Podcast: Play in new window | Download
Esophagitis
- An inflammation of the esophagus
Causes
- GERD
- Medications
- NSAIDS
- Antibiotics
- Bisphosphonates
- Many others
- Excessive alcohol consumption
- Infectious causes are related to an immunocompromised patient.
- Candida
- Herpes
- Cytomegalovirus (CMV)
Clinical Presentation
- Dysphagia (diffic ulty swallowing)
- Odynophagia (painful swallowing)
- Heartburn
- Nausea
- Cough
Labs and Studies
- Endoscopy with biopsy
- Herpes – Multiple shallow ulcers throughout the esophagus
- CMV – Large solitary deep ulcers
- Candida – Raised white plaques which can be removed
Treatment
- Treatment is based on the diagnosis
- Stop the offending agent
- GERD – antacids and PPIs
- Candida – Fluconazole x 3 weeks
- CMV – antivirals
- Herpes – antivirals
Zenker’s Diverticulum
Diverticula within the esophagus
Clinical Presentation
- Regurgitating undigested food hours after a meal
- Bad breath
- Neck pain
- Dysphagia
- Odynophagia
Labs and Studies
- Barium swallow
- Endoscopy is both diagnostic and therapeutic
- Endoscopic stapling
Treatment
- Behavioral modification
- Hydration after meals
- Thorough chewing
- Endoscopic repair
- Surgical repair
Achalasia
Decreased peristalsis of the esophagus along with increased muscle tone of the lower esophagus
Clinical Presentation
- Progressive dysphagia with both fluids and solids
- Regurgitation of undigested foods
- Non-cardiac chest pain
Labs and Studies
- Barium swallow is the study of choice – A clear tapering at the lower esophageal sphincter looks like a bird’s beak or rat tail
- Endoscopy
Treatment
- Calcium channel blockers – nifedipine
- Nitrates
- Botox injections
- Pneumatic dilation
- Surgical myotomy
Mallory-Weiss Tears
Longitudinal mucosal lacerations of the esophagus. These are often associated with forced retching and vomiting. Typically associated with alcohol.
Clinical Presentation
- Hemoptysis (vomiting blood)
- Epigastric pain
- Back pain
Labs and Studies
- Endoscopy
Treatment
- Bleeding is typically self limiting
- Endoscopy
- Injection of epinephrine
- Thermal coagulation
- Transfusion may be necessary
Esophageal Stricture
A narrowing of the esophagus. Often the patient will have a history of GERD.
Clinical Presentation
- Odynophagia
- Dysphagia
- Heartburn
- Cough
- Hiccups
Labs and Studies
- Barium swallow
- Endoscopy
Treatment
- Proton pump inhibitors – omeprazole
- H2 Blockers
- Surgical correction
Esophageal Varices
Dilated veins usually of the lower portion of the esophagus. Portal HTN is the most common predisposing factor which is usually secondary to cirrhosis which is often secondary to alcoholism.
Clinical Presentation
- Hemoptysis
- Black, tarry or bloody stool
- Signs and symptoms of GI bleed (lightheaded etc)
Labs and Studies
- Endoscopy
- CBC
Treatment
- Fluids
- Endoscopy
- Variceal ligation or banding
- Sclerotherapy
- Balloon tamponade
- Blood transfusion
Gastroesophageal Reflux Disease (GERD)
The sphincter between the stomach and the esophagus relaxes allowing acid from the stomach to move into the esophagus.
Clinical Presentation
- Substernal chest pain
- Pain which is typically postprandial and relieved with antacids
- Dysphagia
- Chronic dry cough
- Chronic laryngitis
Labs and Studies
- Endoscopy is not necessary in most cases of GERD
- Barium swallow is not helpful in diagnosing GERD but may be used for other diagnoses with similar symptoms.
Treatment
- Behavioral modifications
- Smaller portion sizes
- Do not lay down after meals
- Weight reduction
- Avoid acidic foods
- Avoid things that relax the lower esophageal sphincter
- Fatty foods
- Mint
- Chocolate
- Alcohol
- Smoking
- Medical treatment
- Over the counter antacids
- H2 receptor blockers
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Cimetidine (Tagamet)
- Proton pump inhibitors – PPIs
- Omeprazole – (Prilosec)
- Lansoprazole (Prevacid)
- Surgical correction
Complications
- Patients are at an increased risk of esophageal strictures
- Barrett’s esophagus
- Premalignant esophageal tissue
- Believed to be caused by chronic exposure to gastric acid