Exam (elaborations)
GIT Achalasia
Exam of 14 pages for the course ARTICLE at ARTICLE (GIT Achalasia)
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GITAchalasia
➢ Idiopathic loss of the normal neural structure of the lower esophageal sphincter resulting in inability to relax
Features
• Progressive dysphagia to both solid and fluids (more to fluids)
• Regurgitation (hours after eating)
• Weight loss
• There may be history of recurrent URTIs or aspiration pneumonia as a result from untreated achalasia that
leads to nocturnal inhalation of material lodged in the esophagus
• NO relationship with alcohol or tobacco use
Investigations Esophageal cancer
• dysphagia to solid first then liquids
• Barium swallow → (Sigmoid esophagus); dilation of the
• common in elderly with long history of
esophagus, which narrows into a “parrot’s beak” at the distal alcohol and tobacco use
end
• Manometric studies (most accurate) → increased tone of Schatzki ring
• Narrowing of the lower esophagus that
lower esophagus
leads to intermittent dysphagia but not
Management associated with pain, mainly to solids and
Dilation of the lower esophageal sphincter in old patients
• HELLER'S OPERATION (myotomy)
• Botulinum toxin injection, elderly not able to tolerate operations
Esophageal spasm (CCCC)
• Intermittent Chest pain and dysphagia, pain can be precipitated by
Cold liquids
• Pain can simulate that of MI, but it has no relation to exertion
• Relieved after ingestion of nitrates as they are smooth muscle
relaxants
Investigations
• Manometric study → High intensity and disorganized contractions
(most accurate)
• Barium meal → Corkscrew pattern
Treatment
• Ca channel blockers: nifedipine
Plummer Vinson $
➢ Middle-aged woman
➢ Dysphagia (painless/intermittent) + IDA + post cricoid esophageal web
Management
- Iron supplement
- Dilation of the web
Barret’s esophagus
• Occasional dysphagia
• Results from long history of GERD
• Replacement of Sq. epithelium to columnar epithelium
• Associated with esophageal adenocarcinoma
PLABverse - plabverse@yahoo.com 1
, GIT
Dysphagia
• Dysphagia to both solids and liquids WITHOUT regurgitation
• Results from scarring due to:
- Acid reflux
Benign esophageal stricture
- Persistent GERD (retrosternal discomfort)
(peptic stricture)
- Ingestion of corrosives
- Drugs: Bisphosphonates (alendronate) – NSAIDs. So patients are
advised to lie down for 30min after administration
Esophageal carcinoma • Symptoms of cancer
Barrett's esophagus • A long hx of GERD, occasional dysphagia not persistent
• Hx of halitosis, regurgitation of stale food & a throat lump
Pharyngeal pouch (Zenker’s
• Barium swallow may show a residual pool of contrast within the pouch
diverticulum)
• Endoscopy should be AVOIDED in fear of perforation
Achalasia • Dysphagia + regurgitation
Ulcers and esophageal candidiasis • Painful dysphagia
Plummer Vinson $ • IDA + Esophageal web
- Bisphosphonates are used to treat osteoporosis but long-term use can cause esophagitis resulting in a stricture
Esophageal cancer
➢ Adenocarcinoma is more common
➢ Commonly occur in the lower third, Squamous cell type is less common and it affects the upper 2/3
➢ More likely to develop in patients with history of GERD or Barret’s
➢ Dysphagia to solid first then liquids + weight loss
Risk factors
• Smoking (RF for both but mainly for SCC)
• Alcohol
• GERD
• Barret’s
• Achalasia
• Plummer Vinson $
Diagnosis
• Upper GI endoscope and biopsy → 1st line
• Barium swallow
- Rat-tail appearance
- Apple-core appearance
- Shouldering
Treatment
• Operable → surgical resection, radiotherapy
• Inoperable (e.g. metastasis) → palliative esophageal Stent, Percutaneous endoscopic gastrostomy (PEG)
usually in stroke patients who are at risk of aspiration pneumonia or to decompress the stomach in cases of
gastric volvulus
PLABverse - plabverse@yahoo.com 2
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