Upper GI Diseases 1

Achalasia:

Achalasia is an esophageal motility disorder. It is diagnosed when there is a complete lack of peristalsis within the body of the esophagus. The lower esophageal sphincter does not relax to allow food to enter the stomach. Symptoms are difficulty swallowing both liquids and solids. Many people also have associated regurgitation, vomiting, weight loss, and atypical chest discomfort.

• Botulinum injections are most effective of all the options for relieving a lower oesophageal sphincter restriction which leads to achalasia.
• Nifedipine, nitrates or sildenafil can also be used, but are less effective.
• Surgically, Heller’s oesophageal myotomy is the best treatment option, it can be done via an abdominal incision or laparascopically.

• Barrett's Columnar replaces Squamous in Barrett’s oesophagus.
• This is also known as small intestinal (columnar) metaplasia.
• There is increased risk of oesophageal adenocarcinoma.
• Nitrates, caffeine and alcohol can help relieve symptoms by relaxing lower oesophageal tone.
• Not all patients with GORD should undergo an OGD (should be considered if GI bleeding or symptoms of dysphagia occur).
• Oesophagitis is present in half of GORD patients.
• Oesophageal manometry or oesophageal motility study measures the strength of the lower oesophageal sphincter. This would rule out achalasia.

• Mallory-Weiss tears are usually caused by forceful or prolonged vomiting or coughing.
• They may also be caused by epileptic convulsions.
• The tear may be followed by vomiting bright red blood or by passing blood in the stool.
• The incidence is 4 in 100,000 people. Achlorhydria (absence of gastric acid secretion) can be caused by immune destruction to the stomach wall, malnutrition and marijuana use. The pentagastrin testis used as a diagnostic aid for evaluation of gastric acid secretory function

Category: Gastroenterology Notes