Duke PA Diseases of the Esophagus
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| substernal burning, epigastric pain radiating to the neck | heartburn
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| substernal burning, epigastric pain radiating to the neck | pyrosis
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| dysphagia | difficulty in swallowing-liquids/solids
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| odynodphagia | painful swallowing-reflects erosive esophageal disease
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| infectious causes of odynophagia | CMV, herpes, candida, HIV
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| __ of adults report occasional heartburn | 1/3
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| __ of adults report daily heartburn | 7%
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| etiologies of GERD | incompetent lower esophageal sphincter, transient lower esophageal sphincter relaxation, irritant effects of the refluxate, delayed gastric emptying, abnormal esophageal clearance
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| heartburn 30-60 minutes after meal, regurgitation, sour brash, dysphageia, relieft with antacids, severity does not correlate with esophagitis, asthma flairs, non-cardiac chest pain, laryngitis, hoarsness, loss of dental enamel | symptoms of GERD
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| treatment for uncomplicated GERD | conservative-PPI empirically, no need for further investigation unless treatment failure
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| symptoms of GERD after age __ warrants furhter investigation | 50
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| complicated GERD alarm symptoms | dysphagia, weight loss, hematemesis, melena
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| __ has a limited role in investigation of reflux | barium swallow
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| indications for ambulatory pH monitoring | refractory symptoms and normal EGD, atypical symptoms, failure to respond to pharmacology therapy, patients considered fro antireflux surgery
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| tests the function of the esophageal muscel contractions and esophageal sphincters | manometry
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| occurs in 10-20% of GERD patients, change fro squamous to columnar epithelium in esophagus | Barrett's esophagus
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| Barrett's esophagus predisposes to __ | adenocarcinoma of the esophagus
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| lifestyle modifications for GERD | elevated the head of the bed, lose excess weight, eliminate: tobacco, late night meals, ETOH, fatty foods, chocolate, caffeine
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| Medical treatment for GERD | acid suppression (PPI's), motility agents (not used as much anymore)
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| Surgical treatment for GERD | Nissen fundoplication
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| __ increases the risk of esophageal cancer 30-60 times the general population | Barret's esophagus
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| heartburn, regurgitation or both greater than or equal to once per week increases cancer risk __ times | 8
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| frequent sever heartburn and regurgitation for >20 years increases cancer risk by __ times | 44
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| GERD is a __ disease | chronic
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| complications of GERD | Barrett's esphagus, esophageal cancer, stricture
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| most GERD patients will eventually be sent for __ | endoscopic evaluation
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| signs and symptoms of infectious esophagitis | odynophagia, dysphagia, chest pain
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| treatment for candida esophagitis | fluconozole for 14 days
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| HSV, HIV and CMV will cause __ in the esophagus | ulcerations
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| occurs secondary to portal hypertension | esophageal varices
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| treatment for esophageal varices | banding, shunt procedure, meds
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| secondary to repeated retching | Mallory Weiss tear
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| patients with a caustic injury to esophagus need to have endoscopy withing the first __ hours | 24
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| outpouchings of upper esophagus, always involves the posterior wall of the pharynx, most common cause of transfer dysphagia. Symptoms are regurgitation, dysphagia, halitosis | Zenker's diverticulum
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| esophageal motility disorders | achalasia, diffuse esophageal spasm, nutcracker esophagus, scleroderma esophagus
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| means- failure to relax | achalasia
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| one identifiable cause of achalasia, not prevalent in this country | Chagas disease
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| gradual progressive dysphagia for solids and liquids, regurgitation of undigested foods, develops at 25-60 y/o, symptoms usually lasted months to years, substernal discomfort or fullness after eating, poor esoph emptying, nocturnal regurg | achalasia clinical presentation
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| gold standard for diagnosis of achalasia | manometry
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| on manometry in achalasia you will see | complete absense of peristalisis, with simultaneous, low amplitude waves. Incomplete LES relaxation
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| chest x-ray finding in achalasia | air fluid level
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| barium swallow finding in achalasia | bird's beak, esophageal dilation, loss of peristalsis
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| achalasia therapy | pharmacologic therapy to relax smooth muscle, pneumatic dilation, surgical myotomy, botox
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| treatment of choice for achalasia | surgical myotomy-85% success rate with a mortality <1%
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| achalasia treatment with __ is highly variable and usually doesn't work very well | medications (nifedipine, calcium channel blockers, nitrates)
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| simultaneous, nonperistaltic contractions of the esophagus, provoked by stress, large food boluses, hot or cold liquids (carbonation), anterior chest pain unrelated to exertion or eating | diffuse esophageal spasm
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| barium esophagography reveals simultandeous cork screw contractions, "rosary bead" appearance | diffuse esophageal spasm
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| common in patients with progressive systemic sclerosis, raynaud's phenomena, or CREST, atrophy and fibrosis of the esophageal smooth muscle | scleroderma esophagus
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| causes of esophageal stenoses | rings and webs, reflux esophagitis, tumors, caustic ingestions, infections
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| iatrogenic causes of esophageal stenoses | pill-induced, radiation, sclerotherapy
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| presents with progressive solid food dysphagia, weight loss, most present in late stages, seen in 50-70 y/o | esophageal cancer
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| predisposing factors for squamous cell carcinoma | alcohol, tobacco, achalasia, caustic induced esophageal injury, head and neck cancers, plummer-vinson syndrome. African American, male
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| develops as a complication of Barrett's esophagus, more common in whites than blacks, lower third of esophagus | adenocarcinoma
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| complications of esophageal cancer | local tumor extension into the trachobronchial tree, chest or back pain, laryngeal nerve involvement-hoarsness, pneumonia, malnutrition
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| treatment for unresectable esophageal cancer for palliation | radiation, stenting
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| chemotherapy for esophageal cancer | cisplatin/5 FU
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