00:01
Let’s move on to esophagitis.
00:03
In general, a nice little overview of the different
things we’ll take a look at with esophagitis.
00:08
GERD - we’ll take a look at
symptoms, diagnosis, treatment.
00:11
Pill induced - for example if it’s NSAIDs and such,
and aspirin over a long period of time you
decrease the lining of the esophagus.
00:18
Caustic ingestion - And by that we mean that the
patient is now taking up some type of chemical.
00:23
Infectious to you should
mean immunocompromised.
00:28
Viral - maybe Herpes,
Cytomegalovirus, HIV.
00:33
Immunocompromised.
00:35
Maybe bacterial, fungal, definitely,
definitely immunocompromised.
00:39
You’ve heard of candidiasis,
you’ve heard of oral thrush.
00:44
If you have a Candida infection of esophagus, you’ll
have the same type of cottage cheese appearance.
00:50
Let’s begin.
00:52
Reflux esophagitis is what
we are, GERD is my topic.
00:57
Reflux disease.
00:59
Gastroesophageal Reflux Disease, we had
talked about this and discussed
as to how a patient as an adult may then have
hiatal hernia, at the level of T10.
01:08
This reflux over a long period of time, with this acid
coming back into the esophagus, may then
bring about a metaplastic change.
01:17
Mean to say that the squamous cells of the esophagus may
then turn into or undergo metaplasia into columnar cells.
01:27
If it continues from… this is then
referred to as Barrett’s esophagus.
01:31
If this continues, and the patient is either non-compliant,
and we’ll talk more about this later in steps of management.
01:38
For example, lifestyle
modification is huge.
01:41
Don’t eat late at night.
01:42
When you go to sleep, angle yourself so that you
do not… you prevent the reflux from taking place.
01:49
And try not to smoke,
and so on and so forth.
01:53
But if the reflux continues to
Barrett’s esophagus, which is not a cancer,
but its metaplasia, is at risk
for dysplasia and adenocarcinoma.
02:02
Common.
02:03
Associated with hiatal
hernia as we talked about.
02:06
Or what if a patient has diabetes
mellitus, and there’s something called
gastroparesis and you don’t have
proper emptying of your stomach?
And then you might
then result in reflux.
02:18
Transient relaxation of the lower
esophageal sphincter, that’s my problem.
02:22
Excessive relaxation of the LES.
02:25
GERD has a more frequent transient
relaxation and longer periods of that reflux.
02:31
See relaxation is a good thing.
02:33
It’s called your receptive relaxation.
02:36
Remember, there’s a test that you’ve
seen in physio which is called manometry.
02:41
If you were to put a bolus into the mouth and get
into esophagus, the pressure within esophagus rises.
02:50
As soon as you have a rise, physiologically, of
pressure in the esophagus, this then triggers
automatically relaxation of the lower esophageal
sphincter because obviously peristalsis.
03:03
You want to get the
food into the stomach.
03:06
However in GERD, there’s
excessive relaxation.
03:09
Underlying cause remains unknown, potentially maybe perhaps
one of you will end up finding it and go on to great praise.
03:20
The symptoms of GERD: If there’s reflux taking place,
heartburn, “chest pain”, often times could be…
well in your head as a differential you should be
thinking about things such as myocardial infarction.
03:37
Dyspepsia, water-brash and dysphagia.
03:41
Dysphagia here reflux, difficult
because of that chest pain.
03:45
And also, with all this acid reflux, there might be with enough
reflux in the esophagus, may actually
irritate the respiratory system.
03:53
And so therefore, your patient may complain of
breathing issues, similar to that of asthma.
03:59
“Doc, for whatever reason, I feel
like I’ve just developed asthma.
04:04
I’m having a hard time
breathing at times."
“Hmm."
Along with this you go on to do a barium swallow
and you end up finding issues with reflux.
04:16
Chronic cough.
04:18
Atypical symptoms.
04:20
The diagnostic evaluation of GERD: dysphagia;
Testing not necessary for typical symptoms.
04:27
Weight loss, anemia, refractory symptoms, prolonged
symptoms, atypical symptoms are extremely alarming.
04:35
So testing not necessarily for typical
symptoms but recommended for “alarm” features.
04:41
The reason for this is because you’re worried about your
patient going on to developing cancer of the esophagus.
04:48
What kind would this be
most likely with GERD?
You go from Barrett’s esophagus
to metaplasia, into dysplasia
and into your adenocarcinoma, most likely
located in your lower esophagus.
05:05
May present as progressive dysphagia.
05:10
You start losing blood and such,
you’re worried about iron deficiency.
05:13
The diagnostic evaluation’s
important for you.
05:18
Quite a bit of a problem is GERD in the
US, but because of proper
diagnostic evaluation and screening methods, and
hopefully the patient is compliant.
05:28
The incidence of adenocarcinoma in
the US, thank goodness is dropping.
05:35
You’ll want to do a 24 to 48 hour pH
monitoring; now we do this wirelessly.
05:41
Presence of esophageal damage, this you’re
going to check out on endoscopic examination.
05:47
And the damage that you’re looking
for here, we call Barrett’s tongue.
05:51
The Barrett’s tongues represents the metaplastic changes
taking place of your squamous into columnar cells.
05:59
Symptoms correlation with reflux; for
example, with something called the Bernstein
test - the perfusion of esophagus with
acid to induce the symptoms of GERD.
06:11
Such as, your coughing we talked about, the burning
sensation in the chest, so on and so forth.
06:19
The complications of
reflux: The barium swallow.
06:21
Well, what does damage that’s
taking place with the esophagus
due to the reflux, remember there’s strictures,
means what to you?
Increased repair process of
the esophagus upon injury.
06:38
Of course reflux is injury.
06:40
So things that you’re looking for with the GERD as very
common associated diagnoses include stricture formation.
06:51
And also I’d mention that hiatal hernia is also
accompanying, accompanying issue with in fact reflux.