Esophagus - Congenital, Motility & Inflammatory Disorders MCQs

This patient presents with features of gastroesophageal reflux disease (GERD). In some cases of GERD, endoscopic signs may be absent due to- A partially treated disease In nonerosive reflux disease - most common cause. In such instances, 24 hour oesophageal pH study can demonstrate excessive esophageal exposure to refluxed gastric fluid, the physiologic abnormality of GERD. Urease breath test is done to identify Helicobacter pylori. Gastric biopsy is done in cases of suspected gastric carcinoma. Reference : Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 323, Pg: 2424

The most effective drugs in Gastro-oesophageal reflux are proton pump inhibitors such as omeprazole. Treatment for GORD includes - Lifestyle changes - Avoiding foods that reduce LES pressure like coffee, alcohol, fatty foods Avoiding acidic foods like citrus fruits, tomato based foods Weight loss Pharmacological treatment -PPI like omeprazole >> H2 receptor antagonists like ranitidine Surgical management -Nissen fundoplication -In refractory cases Reference : Harrison's Principles of Internal Medicine, 21 st , Ch: 323, Pg: 2429-2431

The only durable therapies for achalasia are pneumatic dilation and LES myotomy (Heller myotomy). The patient shows excellent symptom improvement. Reflux is the most common side effect and a concomitant anti-relfux procedure (Nissen's fundoplication) may be performed. Both calcium channel blockers (nifedipine) and nitrates relax the lower oesophageal sphincter. However the effect on symptoms is variable, short-lived and usually suboptimal. Use is frequently limited by adverse effects. Consequently medical therapy is typically limited to those patients too frail or unwilling to undergo definitive treatment or other therapies. Latest treatment is POEM. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 23,Pg: 2427-2428

This is a case of Mallory Weiss tear . Longitudinal tear in the mucosa at the gastroesophageal junction . Caused by forceful or prolonged vomiting or coughing. They may also be caused by epileptic convulsions. Usually seen in alcoholics, bulimia nervosa patients. The tear may be followed by vomiting bright red blood or by passing blood in the stool. Active bleed can be treated by endoscopy (band ligation or coaptive coagulation). A transmural rupture at gastroesophageal junction is called Boerhaave's syndrome. Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 323, Pg: 2433

Symptoms of GERD do not correlate with the mucosal appearances at endoscopy. PPIs can be given continuously where the diagnosis has been satisfactorily proven and relapse of symptoms persist after withdrawal. Although endoscopy can be performed in cases that are not clear cut or do not respond to proton pump inhibitors (PPIs), it is not mandatory. The doubt of Barrett's oesophagus can only be clarified with biopsy. Monitoring of pH is not a good guide to therapy. Symptomatic improvement is a good guide to the efficacy of therapy. Reference : Harrison's Principles of Internal Medicine, 21 st , Ch: 323, Pg: 2429-2431

Immunologic factors. Humoral and cell-mediated immune reactions directed againstintestinal cells in Crohn disease suggest an autoimmune phenomenon. Attention has focused on the role of cytokines, such as interleukin (IL)-1, IL-2, IL- 8, and TNF-α, as contributing factors in the intestinal inflammatory response. The role of the immune response remains controversial in Crohn disease and may represent an effect of the disease process rather than an actual cause. Reference : Sabiston textbook of Surgery, chapter: 50, Edition: 21 st , Pg: 1259

Ambulatory reflux monitoring is considered one of the most important confrmatory tests for GORD. There are two types of monitoring devices: catheter based and wireless capsule. Both measure the pH value at 5-6 cm above the upper border of the LOS, Ambulatory refux monitoring is considered one of the most important confrmatory tests for GORD. There are two types of monitoring devices: catheter based and wireless capsule. Both measure the pH value at 5-6 cm above the upper border of the LOS, A composite score (Johnson-DeMeester) consists of six parameters that can be calculated. The patient needs to record their symptoms throughout the study period, so that symptom correlation with pH data can be calculated.