oesophageal disorders

Question 1

what are the three features of the lower oesophageal sphincter ?

Answer 1

high resting pressure in distal smooth muscle

striated muscle of right crud of the diaphragm

mucosal rossette formed by acute angle at GOJ

Question 2

what drugs/foods can cause oesophageal dyspepsia ?

Answer 2

alcohol
smooth muscle relaxants
nicotine
dietry
xanthines

Question 3

what should we enquire about in dysphagia ?

Answer 3

type of food
pattern
associated features (weight loss, regurgitation,cough)

location - oropharyngeal or oesophageal

Question 4

what are the causes of dysphagia ?

Answer 4

benign stricture
malignant stricture
motility disorders
eosinophilic oesophagitis
extrinsic compression (lung cancer)

Question 5

what investigations can we do for oesophageal dysphagia ?

Answer 5

oesophagi gastro duodenoscopy (OGD)
upper GI endoscopy (UGIE)

contrast barium swallow

oesophageal pH metry

manometry

Question 6

what is hypermotility ?

Answer 6

diffuse oesophageal spasm with severe episodic chest pain +/- dysphagia

Question 7

how do we treat hypermotility ?

Answer 7

smooth muscle relaxants

Question 8

describe hypomotility ?

Answer 8

failure of LOS mechanism leading to heartburn

associated with connective tissue diseases (diabetes,neuropathy)

Question 9

what is the appearance of hypermotility on a barium swallow ?

Answer 9

corkscrew appearance

Question 10

what is achalasia ?

Answer 10

functional loss of myenteric plexus ganglion in the distal oeosphagus causing failure of LOS muscle to contract and open

• build up of food and acid in the oesophagus

Question 11

who is most likely to get achalasia ?

Answer 11

30-50 yrs
men and women

incidence 1-2/100,000

Question 12

what are the features of achalasia ?

Answer 12

progressive dysphagia for solids and liquids
weight loss
chest pain (30%)
regurgitation and chest infection

Question 13

what is the treatment of achalasia ?

Answer 13

pharmacological (smooth muscle relaxants nitrates and CCB)
endoscopic botulinum toxin
pneumonic balloon dilatation
myotomy (laproscopic)

Question 14

what are the complications of achalasia ?

Answer 14

aspiration pneumonia and lung disease
increased risk of squamous cell oesophageal carcinoma

Question 15

what are the symptoms of GORD ?

Answer 15

some do not recieve any symptoms
heartburn, cough, waterbash, sleep disturbance

Question 16

what are the risk factors for GORD ?

Answer 16

pregnancy, obesity, smoking , alcoholism, hypomotility, drugs lowering LOS pressure

Question 17

who is most affected by GORD ?

Answer 17

men
caucasia>black>asian

Question 18

when do we perform an endoscope for GORD ?

Answer 18

when they are >55 or have alarm features such as dysphagia, weight loss, vomiting

Question 19

what are the causes of GORD without abnormal anatomy ?

Answer 19

increased transient relaxation of the LOS
hypotensive LOS
delayed gastric and oesophageal emptying
decreased oesophageal acid clearence
decreased tissue resistance to acid/bile

Question 20

what kind of hernias can be present in GORD ?

Answer 20

sliding
paraoesophageal
risk increased by age and obesity

Question 21

what is the pathology of GORD ?

Answer 21

mucosa exposed to acid-pesin and bile
increased cell loss and regenerative activity (inflammation)
erosive oesophagitis

Question 22

what are the complications of GORD ?

Answer 22

ulceration
stricture
glandular metaplasia
carcinoma

Question 23

what is barrett’s oesophagus ?

Answer 23

intestinal metaplasia related to prolonged acid exposure in the distal oesophagus

change from squamous to mucous secreting simple columnar which is a precursor to dysplasia/adenocarcinoma

cancer rate 0.3%

Question 24

what does the cancer rate increase to in high grade dysplasia in barrett’s oesophagus ?

Answer 24

6%

Question 25

what is the treatment for high grade dysplasia in barrett’s oesophagus ?

Answer 25

endoscopic mucosal resection (EMR)
radio-frequency ablation (RFA)
oesophagectomy (10% mortality so rare)

Question 26

what is the treatment for GORD ?

Answer 26

lifestyle measurements
alginates (gaviscon)
H2RA (ranitidine)
proton pump inhibitor (omeprazole)

if symptoms proceed after investigation then anti-reflux surgery (fundoplication full or partial)

Question 27

where are squamous carcinomas common ?

Answer 27

world except western europe and USA
proximal and middle third of oesophagus

smoking and alcohol related

Question 28

where are adenocarcinomas common ?

Answer 28

western europe /USA
distal oeosphagus

barrett’s and obesity related

Question 29

what is the presentation of oesophageal cancer ?

Answer 29

progressive dysphagia
anorexia and wight loss
chest pain
cough
pneumonia

Question 30

where does oesophageal cancer metastasise ?

Answer 30

liver /nodes

hepatic, brain, pulmonary, bone

Question 31

what is the prognosis for oesophageal cancer ?

Answer 31

5yr survival <10%

Question 32

what are the investigations for oesophageal cancer ?

Answer 32

endoscopic biopsy
CT, endoscopic ultrasound, PET scan

Question 33

what is the treatment for oesophageal cancer ?

Answer 33

oesophagectomy if localised disease, no co-morbidities and <70yrs of age with adjuvant/neoadjuvant chemotherapy

palliation - combined radiochemotherapy with stent, PEG, brachytherapy

Question 34

what is eosinophilic oesophagitis ?

Answer 34

immune/allergen conditon where eosinophils infiltrate the epithelium (>15 per microscopic field) which mediated an allergen enviroment

common in asthma, hay fever and younger adults

Question 35

what is the presentation of eosinophilic oesophagitis ?

Answer 35

dysphagis and food bolus obstruction

circular rings in and endoscope (like trachea )

Question 36

what is the treatment of eosinophilic oesophagitis ?

Answer 36

topical/swallowed corticosteroids

dietry elimination

endoscopic dilatation