Oesophageal conditions

Question 1

What is oesophageal hyper motility?

Answer 1

Exaggerated, uncoordinated hypertonic contractions of the oesophagus

Question 2

What are the symptoms of oesophageal hyper motility?

Answer 2

Severe episodic pain with or without dysphagia

Question 3

What investigations are done for oesophageal hyper motility?

Answer 3

Barium swallow- corkscrew appearance

Manometry- uncoordinated, exaggerated contractions

Question 4

What is the management of oesophageal hyper motility?

Answer 4

Smooth muscle relaxants

Question 5

What is the presentation of globus pharyngus?What is globus pharyngus?

Answer 5

Persistent feeling of a lump in throat without anything being there
Dysphagia
Intermittent symptoms
Relieved by swallowing food or drink
Worse swallowing saliva
Painless
History of anxiety

Question 6

What is achalasia?

Answer 6

Functional obstruction caused by loss of myenteric plexus ganglion cells in distal oesophagus and lower oesophageal sphincter –> cannot relax

Question 7

What are the features of achalasia?

Answer 7

Progressive dysphagia- both solids and liquids from stat
Weight loss
Regurgitation
Chest infections
Chest pain

Question 8

What investigations are done for achalasia?

Answer 8

Manometry- excessive LOS tone that doesn’t relax on swallow

Barium swallow- bird’s beak appearance

Question 9

What is the management principle of achalasia?

Answer 9

Pharm is limited
Endoscopic
Surgical

Question 10

What pharm management options are available for achalasia?

Answer 10

Limited
Nitrates
CCB

Question 11

What endoscopic and surgical management options are there for achalasia?

Answer 11

Pneumatic balloon dilatation
Intra-sphenteric botulinum toxin injection
Myotomy

Question 12

What are the complications of achalasia?

Answer 12

Increased risk SCC

Aspiration and pneumonia

Question 13

What are the 2 types of causes of GORD?

Answer 13

Functional

Anatomical- hiatus hernia

Question 14

What can cause functional GORD?

Answer 14

Increased transient relaxations of LOS
Hypotensive LOS
Delayed gastric empyting
Delayed oesophageal emptying
Decreased oesophageal acid clearance
Decreased tissue resistance to bile

Question 15

What are the risk factors for GORD?

Answer 15

Pregnancy
Obesity
Smoking
Alcohol
Hypomotility
Drugs lowering LOS pressure

Question 16

What is the presentation of GORD?

Answer 16

Heartburn
Cough
Water brash
Sleep disturbance

Question 17

What are the alarm features in GORD?

Answer 17

Dysphagia
Weight loss
Vomiting

Question 18

What is the pathophysiology in GORD?

Answer 18

Mucosa exposed to pepsin and bile causing increased cell loss and regenerative activity, and erosive oesophagitis

Question 19

How is GORD diagnosed?

Answer 19

Characteristic history

Question 20

What should eb done if there are alarm features in GORD?

Answer 20

Endoscopy

Question 21

How is GORD managed?

Answer 21

1st- Lifestyle measures
2nd- PPI
3rd- H2RA
Anti-reflux surgery if severe

Question 22

What are the complications of GORD

Answer 22

Ulceration
Stricture
Barrett’s oesophagus
Carcinoma

Question 23

What is Barrett’s oesophagus?

Answer 23

Metaplasia of lower oesophageal mucosa- change from start squamous epithelium to simple columnar epithelium with goblet cells

Question 24

What is the main risk factor for Barrett’s?

Answer 24

GORD

Question 25

What is the presentation of Barrett's?

Answer 25

Asymptomatic but patients will likely present with GORD

Question 26

How is Barrett's screened?

Answer 26

Endoscopy for males >60 with persistent/treatment resistant GORD

Question 27

What is the management of Barrett's?

Answer 27

Endoscopic surveillance every 3-5 years | High dose PPI

Question 28

What are oesophageal SCCs?

Answer 28

Large exophytic occulting tumours occurring in proximal 2/3 oesophagus

Question 29

What are oesophageal SCCs preceded by?

Answer 29

Dysplasia and carcinoma in situ

Question 30

What is oesophageal SCC associated with?

Answer 30

Achalasia Caustric strictures Plummer-Vinson syndrome Smoking and alcohol

Question 31

What are oesophageal adenocarcinomas?

Answer 31

Change of strat squamous epithelium to glandular columnar epithelium in distal 1/3 oesophagus

Question 32

What precedes oesophageal adenocarcinoma?

Answer 32

Barrett's oesophagus

Question 33

What are the risk factors for oesophageal adenocarcinoma?

Answer 33

GORD! | Male, middle aged, obese

Question 34

What are the features of oesophageal cancer?

Answer 34

``` Progressive dysphagia Odynophagia Anorexia and weight loss Chest pain Cough and haematemesis Pneumonia Vocal cord paralysis Typically presents late ```

Question 35

How is oesophageal cancer diagnosed?

Answer 35

Endoscopy and biopsy

Question 36

How is oesophageal cancer staged?

Answer 36

CT PET Endoscopic US

Question 37

What is the curative management of oesophageal cancer?

Answer 37

Oesophagectomy +/- adjuvant and/or neoadjuvant chemo

Question 38

What options are there for management in oesophageal cancer?

Answer 38

Surgery Combined chemo and radio- localised but non op disease Palliative

Question 39

What palliative options are available for oesophageal cancer?

Answer 39

``` Chemo Radio Brachytherapy Stent Laser PEG tube ```