This section will outline disorders of the oesophagus and will include the following sections:
1. Symptoms related to oesophageal disease
2. Gastro-oesophageal reflux disease (GORD)
3. Eosinophilic oesophagitis, infectious oesophagitis and pill-induced oesophagitis
6. Oesophageal motility disorders
The following are some key points with regards to oesophageal disease:
– Dysphagia can be oropharyngeal or oesophageal in nature. Oropharyngeal dysphagia often is neruomuscular in origin and occurs immediately upon swallowing. Oesophageal dysphagia generally occurs after swallowing has started and is generally mechanical in nature.
– Dysphagia for both solids and liquids is is generally due to a motility disorder, whereas dysphagia for solids is generally due to a structural lesion.
– The most common reason for odynophagia is oesophageal ulceration.
– The primary mechanism underlying GORD is transient relaxation of the lower oesophageal sphincter.
– 24 hour pH probe is the gold standard for diagnosing GORD.
– Empirical treatment with a proton pump inhibitor (PPI) is a useful way to diagnose GORD. Treatment of GORD with a PPI is the standard of care.
– Other options for treating GORD include lifestyle modifications and surgery, although the long term outcomes are unclear.
– Up to 1/3 of people with GORD experience symptoms which are outside the oesophagus, including asthma, chronic cough, laryngitis and noncardiac chest pain.
– Making a diagnosis of Barrett’s oesophagus requires upper endoscopy and biopsies with oesophageal intestinal metaplasia.
– There is a 30 fold increase in the risk of developing oesophageal cancer in people with Barrett’s oesophagus. Surveillance endoscopy and biopsy is currently recommended as early detection and surgery offers the best long term outcomes. Unfortunately, most oesophageal cancers are detected late.
– Manometric findings of achalasia are identical to pseudo-achalasia and an endoscopy is required to exclude an underlying cancer.
– The majority of motility disorders are hypertonic, the classic type being achalasia. Achalasia is characterised by a failure of the lower oesophageal sphincter to relax and can be treated by disruption of the sphincter tone.
– Odynophagia is the most common symptom occurring in infectious oesophagitis, with the most common cause being oesophageal candidiasis. There is generally an associated underlying immunosuppression or abnormal oesophageal stasis.
– The most common medications associated with pill-induced oesophagitis include NSAIDs, bisphosphonates, potassium, iron sulfate, tetracycline and quinidine.
– Eosinophilic oesophagitis is being diagnosed more commonly and generally manifests as dysphagia with food bolus impaction in young patients with atopy.