Chinnu
MEDICINE
Esophageal Disorders
GER vs GERD
Gastroesophageal reflux - normal finding
Natural phenomenon
Gastroesophageal Reflux disease- abnormality
In the presence of certain abnormal features
Lower esophageal sphincter is loose (Laxity, i’e ↓ tone of LES)
m/c/c is Idiopathic
Other factors:
Smoking (d/t Nicotine content of smoke)
Alcohol
Caffeine
Any condn which increases intra- abdominal pressure (eg: obesity, pregnancy, tumours,
massive ascites)
Clinical features:
Heartburn (m/c) - Retrosternal/Substernal pain, gets worse after meals, present in lying
supine posture
{this is not anginal pain (anginal pain=chest pain d/t heart problems), Anginal pain usually
radiates but here is doesn't}
Recurrent cough
Sore throat
Metallic taste in the mouth
In paediatrics
Recurrent vomiting (kids do not have long oesophagus)
Failure to thrive (not enough growth in child d/t food getting vomited out and no enough
nutrition received)
Complication: Aspiration of feeds
Diagnosis:
Ph monitoring= 24 h monitoring
Acidic Ph < 4
It might cause metabolic alkalosis for children with continuous vomiting
IOC = Multichannel intraluminal impedance monitoring
Treatment:
Lifestyle modifications (quit smoking and alcohol, decrease caffeine, avoid late night
meals, weight loss)
Lie with minimal head end elevation ~ 15-30degree
If this does not work, the drugs
PPI
{In GERD, dysphagia is an unusual symptom. If it is prominent, other condn should be
suspected}
, Chinnu
GERD Symptoms with dysphagia
Progressive and non progressive
Progressive Dysphagia Non Progressive Dysphagia
Achalasia Cardia - Initially liquid Intermittent chest pain and not
dysphagia, then with solids related to meals - Esophageal Angina
[DES]
Complications of GERD-
Reflux esophagitis- chronic
inflammation
can be a/w Fibrosis causing
strictures
Can be Metaplasia (squamous to
columnar epithelium) - Barrett’s
Esophagus
BARRETT’S ESOPHAGUS
In Endoscopy, the pale part is the normal esophagus. The salmon pink Epithelium or red velvety
appearance is Barrett's esophagus
On histology, presence of goblet cells will tell you that it is a Columnar epithelium
Sometime if metaplasia not treated it can change to Dysplasia and then Anaplasia or cancer
Therefore, Barrett's oesophagus is a precancerous condition
Which type of cancer will develop? Cancer of columnar epithelium- Adenocarcinoma
DES- Diffuse Esophageal Spasm
All parts of oesophagus undergoes unnecessary continuous contraction of the smooth muscle of
the oesophagus
Normally peristaltic activity has contraction followed by relaxation but here there is no
relaxation.
Pt has difficulty in peristalsis causing dysphagia
Diagnosis = Barium Swallow= Corkscrew appearance of esophagus
IOC= Manometry to check for pressure in the esophagus
The pressure will increase >120mmHg
In severe DES >180mmHg ⇒ called NUTCRACKER OESOPHAGUS
Treatment:
CCB - best
Nitrates
Antidepressants
PUD
M/c Duodenal ulcer>Gastric Ulcer
Duodenal Ulcer = D1 part At the Cap
Gastric Ulcer = Lesser curvature in stomach
MEDICINE
Esophageal Disorders
GER vs GERD
Gastroesophageal reflux - normal finding
Natural phenomenon
Gastroesophageal Reflux disease- abnormality
In the presence of certain abnormal features
Lower esophageal sphincter is loose (Laxity, i’e ↓ tone of LES)
m/c/c is Idiopathic
Other factors:
Smoking (d/t Nicotine content of smoke)
Alcohol
Caffeine
Any condn which increases intra- abdominal pressure (eg: obesity, pregnancy, tumours,
massive ascites)
Clinical features:
Heartburn (m/c) - Retrosternal/Substernal pain, gets worse after meals, present in lying
supine posture
{this is not anginal pain (anginal pain=chest pain d/t heart problems), Anginal pain usually
radiates but here is doesn't}
Recurrent cough
Sore throat
Metallic taste in the mouth
In paediatrics
Recurrent vomiting (kids do not have long oesophagus)
Failure to thrive (not enough growth in child d/t food getting vomited out and no enough
nutrition received)
Complication: Aspiration of feeds
Diagnosis:
Ph monitoring= 24 h monitoring
Acidic Ph < 4
It might cause metabolic alkalosis for children with continuous vomiting
IOC = Multichannel intraluminal impedance monitoring
Treatment:
Lifestyle modifications (quit smoking and alcohol, decrease caffeine, avoid late night
meals, weight loss)
Lie with minimal head end elevation ~ 15-30degree
If this does not work, the drugs
PPI
{In GERD, dysphagia is an unusual symptom. If it is prominent, other condn should be
suspected}
, Chinnu
GERD Symptoms with dysphagia
Progressive and non progressive
Progressive Dysphagia Non Progressive Dysphagia
Achalasia Cardia - Initially liquid Intermittent chest pain and not
dysphagia, then with solids related to meals - Esophageal Angina
[DES]
Complications of GERD-
Reflux esophagitis- chronic
inflammation
can be a/w Fibrosis causing
strictures
Can be Metaplasia (squamous to
columnar epithelium) - Barrett’s
Esophagus
BARRETT’S ESOPHAGUS
In Endoscopy, the pale part is the normal esophagus. The salmon pink Epithelium or red velvety
appearance is Barrett's esophagus
On histology, presence of goblet cells will tell you that it is a Columnar epithelium
Sometime if metaplasia not treated it can change to Dysplasia and then Anaplasia or cancer
Therefore, Barrett's oesophagus is a precancerous condition
Which type of cancer will develop? Cancer of columnar epithelium- Adenocarcinoma
DES- Diffuse Esophageal Spasm
All parts of oesophagus undergoes unnecessary continuous contraction of the smooth muscle of
the oesophagus
Normally peristaltic activity has contraction followed by relaxation but here there is no
relaxation.
Pt has difficulty in peristalsis causing dysphagia
Diagnosis = Barium Swallow= Corkscrew appearance of esophagus
IOC= Manometry to check for pressure in the esophagus
The pressure will increase >120mmHg
In severe DES >180mmHg ⇒ called NUTCRACKER OESOPHAGUS
Treatment:
CCB - best
Nitrates
Antidepressants
PUD
M/c Duodenal ulcer>Gastric Ulcer
Duodenal Ulcer = D1 part At the Cap
Gastric Ulcer = Lesser curvature in stomach
