Let’s move on to esophagitis.
In general, a nice little overview of the different
things we’ll take a look at with esophagitis.
GERD - we’ll take a look at
symptoms, diagnosis, treatment.
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.
Caustic ingestion - And by that we mean that the
patient is now taking up some type of chemical.
Infectious to you should
Viral - maybe Herpes,
Maybe bacterial, fungal, definitely,
You’ve heard of candidiasis,
you’ve heard of oral thrush.
If you have a Candida infection of esophagus, you’ll
have the same type of cottage cheese appearance.
Reflux esophagitis is what
we are, GERD is my topic.
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.
This reflux over a long period of time, with this acid
coming back into the esophagus, may then
bring about a metaplastic change.
Mean to say that the squamous cells of the esophagus may
then turn into or undergo metaplasia into columnar cells.
If it continues from… this is then
referred to as Barrett’s esophagus.
If this continues, and the patient is either non-compliant,
and we’ll talk more about this later in steps of management.
For example, lifestyle
modification is huge.
Don’t eat late at night.
When you go to sleep, angle yourself so that you
do not… you prevent the reflux from taking place.
And try not to smoke,
and so on and so forth.
But if the reflux continues to
Barrett’s esophagus, which is not a cancer,
but its metaplasia, is at risk
for dysplasia and adenocarcinoma.
Associated with hiatal
hernia as we talked about.
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.
Transient relaxation of the lower
esophageal sphincter, that’s my problem.
Excessive relaxation of the LES.
GERD has a more frequent transient
relaxation and longer periods of that reflux.
See relaxation is a good thing.
It’s called your receptive relaxation.
Remember, there’s a test that you’ve
seen in physio which is called manometry.
If you were to put a bolus into the mouth and get
into esophagus, the pressure within esophagus rises.
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.
You want to get the
food into the stomach.
However in GERD, there’s
Underlying cause remains unknown, potentially maybe perhaps
one of you will end up finding it and go on to great praise.
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.
Dyspepsia, water-brash and dysphagia.
Dysphagia here reflux, difficult
because of that chest pain.
And also, with all this acid reflux, there might be with enough
reflux in the esophagus, may actually
irritate the respiratory system.
And so therefore, your patient may complain of
breathing issues, similar to that of asthma.
“Doc, for whatever reason, I feel
like I’ve just developed asthma.
I’m having a hard time
breathing at times."
Along with this you go on to do a barium swallow
and you end up finding issues with reflux.
The diagnostic evaluation of GERD: dysphagia;
Testing not necessary for typical symptoms.
Weight loss, anemia, refractory symptoms, prolonged
symptoms, atypical symptoms are extremely alarming.
So testing not necessarily for typical
symptoms but recommended for “alarm” features.
The reason for this is because you’re worried about your
patient going on to developing cancer of the esophagus.
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.
May present as progressive dysphagia.
You start losing blood and such,
you’re worried about iron deficiency.
The diagnostic evaluation’s
important for you.
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.
The incidence of adenocarcinoma in
the US, thank goodness is dropping.
You’ll want to do a 24 to 48 hour pH
monitoring; now we do this wirelessly.
Presence of esophageal damage, this you’re
going to check out on endoscopic examination.
And the damage that you’re looking
for here, we call Barrett’s tongue.
The Barrett’s tongues represents the metaplastic changes
taking place of your squamous into columnar cells.
Symptoms correlation with reflux; for
example, with something called the Bernstein
test - the perfusion of esophagus with
acid to induce the symptoms of GERD.
Such as, your coughing we talked about, the burning
sensation in the chest, so on and so forth.
The complications of
reflux: The barium swallow.
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.
Of course reflux is injury.
So things that you’re looking for with the GERD as very
common associated diagnoses include stricture formation.
And also I’d mention that hiatal hernia is also
accompanying, accompanying issue with in fact reflux.