This document discusses various gastrointestinal conditions and the appropriate diagnostic tests and treatments. It presents several case studies and identifies the following key points: 1. For a patient with vague epigastric pain, esophageal pH monitoring can help determine if gastroesophageal reflux is the cause. 2. A patient with longstanding heartburn and acid reflux symptoms should undergo endoscopy to check for esophagitis or Barrett's esophagus. 3. Manometry is the best test for evaluating a patient with symptoms of achalasia. 4. A smoker with progressive dysphagia requiring investigation with endoscopy and biopsy to identify esophageal cancer followed by CT scan to determine operability.

1. Professor Reda Abd Eltawab
January 2010

2. Typically there is no difficulty in understanding
the symptomatology of oesophageal diseases and
easy to diagnose the condition but you may be
confused about the varieties of investigations .
 X ray with barium or gastrographin
 Endoscopy and biopsy
 Manometry
 PH monitoring
Which of the tests in a particular situation will be
best for the pt?

3.  A 62 years old man describes epigastric and
substernal pain that he can not characterize
well. At times his description sounds like
gastro esophageal reflux, at times it does not.
 US of the gall bladder, ECG and cardiac
enzymes are negative.
 What is the best investigation to be done?
Esophageal pH monitoring

4.  53 y man gives history of burning retrosternal
pain and heart burn that is brought about by
bending over, wearing tight clothes or lying
flat in bed at night. He gets symptomatic relief
from antacids, but has never been formally
treated. The problem has been present for
many years and seems to be progressive.
 Diagnosis
 GERD
 But what damage affected the esophagus
 So endoscopy and biopsy

5.  54 old obese man gives a history of burning
retrosternal pain and heart burn that is brought about
by bending over, wearing tight clothing or lying flat in
bed at night. He gets symptomatic relief from antacids
but has never been formally treated. the problem has
been present for many years and seems to be
progressive. Endoscopy shows severe peptic
oesophagitis and barrettes oesophagus
 Management?
 Biopsy
 Treatment
 Nissen fundoplication not proton pump inhibitors for
long time

6.  47 y woman describes difficult swallowing
which she has had for many years. She says
that liquids are more difficult to swallow than
solids and she has learned to sit up strait and
wait some time for the fluid to make it through
occasionally she regurgitates large amount of
undigested food.
 Diagnosis?
 Achalasia
 Investigation?
 Best is manometry.

7. 1. Endoscopic Balloon Dilataion.
2. Botulinum Toxin injection.
3. Heller’s Cardiomyotomy(open or
laparoscopic).

8.  54 y man with a history of smoking and drinking
describes progressive dysphagia that began 3
months ago, with difficulty swallowing meat,
progressed to other solid food then soft food and
now even for liquids as well. He locates the site
where food sticks at the lower part of sternum and
he lost 20 Kgm of his body weight over the last 2
months.
 Diagnosis?
 Cancer oesophagus
 What is the next step?
 Endoscopy and Biopsy
 Ct scan to determine operability

9.  24 young man spent the night cruising bars
and drinking heavily. By the early hours of the
morning he was quite drunk and started
vomiting repeatedly
He initially brings gastric contents only
But eventually he vomits bright red blood
 Diagnosis?
 Mallory weiss syndrome
 Treatment:
 Endoscopy and photocoagulation

10.  A 46 ys old obese lady suffers for many years
from flatulance and upper abdominal
discomfort following fatty meals.
Recently she suffered from repeated attacks of
severe upper abdominal colicky pain that is not
relieved except at the hospital by receiving
injections to stop the pain.
 Last attack was associated with fever and
rigors and dark discoloration of urine and she
was admitted to the hospital.
 Management?

11.  74 y man has lost 20 kgm of his body wt over a
2 month period he gives a history of anorexia
for several months and a vague epigastric
discomfort for the past 3 weeks
 Investigation?
 Endoscopy and biopsy
 If cancer ask for a CT scan
 Then surgery