Oesophageal Disease Flashcards
(19 cards)
Muscle type distribution in oesophagus?
Upper third - striated muscle
Middle third - mixed
Lower third - smooth muscle
GORD causes increased exposure to which stomach chemicals of concern?
acid
pepsin
bile salts
Risk factors for GORD
Age
Obesity, Pregnancy
Smoking, Alcohol
Hiatus Hernia,
Scleroderma
Asthma
H. Pylori (negative risk factor)
Complications of GORD?
Ulcerations/ bleeding
Stricture/ Schatzki ring
Barret’s oesophagus, adenocarcinoma
pharyngeal reflux
Diagnosis of GORD?
Clinical (Sx + response to anti-acids)
Endoscopy
- if atypical symptoms, other red flags/ issues
pH testing (of oesophageal fluid)
Endoscopic classification of GORD system?
Los Angeles A,B,C,D
Purposes of endoscopy in GORD?
classify
?barret’s
?malignancy
?other pathology - hernia, strictures, mimickers
Meds that worsen GORD?
Decrease LOS function
- beta agonists, alpha antagonists
- theophylline
- diazepam
- tricyclic ant-depressants
- calcium channel blockers
- progesterone
- anticholinergics
Damage to mucous
- doxycycline
- aspirin
- bisphosphonates
- quinidine
Complications of fundopilication
Serious Morbidity 0.4%, Mortality 0.1%
Inevitable complications
- increased flatulence
- initial dysphagia
Uncommon complications
- severe dysphagia
- inability to belch
- vomiting
- para-oesophageal hernia
What is Barrett’s oesophagus really?
Metaplasia of the lower oesophagus
- to cardia/ gastric/ intestinal type
Carcinoma increased with Barrett’s oesophagus/
adenocarcinoma
RFs for Barrett’s oesophagus?
age
reflux (10% of reflux patients), increases with severity
male
caucasian
RFs for adenocarcinoma of oesophagus?
Male
Caucasian
Age
Barrett’s oesophagus
Obesity
Smoking
GORD
Medications -> decreased LOS pressure
H.pylori (negative risk factor)
Management of Barrett’s Oesophagus
Monitoring
No dysplasia: 3-5 years
Low grade dysplasia: 6 monthly
High grade: close surveillance or definitive management
Management strategies for High Grade Barret’s Oeophagus
Oesophagectomy
Mucosal ablation + High dose acid suppression
Presentation of Eosinophilic Oesophagitis?
dysphagia, food impaction
Often in young males
Associated asthma, atopy,
Management of Eosinophilic Oesophagitis?
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
Ix/ Diagnosis of achalasia
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
Management of Achalasia
Meds: GTN, CCBs
Balloon dilatation
- risk of perforation/ rupture
- can require repitition
Botox
Myotomy - surgical
POEM Procedure (per oral endoscopic myotome )
PEG,
Oedsophagectomy
