Term
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Definition
| Inflammatory process of esophagus caused by chemical (Caustic agents, Drugs), biochemical (Gastric acid), and infectious agents (CMV, HSV, Candida) |
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Term
| Types of Drugs implicated in Pill-induced Esophagitis |
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Definition
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Term
| Risk factors for Pill-induced Esophagitis |
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Definition
Patients (motility disorder, position, LES stricture, age)
Pill (size, shape, pH, contact time) |
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Term
|
Definition
* Odynophagia in elderly and/or immunosuppressed
* HSV & CSV - reactivation of latent virus
* Candida - normal oral flora
* Bacterial causes are uncommon |
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Term
|
Definition
* White plaques
* Erythematous mucosa
* Fungal organisms visible microscopically |
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Term
| Gastroesophageal Reflux Disease |
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Definition
* Decreased LES tone
* Sliding hiatal hernia
* Decreased clearance of refluxed material
* Delayed gastric emptying
* Increased gastric pressure
* Acid-peptic juice
* Duodenal reflux |
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Term
| Reflux Esophagitis - Histology |
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Definition
| Hyperplasia and esoniphils |
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Term
|
Definition
- Newly recognized disease of industrialized nations
- Solid food dysphagia, strictures
- Failure to respond to acid suppression
- History of asthma or other allergies
- Caucasians, male > female, age of onset 20-40 yrs |
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Term
| Eosinophilic Esophagitis - Pathophysiology |
|
Definition
* Inflammatory process similar to other allergic rxns:
- Eos, T-cells, Mast cells
- IL-5, IL-13, TNF-a
- Oxygen free radicals & peroxidase
- Induction of IgE
* Food allergens and aeroallergens implicated --> "Asthma of the Esophagus"
* Hygiene hypothesis |
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Term
| Eosinophilic Esophagitis - Treatment |
|
Definition
* Suppress inflammatory response - Steroids (systemic, topical)
* Eliminate allergic triggers that incite inflammatory response - Allergy testing, Diet restriction |
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Term
|
Definition
- Columnar epithelium in lower esophagus: Metaplasia
- Assoc. w/ chronic GE reflux (10% of all patients)
- Most patients are asymptomatic
- Intestinal metaplasia assoc. w/ dysplasia and cancer risk (30-40x normal) |
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Term
| Dysplasia in Barrett Esophagus |
|
Definition
- Occurs in small % of patients, may progress to carcinoma
- Surveillance endoscopy w/ biopsy
- Rx w/ acid suppression (proton pump inhibitors)
- Low grade dysplasia: Surveillance
- High grade dysplasia: Surveillance or local ablation (photodynamic vs. surgical) or esophagectomy |
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Term
|
Definition
Benign Epithelial - squamous papilloma
Benign Stromal - leiomyoma, granular cell tumor
Malignant Epithelial - adenocarcinoma, squamous cell carcinoma |
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Term
|
Definition
- Accounts for 1/3 of all esoph. ca.
- Alarming increase recently (21% per yr)
- Similarity in age distr., sex ratio, race, clin & path features with Barrett's
- 80% in lower esophagus
- Mean age = 60 yrs
- Diagnosed by endoscopy and biopsy
- Histo feature: irregular, infiltrative glands |
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Term
| Adenocarcinoma - Presentation |
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Definition
- Prognosis closely related to tumor stage (depth of invasion)
- Often not operable (50%)
- Often w/ lymph node metastasis
- Operative mortality 5-10%
- Operative complications 25-40%
- 5-yr survival post surgery 15-25% |
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Term
| Squamous Cell Carcinoma (SCC) |
|
Definition
- Unrelated to Barrett esophagus
- Risk factors: excess EtOH & tobacco, food carcinogens & hot bevs, Virus (HPV 16, 18; EBV), genetics
- Prognosis: as poor as in adenocarcinoma
- Marked geog variation: Iran, China = 20% of all cancer deaths |
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Term
| Stenosis, Webs, and Rings |
|
Definition
- Caused by inflammatory scarring (radiation, caustic injury, reflux)
- Progressive dysphagia in adults
- Fibrous thickening of submucosa
- Ulcer |
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Term
|
Definition
- Difficulty in swallowing
- Absent myenteric ganglia
- Progressive dilatation of esophagus above LES |
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Term
| Achalasia - Pathophysiology |
|
Definition
- Increased resting tone or incomplete relaxation of the LES during swallowing
- Aperistalsis |
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Term
|
Definition
- Located above UES
- Pathogenesis: Crocopharyngeal motor dysfunction
- Sx: Food regurgitation |
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Term
|
Definition
- Located mid esophagus
- Pathogenesis: (1) Mediastinal lymphadenitis; (2) Congenital
- Symptoms: None (asymptomatic) |
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Term
|
Definition
- Located above LES
- Pathogenesis: (1) Dyscoordination of peristalsis; (2) LES relaxation
- Sx: Nocturnal regurgitation |
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