Ulcerative oesophagitis

Question 1

What are 5 types of causes of oesphagitis?

Answer 1

1. Reflux oesophagitis
2. Corrosive chemical
3. Infections
4. Malignancies
5. Eosinophilic oesophagitis

Question 2

What are 4 types of infections which can cause oesophagitis?

Answer 2

1. Candida
2. Cytomegalovirus
3. Herpes simplex virus
4. Mycobacterium avium complex

Question 3

What are 2 types of malignancy which can cause oesophagitis?

Answer 3

1. Kaposi’s sarcoma
2. Lymphoma

Question 4

Which patients are particularly susceptible to oesophageal infections causing oesophagitis? 2 groups

Answer 4

1. Patients with HIV/AIDS
2. Patients taking broad-spectrum antibiotics or cytotoxic drugs - candidiasis

Question 5

What are 2 types of corrosives that can cause oesophagitis when ingested?

Answer 5

1. Household bleach
2. Battery acid

–> suicide attempts

Question 6

What are 3 types of drugs which can cause oesophagitis?

Answer 6

1. Potassium supplements
2. NSAIDs
3. Bisphosphonates

Question 7

What causes reflux oesophagitis?

Answer 7

gastro-oesophageal reflux disease due to abnormal lower oesophageal sphincter - reduced tone, inappropriate relaxation, hiatus hernia or delayed gastric empty

Question 8

What are 6 factors that contribute to gastro-oesophageal reflux disease?

Answer 8

1. Obesity, dietary factors
2. Defective oesopahgeal clearance
3. Hiatus hernia
4. Abnormal lower oesophageal sphincter - reduced tone/inappropriate relaxation
5. Delayed gastric emptying
6. Increased intrabadominal pressure

Question 9

What are 3 symptoms of oesophagitis?

Answer 9

1. Heartburn - retrosternal burning pain
2. Nausea ± vomitin
3. Odynophagia (painful swallowing)

Question 10

What investigation enables a diagnosis of oesphagitis?

Answer 10

endoscopy - allows direct visualisation and can be used to grade degree of oesophagitis

Question 11

What are 2 types of scoring systems that can be used to grade the degree of oesophagitis on endoscopy?

Answer 11

1. Savary-Miller grading system
2. Los Angeles grading system

Question 12

What procedure may be performed at the same time as endoscopy for oesohpagitis?

Answer 12

biopsy

Question 13

What are 2 investigations which can be used for diagnosing reflux oesophagitis?

Answer 13

1. Oesophageal pH monitoring
2. Endoscopy

Question 14

What is the management of reflux oesophagitis? 2 aspects

Answer 14

1. conservative: lifestyle - weight loss, stopping smoking, reducing alcohol intake
2. pharmacological; full-dose PPI for one month

Question 15

What is the commonest cause of oesphagitis?

Answer 15

reflux

Question 16

In which individuals is eosinophilic oesophagitis more common?

Answer 16

children, increasingly recognised in young adults

more in atopic individuals

Question 17

What is eosinophilic oesophagitis?

Answer 17

eosinophilic infiltration of the oesophageal mucosa

Question 18

What are 4 key symptoms of eosinophilic oesophagitis?

Answer 18

1. Dysphagia
2. Food bolus obstruction
3. Chest pain
4. Vomiting

Question 19

What may be seen on endoscopy in eosinophilic oesophagitis?

Answer 19

usually normal but mucosal rings, strictures or narrow-calibre oesophagus can occur

Question 20

What management may work to treat eosinophilic oesophagitis in children?

Answer 20

elimination diets

Question 21

What are 2 aspects of the management of eosinophilic oesophagitis?

Answer 21

1. 8-12 weeks topical glutocorticoids (e.g. fluticasone or metamethasone) using metered-dose inhaler but swallow rather than inhale
2. In adults: PPIs

Question 22

How long should topical steroids be used to treat eosinophilic oesophagitis?

Answer 22

8-12 weeks