Esopha-function disease.ppt

Esophagus Function Diseases Klaus Bielefeldt, M.D., Ph.D. Division of Gastroenterology Scope of the Talk Esophageal structure Esophageal function Esophageal disorders Gastroesophageal reflux disease Esophageal motility disorders / dysphagia What Does it Do? Propulsion of a food bolus along the pharyngo-esophageal conduit. volitional (primary) reflex (secondary) Protection of airways. Prevention of reflux / regurgitation. Volitional Swallowing From there on Down Let’s Start the Trip Down it Goes Getting Out See the Pattern Not Just Will Power What are the Signals? Control of contraction Control of propagation Control of LES relaxation Therapeutic targets? Experimental Data Experimental Data LES Human Correlate Bottom Line Bolus transport from the oropharynx to the stomach is complex, involving multiple cranial nerves, striated and smooth muscle structures. Cholinergic agonists give power. NO relaxes and delays. Disorders Burning or hot sensation in the retrosternal or epigastric area. Exacerbation by food intake (greasy or spicy meals; acidic food), caffeine, recumbent body position. Alleviated by antacids, milk. Associated with “water brash” (saliva production) and acidic / bitter taste. How Common is Heartburn? Gastric Acid – A Looming Threat Mechanisms of RefluxImpaired Barrier Function Take Home Message Several mechanisms contribute to the maintenance of a normal esophageal pH. A hiatal hernia predisposes to reflux ( may be caused by reflux). What Do We Look For? Symptoms mucosal injury. Symptoms no mucosal injury. Take Home Message Heartburn / GERD is very common. Empiric therapy with acid suppression is the most cost effective approach in patients with uncomplicated heartburn. Endoscopy is the diagnostic method of choice to grade severity and identify complications. Compare Contrast Complications of GERD Stricture formation. Barrett’s metaplasia. Extraesophageal complications. Barrett’s Metaplasia Case - 2 What is Dysphagia? Oropharyngeal Dyspha