Review Questions

• What is the etiology of achalasia?

  Achalasia is characterized by the loss of ganglion cells within the oesophageal myenteric plexus.
• What are the three classifications of achalasia?

  The classifications include Type I (classic achalasia), Type II (achalasia with pan-oesophageal pressurization), and Type III (spastic achalasia with premature or spastic contractions).
• What is the pathogenesis of achalasia?

  Achalasia involves both excitatory (cholinergic) and inhibitory (nitric oxide) ganglionic neurons, leading to impaired lower oesophageal sphincter (LES) relaxation and absent peristalsis.
• What are the clinical signs of achalasia?

  Clinical signs include dysphagia, regurgitation, chest pain, weight loss, and respiratory issues such as bronchitis, pneumonia, or lung abscess due to chronic regurgitation and aspiration.
• What are some common symptoms of achalasia?

  Symptoms include dysphagia, regurgitation, chest pain, and heartburn.
• What are the potential complications of achalasia?

  Complications may include stasis esophagitis and oesophageal squamous cell cancer.
• How is achalasia diagnosed?

  Diagnosis is typically made through barium swallow x-ray and oesophageal manometry.
• What conditions are included in the differential diagnosis of achalasia?

  Differential diagnoses include DES, Chagas’ disease, and pseudoachalasia.
• What management strategies are used for achalasia?

  Management includes promoting oesophageal emptying through pneumatic balloon dilation, surgical myotomy, and muscle relaxants like nitroglycerin and nifedipine.
• What is a common treatment option for achalasia?

  Pneumatic dilation and Heller myotomy are common treatment options for achalasia
• What is the primary etiology of diffuse oesophageal spasm?

  Diffuse oesophageal spasm is characterized by the impairment of inhibitory myenteric plexus neurons.
• What are the clinical signs associated with diffuse oesophageal spasm?

  Clinical signs include abnormal oesophageal contractions, often presenting as spontaneous and repetitive contractions, with a normal lower oesophageal sphincter.
• What symptoms are commonly observed in patients with diffuse oesophageal spasm?

  Symptoms include dysphagia, chest pain, regurgitation, and heartburn.
• How is diffuse oesophageal spasm diagnosed?

  Diagnosis can be made through radiography, manometry, and endoscopy.
• What conditions should be considered in the differential diagnosis of diffuse oesophageal spasm?

  Differential diagnoses include angina pectoris and peptic or infectious oesophagitis.
• What are the treatment options for diffuse oesophageal spasm?

  Treatment may involve long myotomy or oesophagectomy.
• What potential complications may arise from untreated diffuse oesophageal spasm?

  Complications may include persistent dysphagia, chest pain, and an increased risk of developing other oesophageal disorders.
• How does the pathophysiology of diffuse oesophageal spasm contribute to its clinical presentation?

  The impaired function of inhibitory myenteric plexus neurons leads to abnormal oesophageal contractions, resulting in characteristic symptoms such as dysphagia and chest pain.
• What distinguishes diffuse oesophageal spasm from other motility disorders of the oesophagus?

  Unlike other motility disorders, diffuse oesophageal spasm presents with spontaneous and repetitive contractions throughout the oesophagus, often resembling a "corkscrew oesophagus" on radiography.
• How does the management approach for diffuse oesophageal spasm differ from that of achalasia?

  While achalasia typically requires interventions to disrupt LES function, diffuse oesophageal spasm may be managed conservatively with lifestyle modifications or surgical intervention for severe cases.
• What are the primary etiological factors contributing to GERD?

  The primary etiological factors include transient lower oesophageal sphincter (LES) relaxations, LES hypotension, hiatal hernia, and impaired oesophageal clearance mechanisms.
• What are some common risk factors associated with GERD?

  Common risk factors include obesity, smoking, alcohol consumption, pregnancy, certain medications (e.g., calcium channel blockers, nitrates), and scleroderma gastroparesis.
• How is GERD classified?

  GERD is classified into erosive esophagitis, non-erosive reflux disease (NERD), Barrett's oesophagus, and reflux-induced respiratory or laryngeal symptoms (extraoesophageal reflux).
• What are the clinical signs of GERD?

  Clinical signs may include erosions, ulcerations, and strictures in the oesophagus.
• What symptoms are commonly associated with GERD?

  Common symptoms include dysphagia, heartburn (retrosternal burning), regurgitation, chronic cough, hoarseness, and exacerbation of asthma.
• What complications can arise from untreated GERD?

  Complications may include bleeding, stricture formation, Barrett's oesophagus (metaplasia), adenocarcinoma, dental erosions, and aspiration pneumonia.
• How is GERD diagnosed?

  Diagnosis often involves endoscopy, biopsy, manometry, and barium swallow.
• What conditions should be considered in the differential diagnosis of GERD?

  Differential diagnoses include peptic ulcer, eosinophilic oesophagitis, functional dyspepsia, angina, and myocardial infarction.
• What are the management strategies for GERD?

  Management typically includes lifestyle changes (e.g., dietary modifications, weight loss) and medication (e.g., proton pump inhibitors, H2 antagonists).
• What is a common surgical treatment option for GERD?

  Laparoscopic Nissen fundoplication is a common surgical option for managing GERD, especially in cases resistant to medical therapy.