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Section VIII: Disorders of the Gastrointestinal System

The advantages of endoscopy over barium radiography in the evaluation of dysphagia include all of the following EXCEPT:

A. Ability to assess function and morphology

B. Ability to intervene as well as diagnose

C. Ability to obtain biopsy specimens

D. Increased sensitivity for the detection of abnormalities identified by color, e.g. Barrett metaplasia

E. Increased sensitivity for the detection of mucosal lesions

The answer is A. (Chap. 347) Endoscopy, also known as esophagogastroduodenoscopy (EGD) is the best test for evaluation of the proximal gastrointestinal tract. Because of high-quality images, disorders of color such as Barrett metaplasia and mucosal irregularities are easily demonstrated. Sensitivity of endoscopy is superior to that of barium radiography for mucosal lesions. Because the endoscope has an instrumentation channel, biopsy specimens are easily obtained, and dilation of strictures can also be performed. The sensitivity of radiography compared with endoscopy for detecting reflux esophagitis reportedly ranges from 22%–95%, with higher grades of esophagitis (i.e., ulceration or stricture) exhibiting greater detection rates. Conversely, the sensitivity of barium radiography for detecting esophageal strictures is greater than that of endoscopy, especially when the study is done in conjunction with barium-soaked bread or a 13-mm barium tablet. Barium studies also provide an assessment of esophageal function and morphology that may be undetected on endoscopy. The major shortcoming of barium radiography is that it rarely obviates the need for endoscopy. Barium radiography does not require sedation, which in some populations at risk for conscious sedation is an important consideration.

A 47-year-old man is evaluated in the emergency department for chest pain that developed at a restaurant after swallowing a piece of steak. He reports intermittent episodes of meat getting stuck in his lower chest over the past 3 years, but none as severe as this event. He denies food regurgitation outside of these episodes or heartburn symptoms. He is able to swallow liquids without difficulty and has not had any weight loss. Which of the following is the most likely diagnosis?

A. Achalasia

B. Adenocarcinoma of the esophagus

C. Esophageal diverticula

D. Plummer-Vinson syndrome

E. Schatzki ring

The answer is E. (Chap. 347) Intermittent solid food dysphagia is a classic symptom in Schatzki ring in which a distal esophageal ring occurs at the squamocolumnar mucosal junction. The origin of these rings is unknown, and smaller rings with a lumen of greater than 13 mm are common in the ...

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