Esophageal disorders

What is this?

endoscopically visible breaks in the distal esophageal mucosa with or without symptoms

erosive esophagitis

Classification of erosive esophagitis: what is the main difference between A-D?

A: 1+ breaks less then 5mm

B: 1+ breaks more than 5mm

C: break that touches an adj fold but is not circumferential

D: mucosal breaks that involve at least 3/4th of the luminal circumference

What are the 4 alarm signs for esophageal disorder symptoms?

“BCDE”

blood (hematemesis or melena)

Cachexia (weight loss)

dysphagia

early satiety

What are the two most common causes of GERD?

functional: frequent transient LES relaxation

mechanical: hypotensive LES

What can we do on a PE to assess for GERD? What should we consider if this is positive?

pt supine, remove the pillow, press upward on xyphoid process, see if the pt feels reflux come on

consider LES laxity

What are 4 diagnostic tests we can do for GERD?

ambulatory pH monitoring, EGD, manometry, and upper GI series

What are some treatments for GERD? (nonspecific)

lifestyle modifications, H2 blockers, and PPIs

What are some lifestyle modifications for GERD treatment?

avoid trigger foods, eat small frequent meals, lose weight, do not recline within 3 hours of eating, stop smoking, avoid alcohol, wear loose fitting clothes

What is this?

dilated esophagus with an air/fluid level and tapered narrowing of the distal esophagus and EGD shows a dilated sphincter

achalasia

what condition is associated with a “bird beak”?

achalasia

What is this?

failure of a hypertensive LES to relax and/or the absence of esophageal peristalsis

achalasia

What is this?

swallowing food and drink causes a feeling of chest tightness and discomfort with increasingly frequent regurgitation of undigested food

achalasia

what is this?

lack of inhibitory ganglion cells causing hypertensive, non-relaxed esophageal sphincter

achalasia

what is this?

final sphincter (LES) does not open so food can’t pass to the stomach and this is why you regurgitate undigested food

achalasia

What is this?

most common symptom: dysphagia to solids and liquids, regurgitation of bland undigested food and saliva

achalasia

What is the gold standard for diagnosing achalasia?

manometry

what is this?

contractions of the esophagus are uncoordinated where several segments of the esophagus contract simultaneously, preventing the propagation of the food bolus

diffuse esophageal spasm

what is this?

presentation: intermittent dysphagia to solids and liquids several seconds after swallowing, occasional chest pain, and food stuck in the esophagus

diffuse esophageal spasm

What is this?

barium swallow shows corkscrew esophagus

diffuse esophageal spasm

what are the treatments for diffuse esophageal spasm?

diltiazem; can do a myotomy (cut the muscle) in extreme cases

what is this?

contractions of the esophagus are coordinated, but the amplitude of contractions is excessive (>2 SDs)

nutcracker esophagus

What is the most common symptom of nutcracker esophagus?

chest pain

The symptoms of DES and nutcracker esophagus may overlap and can be distinguished only by ____

manometry (motility study)

How do we treat an esophageal spasm?

PPIs

What are 3 causes of secondary esophageal motility disorders?

scleroderma, diabetes mellitus, and alcohol

what is this?

a pouch that forms in the upper esophagus, at the junction where the throat (pharynx) meets the esophagus, typically due to a weak spot in the throat wall

Zenker diverticulum

What is this?

a muscular dehiscence most commonly located between the inferior constrictor muscle and the cricopharyngeus (CP) muscle → Killian triangle

Zenker diverticulum

What is the most common life-threatening complication of Zenker diverticulum?

aspiration

What is the diagnostic test for Zenker diverticulum?

barium swallow with videofluoroscopy

What is associated with: caustic ingestion, alcohol, tobacco, AIDS, malignancy, etc.

esophageal stricture

What is this?

most common symptom: progressive dysphagia for solids that may progress to include liquids

esophageal stricture (abnormal narrowing)

What are the diagnostic tests for esophageal stricture?

barium esophagram and EGD

What are 2 treatment options for esophageal stricture (narrowing of the esophagus)?

PPI therapy and/or mechanical dilation

What is this?

a concentric, smooth, thin extension of normal esophageal tissue consisting of mucosa, submucosa, and muscle

esophageal ring

what is this?

an eccentric, smooth, thinner extension of normal esophageal tissue composed of only mucosa and submucosa

esophageal web

What is the most common location for an esophageal ring?

distal esophagus

what is the most common location for an esophageal web?

anterior postcricoid area of the proximal esophagus

What is this?

common complication: meat impaction

most common location: squamocolumnar junction (SQJ)

Schatzki “ring” (really a web)

what is the most common location for a schatzki ring?

squamocolumnar junction

what is the main difference between an esophageal ring vs web?

ring: mucosa, submucosa, and muscle

web: only mucosa and submucosa

What is this?

histologically eosinophil-rich inflammation that is limited to the esophagus

primary eosinophilic esophagitis

What is this?

associated with atopic inflammatory disease; aberrant immune response to antigenic stimulation

primary eosinophilic esophagitis

the esophagus is unique from the rest of the GI tract because ___ is not part of normal histology of the esophagus

eosinophils

What is associated with this?

patients in both adult and peds often have a concomitant history of allergies such as food allergies, asthma, eczema, or chronic rhinitis

primary eosinophilic esophagitis

What is this?

histological diagnosis: need at least 15 eosinophils/hpf

primary eosinophilic esophagitis

What is this?

spontaneous rupture of the esophagus, usually associated with an increase in intraluminal pressures and rupture of esophageal wall (transmural)

Boerhaave syndrome

What is this?

presentation: severe retching, vomiting, valsalva, and weightlifting followed by excruciating retrosternal chest and upper abdominal pain

Boerhaave syndrome

What is this?

PE: subcutaneous emphysema (crepitation/crackling/rattling sound)

CXR: mediastinal or free peritoneal air, CT, UGI series (barium swallow)

Boerhaave syndrome

What is this?

we see forceful retching, hematemesis with epigastric and back pain

Mallory-Weiss syndrome

what is this?

longitudinal mucosal lacerations of the distal esophagus and proximal stomach; no rupture

Mallory-Weiss syndrome

What is this?

we see no subcutaneous mediastinal or peritoneal air on x-ray, and no extravasation of barium contrast on esophagram or CT

Mallory-Weiss syndrome

What is this?

precursor lesion for adenocarcinoma of esophagus

Barrett esophagus

What is this?

well recognized complication of GERD; healthy esophageal epithelium is replaced with the metaplastic columnar cells

Barrett esophagus

what is this?

histology: specialized intestinal metaplasia with goblet cells

Barrett esophagus