Podcast
Questions and Answers
What is the vagus nerve's primary innervation to the oesophagus?
What is the vagus nerve's primary innervation to the oesophagus?
Where does the oesophagus start proximally?
Where does the oesophagus start proximally?
What is a major protective factor preventing GORD?
What is a major protective factor preventing GORD?
What is the primary mechanism of Gaviscon in treating GORD?
What is the primary mechanism of Gaviscon in treating GORD?
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Which of the following is NOT a symptom of GORD?
Which of the following is NOT a symptom of GORD?
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What is the primary difference between GORD and angina pectoris?
What is the primary difference between GORD and angina pectoris?
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Which of the following foods may exacerbate GORD?
Which of the following foods may exacerbate GORD?
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What is the anatomical location where the oesophagus is surrounded by collagen and elastic fibres?
What is the anatomical location where the oesophagus is surrounded by collagen and elastic fibres?
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What is the primary physiological stimulant of hydrochloric acid secretion?
What is the primary physiological stimulant of hydrochloric acid secretion?
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What is the role of somatostatin in acid secretion?
What is the role of somatostatin in acid secretion?
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What is the primary mechanism of mucosal defense against hyperacidity?
What is the primary mechanism of mucosal defense against hyperacidity?
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What is the characteristic of abdominal pain in peptic ulcer disease?
What is the characteristic of abdominal pain in peptic ulcer disease?
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What is a potential complication of peptic ulcer disease?
What is a potential complication of peptic ulcer disease?
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What is the role of the vagus nerve in acid secretion?
What is the role of the vagus nerve in acid secretion?
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What is a risk factor for peptic ulcer disease?
What is a risk factor for peptic ulcer disease?
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What is the timing of basal acid secretion in the body?
What is the timing of basal acid secretion in the body?
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What is the primary function of the lower gastroesophageal sphincter (LES)?
What is the primary function of the lower gastroesophageal sphincter (LES)?
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Which of the following substances can affect the lower gastroesophageal sphincter (LES)?
Which of the following substances can affect the lower gastroesophageal sphincter (LES)?
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What is the primary mechanism of action of antacids in treating gastroesophageal reflux disease (GORD)?
What is the primary mechanism of action of antacids in treating gastroesophageal reflux disease (GORD)?
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Which of the following is a non-drug management option for gastroesophageal reflux disease (GORD)?
Which of the following is a non-drug management option for gastroesophageal reflux disease (GORD)?
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What is the primary function of the vagus nerve in relation to the esophagus?
What is the primary function of the vagus nerve in relation to the esophagus?
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What is the primary mechanism of action of proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease (GORD)?
What is the primary mechanism of action of proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease (GORD)?
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Which of the following is a common side effect of antacids?
Which of the following is a common side effect of antacids?
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What is the primary mechanism of action of H2 blockers in treating gastroesophageal reflux disease (GORD)?
What is the primary mechanism of action of H2 blockers in treating gastroesophageal reflux disease (GORD)?
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Study Notes
The Oesophagus
- The adult oesophagus is a flat, muscular tube that starts proximally at the pharynx (pharyngoesophageal junction) and ends at the stomach (gastroesophageal junction).
- At the level of the diaphragm, the oesophagus is surrounded by collagen and elastic fibres.
- The vagus nerve supplies only parasympathetic innervation to the oesophagus, but below the neck, it carries a mixture of both sympathetic and parasympathetic nerve fibres.
Gastroesophageal Reflux Disease (GORD)
- GORD results from an imbalance between defensive factors protecting the oesophagus and aggressive factors from the stomach content.
- Protective factors include antireflux barriers (LES, crural diaphragm, costal diaphragm, and the angle of His).
- Aggressive factors include gastric acidity, volume, and gastric/duodenal content.
- GORD can be heightened by the ingestion of spicy foods and drinks, pregnancy, smoking, late snacks, and sleeping immediately after eating heavy meals.
- GORD-related chest pain may mimic angina pectoris, but can be differentiated by the duration of pain and response to antacids.
Substances that Affect LES Pressure
- Substances that affect LES pressure include peppermint, chocolate, tomatoes, onions, and alcohol.
Treatment of GORD
- Alginic or sodium alginate suspension (Gaviscon) can be used to treat GORD.
- Non-drug management of GORD includes self-directed learning.
The Stomach
- Acid peptic disorders include peptic ulcer disease (PUD), which affects millions of people worldwide.
- Three major PUDs are Helicobacter pylori PUD, gastric duodenal mucosal ulceration, and nonsteroidal anti-inflammatory drugs-induced (NSAIDs) injury.
Possible Causes of PUD
- Possible causes of PUD include NSAIDs use, dyspepsia, GI bleeding, smoking, alcohol, stress, and psychological factors, and diet.
Manifestations
- Abdominal pain is a common manifestation of PUD, characterized by burning pain localized to the epigastrium, occurring 2-3 hours after meals or at night, and relieved by food or antacids.
- Ulcer complications include bleeding, perforation, and pyloric stenosis (gastric outlet stenosis).
Acid Peptic Disorders - Acid Secretion
- Basal acid (mainly HCl) secretion follows a circadian rhythm, with low secretion in the morning and high at night.
- Cholinergic and histaminergic stimulation are the main determinants of HCl secretion.
- Food ingestion is the principal physiological stimulant of HCl secretion.
- Somatostatin plays an inhibitory role in acid secretion.
Acid Peptic Disorders - Mucosal Defence
- Prostaglandins, nitric oxide, mucous, and bicarbonate (HCO3-) play a role in mucosal defence against hyperacidity.
- Other factors that contribute to mucosal defence include mucosal blood flow, stabilisation of mucosal mast cells and lysosomes, and the effects of gastric motility.
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Description
Learn about the structure and innervation of the oesophagus, including the lower gastroesophageal sphincter and its relation to the pharynx and stomach.
