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Gastroenterology > Oesophagitis > Flashcards

Oesophagitis Flashcards

1
Q

What is the definition of oesophagitis?

A

Inflammation of the oesophageal mucosa secondary to direct mucosal injury or to inflammatory infiltrates due to systemic inflammatory disorder

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2
Q

What is the definition of eosinophilia oesophagitis?

A

Chronic immune mediated eosinophil predominant inflammation of the oesophageal mucosa

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3
Q

What is the definition of infectious oesophagitis?

A

Inflammation of the oesophageal mucosa secondary to a local infection. Common with immunosuppressive patients

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4
Q

What is the definition of substance induced oesophagitis?

A

Oesophageal mucosal injury caused by direct contact with an irritant substance

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5
Q

What is the definition of medication induced oesophagitis?

A

A type of substance induced oesophagitis caused by prolonged contact with certain types of oral medications (eg antibiotics)

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6
Q

What are the causes of oesophagitis?

A

GERD
Infections
Substances
Radiotherapy
Eosinophilia or lymphocytic oesophagitis
Immune mediated disorders eg chron disease
Autoimmune disease (eg scleroderma, SLE)
Anatomical causes (eg hiatal hernia)
Motility disorders (eg achalasia)

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7
Q

What is the most common cause of oesophagitis?

A

GERD

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8
Q

What are the clinical features of Oesophagitis?

A

Retrosternal burning chest pain (heart burn)
Dyspepsia
Regurgitation
Belching
Globus sensation

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9
Q

Which clinical features are a sign of an underlying aetiology?

A

Heartburn that worsens when lying down or bending forward - GERD
Retrosternal chest pain, dysphasia and reflux of indigestion food - achalasia cardia
Dysphasia, weight loss, hematemesis - oesophageal cancer

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10
Q

What is the most likely underlying cause for oesophagitis?

A

GERD

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11
Q

What are the features to diagnose the patient with GERD?

A

Age <60 years
Typical features of GERD (heart burn and regurgitation)
No major red flags for dyspepsia
No major risk factors for Barrett oesophagus

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12
Q

What is the empiric therapy for GERD?

A

PPI’s for 8 weeks

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13
Q

What is their diagnosis for oesophagitis?

A

Eosophagogastroduodenoscopy

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14
Q

What are the indications for EGD?

A

Age >60
Multiple or severe red flags for dyspepsia regardless of age
Multiple risk factors for Barrett oesophagus

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15
Q

What are the findings from an EGD?

A

Non specific findings - mucosal erythema, oedema, friability and erosions

Specific findings - infectious oesophagitis, eosinophilia oesophagitis, medication induced oesophagitis, Barrett oesophagus, oesophageal cancer

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16
Q

What are the clinical features of infectious oesophagitis?

A

Odynophagia (painful swallowing)
Dysphasia
Heart burn
Regurgitation
Lesions in the oral mucosa
Retrosternal chest pain
Systemic signs of infection eg fever

17
Q

What is the aetiology of infectious oesophagitis?1

A

Fungal
Viral
Bacterial (uncommon)

18
Q

What are the clinical features of eosinophilia oesophagitis?

A

Dysphagia
Food bolus impaction (acute dysphasia caused by near total obstruction of the oesophageal lumen)
Symptoms can be worsened by ingestion of food containing allergens
Associated features - atopy (genetic predisposition to produce IgE after antigen exposure) eg asthma, rhinitis

19
Q

What is the diagnosis for eosinophilia oesophagitis?

A

Endoscopic findings - circumferential mucosal lesions (eg rings) with possible multiple rings in the oesophagus
Diffuse narrowing or isolated strictures

Histopathological findings - intraepithelial accumulation of eosinophils (>15 per field on microscope)
Basal cell hyperplasia
Possible eosinophilia microabscesses

20
Q

What is the course of treatment for eosinophilia oesophagitis?

A

Fist line - PPI’s
Second line - topical steroids, fluticasone, budesonide
Dietary eliminations - avoid allergens and reduce certain proteins eg milk to reduce GI inflammation
Oesophageal dilation - for patients with a narrow stricture

21
Q

What is their aetiology for medication induced oesophagitis?

A

Director mucosal injury caused by prolonged contact with certain drugs eg antibiotics, NSAID’s, biphosophonates

22
Q

What is the diagnosis for medication induced oesophagitis?

A

Endoscopy - punched out ulcers with mould inflammatory changes of the surrounding mucosa
Histopathology - ulcerations, inflammatory and necrotic changes of the epithelium, giant cells with multiple nuclei

23
Q

What is the treatment for medication induced oesophagitis?

A

Moist cases are self limiting
Discontinue the medication causing oesophagitis
Ensure nutrition and hydration
Consider antacids
Oesophageal dilation if patient develops stricture

24
Q

What are some complications of oesophagitis?

A

Chronic oesophagitis
Hematemesis
Oesophageal stricture
Aspiration

Gastroenterology (28 decks)

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