPLASIA**?
**RFA** and **EMR** (if abnormalities are noted in the Barrett's mucosa)
81
What should you **ALWAYS** do if you find a patient to have **H.pylori**?
**TREAT**
82
What **MUST** be done after **Barrett's Esophagus** is **ERADICATED** by **EMR** or **RFA**?
Continue surveillance **EGD** every 3-6 months
83
When is **ENDOSCOPIC** therapy for Barrett's Esophagus not an option?
When dysplasia involves the **SUBMUCOSA**
84
How **OFTEN** is **EGD** with **BARRETT's SURVEILLANCE** recommended for a patient **WITHOUT DYSPLASIA**?
Every **3-5 YEARS**
85
How is **DYSPLASIA** in Barrett's Esophagus reviewed?
By **TWO PATHOLOGISTS**, one of which has **EXPERTISE** in GI
86
In patients with **LOW-GRADE DYSPLASIA** in Barrett's Esophagus, what is the recommendation?
**ENDOSCOPIC THERAPY** vs **YEARLY EGD** surveillance
87
How are patients with Barrett's Esophagus treated with findigns of **INDEFINITE** for **DYSPLASIA**?
With **REPEAT EDG** and biopsy **AFTER MAXIMAL PPI** therapy for **3-6 MONTHS** and if **STILL INDEFINITE** for **DYSPLASIA**, **EGD** surveillance every **YEAR**
88
After **COMPLETE ELIMINATION** of **INTESTINAL METAPLASIA** endoscopically in patients with Barrett's Esophagus who had **HIGH-GRADE DYSLASIA** or I**NTRA-MUCOSAL CARCINOMA**, what is the recommended **EGD SURVEILLANCE** period?
Every **3 MONTHS** for the **1st YEAR**, then every **6 MONTHS** for the **2nd YEAR** then **YEARLY**
89
After **COMPLETE ELIMINATION** of **INTESTINAL METAPLASIA** endoscopically in patients with Barrett's Esophagus who had LOW-GRADE DYSLASIA, what is the recommended **EGD SURVEILLANCE** period?
Every **6 MONTHS** for the **1st YEAR** then **YEARLY**
90
**FOOD-ALLERGEN** triggered, **LONG** histroy of **DYSPHAGIA** to **SOLID** foods with hospitalizations for esophageal food **IMPACTIONS**?
Eosinophilic Esophagitis (**EOE**) - asthma, atopic dermatitis, eczema, hay fever
91
What is **REQUIRED** for the diagnosis of **EOE**?
**\>15 EOSINOPHILS/HPF** (reflux will cause usually \<10 eosinophils/hpf)
92
What is the **MOST COMMON** food allergen that triggers **EOE**?
**MILK** (then wheat, eggs, soy, seafood, nuts)
93
What are the **ACCPETED TREATMENTS** for **EOE**?
**STEROIDS** (fluticasone, budesonide); **PPIs**; Elimination **DIET**s
94
Which infectious agents can cause **ESOPHAGEAL ULCERS** that require treatment of the **UNDERLYING** infection?
**HSV**, **CMV**, **HIV** (multiple round ulcers)
95
Whenever there is a **NODULAR** area in **BARRETT's** esophagus, waht **MUST** be done **PRIOR** to proceeding with any other invasive therapy?
**EGD** with **EMR** to ensure **NO SUBMUCOSAL** involvement
96
When **RFA** has been performed in a patient taking **BID PPI** therapy and still after several sessions, there is long-segment Barrett's, what needs to be done **NEXT**?
Ensure patient is taking the **BID PPI** therapy **CORRECTLY**, 30 min before breakfast and 30 min before dinner **PRIOR** to repeating **RFA** - only if this too fails, proceed with fundoplication
97
White exudates, linear furrows, long-standing history of solid-food dysphagia, history of asthma, \>15 eosinophils/hpf allindicate EOE, what **ELSE** needs to be done to **ESTABLISH** a diagnosis of **EOE**?
Exclusion of **OTHER CAUSES** of **EOE** (vasculitis, eosinophilic gastroenteritis, Crohn's, connective tissue disease)
98
By what **MECHANISM** do **PPIs** treat **EOE**?
They **INHIBIT** **Th2** **CYTOKINE-STIMULATED SECRETION** of **EOTAXIN-3** by esophageal epithelial cells due to their **ANTI-INFLAMMATORY** effects
99
What is the **RECOMMENDED** dose of **PPI** in a patient with Barrett's esophagus?
**ONCE DAILY** (increase to twice daily if once daily is insufficient to manage acid reflux or treat GERD esophagitis)
100
After an **ORGAN TRANSPLANT**, a patient develops **FEVER**, **NAUSEA**, **VOMITING**, **ABDOMINAL PAIN** with **SEVERE ODYNOPHAGIA**, whats the **MOST LIKELY CAUSE**?
**INFECTIOUS ESOPHAGITIS** with **CMV**
101
Which is the **ONLY** stage of esophageal carcinoma that is potentially treatable **ENDOSCOPICALLY**?
**T1a** (NO SUBMUCOSAL INVOLVEMENT)
102
Should **ENDOSCOPIC ALBLATIVE THERAPY** be used in Barrett's Esophagus when there is **NO DYSPLASIA**?
**NO**
103
What are the **DIET** therapies that are available and efficacious for **EOE**?
**ELEMENTAL** (most successful), DIRECTED ELIMINATION and EMPIRIC ELIMINATION
104
What is the **ONLY SYMPTOM** indication for a **BARIUM ESOPHAGRAM** in **GERD**?
**DYSPHAGIA** (if ENDOSCOPY is REFUSED)
105
In a patient with features of severe **GERD** with **RAYNAUD's**, what is a test that can be done?
**ANA**
106
In a patient with **FREQUENT CHEST PAIN** and **GERD SYMPTOMS** **UNRESPONSIVE** to MAXIMAL therapy and negative cardiac work-up, what is the **NEXT STEP**?
Ambulatory **pH-IMPEDANCE** testing
107
In a patient with **TYPICAL SYMPTOMS** of **UNCOMPLICATED GERD** (heartburn, regurgitation, etc.) **WITHOUT ALARM** symptoms, what is the **RECOMMENDED TREATMENT**?
**DAILY PPI** (antacids and lifestyle modifications are UNLIKELY to resolve symptoms alone)
108
If suspecting **EOSINOPHILIC ESOPHAGITIS** (**EOE**), where do you perform **BIOPSIES** from on the **EGD**?
**PROXIMAL** and **DISTAL ESOPHAGUS** (\>15 eosinophils/hpf)
109
If a patient with **TYPICAL GERD SYMPTOMS** and **CONFIRMATORY EGD** with **REFLUX ESOPHAGITIS** who does **NOT** respond to once daily **PPI** therapy **BEFORE BED**, what should be **RECOMMENDED NEXT**?
**BID PPI**, **30 min** before **BREAKFAST** and **30 min** before **DINNER**
110
In a patient with **GERD**, being a **WHITE MALE**, having **CENTRAL OBESITY** and **CHRONIC REFLUX SYMPTOMS** (\>5 years), puts him at risk for what?
That **BARRETT'S ESOPHAGUS** will be found on **EGD**
111
What is the **RECOMMENDATION** for **ENDOSCOPIC MANAGEMENT** of a patient with **LONG**-**SEGMENT BARRETT'S ESOPHAGUS WITHOUT DYSPLASIA**?
**EGD** with **SURVEILLANCE** BIOPSIES in **1 YEAR** (then, if no dysplasia is found, EGD every 3-5 years)
112
What is the **PPI DOSAGE GOAL** in patients with **REFLUX** and **BARRETT's** **ESOPHAGUS**?
**SYMPTOM CONTROL** (do NOT increase dosage or frequency if asymptomatic on current regimen)
113
Is **ENDOSCOPIC ABLATIVE THERAPY** recommended in patients with **BARRETT's ESOPHAGUS WITHOUT DYSPLASIA** (i.e. long-segment)?
**NO**
114
What is the **RECOMMENDATION** for treatment of a patient with **BARRETT's ESOPHAGUS** noted to have a **NODULAR LESION** with **DYSPLASIA**?
**ENDOSCOPIC MUCOSAL RESECTION** (superior to biopsy alone)
115
What should be done when a **BIOPSY** of a patient with **BARRETT's** **ESOPHAGUS** comes back as **LOW-GRADE DYSPLASIA**?
**CONFIRMED** by an **EXPERT** **GI PATHOLOGIST** followed by a **REPEAT EGD** with **4**-**QUADRANT BIOPSIES** every **2 cm** within **6 MONTHS**
116
What is the **RECOMMENDED TREATMENT** of **NON**-**METASTATIC CANCER** of the **ESOPHAGUS** post-staging?
**NEOADJUVANT CHEMOTHERAPY** followed by **SURGERY**
117
In the **ABSENCE** of **HIGH**-**GRADE** **DYSPLASIA**, what is the **RECOMENDED** tratment for a patient with **LONG**-**SEGMENT** **BARRETT's** **ESOPAHGUS** with **GI PATHOLOGIST CONFIRMED LOW**-**GRADE** **DYSPLASIA**?
**REPEAT EGD in 1 YEAR**
118
What is the **MAIN INHIBITORY NEUROPEPTIDE** for **RELAXATION** of the **LES**?
**NITRIC OXIDE**
119
What type of **NEUROPEPTIDES** are **SUBSTANCE P** and **ACETYLCHOLINE**?
**EXCITATORY**
120
**ISOBARIC PRESSURIZATIONS** in response to **SWALLOWS**?
**ACHALASIA TYPE-II**
121
**NO DISCERNABLE PRESSURIZATIONS** in response to **SWALLOWS**?
**ACHALASIA TYPE-I**
122
**SPONTANEOUS and REPETATIVE PRESSURIZATIONS** in response to **SWALLOWS** (spastic)?
**ACHALASIA TYPE-III**
123
**PROLONGED PRESSURIZATIONS** in response to **SWALLOWS** is found where?
**DIFFUSE ESOPHAGEAL SPASM**, **ACHALASIA TYPE-III** and **NUTCRACKER ESOPHAGUS**
124
For the **DIAGNOSIS** of **ACHALASIA**, which **MANOMETRIC** **FINDING** is the **MOST SENSITIVE**?
ELEVATED **INTEGRATED RESIDUAL PRESSURE** (**IRP**) - this measures BOTH LES pressure and relaxation
125
**ELEVATED PHARYNGEAL PRESSURES** with **DEGLUTITION** can result in what pathology?
ZENCKER's DIVERTICULUM
126
**WHAT** is the **TREATMENT** of **CHOICE** for a **SMALL** **ZENCKER's** **DIVERTICULUM**?
**CRICOPHARYNGEAL MYOTOMY**
127
What effect do **ACHALASIA**, **SCLERODERMA** and **AMYLOIDOSIS** have on the **ESOPHAGUS**?
**COMPLETE SMOOTH MUSCLE DYSFUNCTION**
128
Does **DERMATOMYOSITIS** cause **COMPLETE SMOOTH MUSCLE DYSFUNCTION** of the **ESOPHAGUS**?
**NO** (only affects striated muscle)
