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Covers achalasia with manometry findings and stepwise therapy (balloon dilation, botox, medications, then Heller myotomy), hiatal hernias by type with repair anchoring strategies, and esophageal perforation including Boerhaave and iatrogenic causes with swallow-based diagnosis and early vs late management. Includes caustic injury principles, GERD evaluation and medical vs surgical management (Nissen fundoplication), Barrett’s surveillance and ablative techniques, and esophageal cancer risk features, staging logic, and operative complications.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cunningham-ssat-absite-prep-upper-and-lower-gi-esophagus-related-disorders/272574/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cunningham-ssat-absite-prep-upper-and-lower-gi-esophagus-related-disorders/272574.png","ImageObject",300,407,{"name":92,"@type":93},"Kurz","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-21","2026-09-15",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What are the hallmark findings and symptoms of achalasia, and how is it diagnosed?","Question",{"text":112,"@type":113},"Achalasia presents with dysphagia, regurgitation of undigested food, and cough. It features no peristalsis and failure of LES relaxation, with esophogram showing a tortuous, dilated esophagus (bird’s beak) and manometry demonstrating high pressure without relaxation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How are hiatal hernias classified, and which types carry the highest risk?",{"text":117,"@type":113},"Hiatal hernias include type 1 sliding hernia, type 2 paraesophageal, type 3 combined, and type 4 containing the entire stomach plus an additional organ in the chest. Type 2–4 have increased risk of incarceration and strangulation.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment strategies are emphasized for Barrett’s esophagus and esophageal cancer?",{"text":121,"@type":113},"Barrett’s is treated with PPI, while high-grade dysplasia requires frequent endoscopic surveillance with biopsies and consideration of radiofrequency ablation or cryotherapy; EMR may help define invasion depth. Esophageal cancer management includes endoscopy for diagnosis, and treatment with pre-op chemo-XRT to downstage when needed, followed by esophagectomy and post-op chemo for node-positive disease.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},272574,1789466174,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":41,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":143},2336478945635,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","SSAT: ABSITE Prep Upper and Lower GI  \nLisa A . Cunningham, MD  \nEsophagus  \nAchalasia  \n• Symptoms: dysphagia, regurgitation of undigested food, cough  \n• No peristalsis, LES does not relax  \n• Destruction of ganglion cells in muscle wall  \n• Esophogram: tortuous dilated esophagus, bird’s beak  \n• Manometry: high pressure, no relaxation  \n• EGD to rule out esophageal CA  \n– Can developed due to chronic irritation (SCC)  \n• Tx: Balloon dilation, botox injection into LES, nitrates, Ca channel blockers  \n• Surgery if above fails: Heller myotomy with wrap  \nHiatal Hernias  \n• Symptoms: chest pain, N/V, difficulty passing NG, bleeding from Cameron’s lesions  \n– Type 1: sliding hernia from dilation of the hiatus  \n– Type 2: paraesophageal  \n– Type 3: combined  \n– Type 4: entire stomach plus one additional organ in the chest  \n• Type 2-4 at risk for incarceration and strangulation  \n• Perform wrap +/-G tube/gastropexy to anchor stomach at time of repair  \n• Associated with Schatzki’s rings – tx with dilation not resection  \nEsophageal Perforation  \n• Symptoms: CP, back pain, dysphagia  \n• Boerhaave’s: forceful vomiting followed by severe chest pain  \n– Most common location: left lateral wall 3-5 cm above the GE junction  \n– Highest mortality of all perforations  \n• Iatrogenic Perforations: Commonly from EGD  \n– Most common location: cervical esophagus near cricopharyngeus muscle  \n• Other causes: trauma, FB ingestion, CA  \n• Diagnosis: Gastrograffin swallow  \nEsophageal Perforation  \n• Treatment:  \n– Contained on swallow with no signs of systemic illness:  \n• NPO, IVF, antibiotics  \n– Not contained:  \n• Early:  \n– Primary repair with drains » complete longitudinal myotomy » intercostal muscle flaps to buttress  \n• Late:  \n– Neck: Drainage only – will heal  \n– Chest: Resection (esophagectomy) or exclusion and diversion (esophagostomy)  \nCaustic Esophageal Injury  \n• Types:  \n– Alkali: deep liquefactive necrosis  \n– Acid: coagulative necrosis  \n• Do NOT place NG or induce vomiting  \n• Evaluation:  \n– CT scan to evaluate for perforation  \n– Endoscopy to assess injury  \n• Do not perform if CT reveals perforation  \n• Treatment:  \n– Superficial: NPO, IVF, antibiotics, serial exams  \n– Deep: starts same as above, but likely esophagectomy  \nGERD  \n• Heartburn, worse with lying down, cough  \n• Reflux of acid into the distal esophagus  \n• Medical Tx: PPI, lifestyle modifications  \n– If fails escalating doses, need further studies  \n• Dx: pH probe, endoscopy, manometry  \n• Surgery: Nissen fundoplication  \nBarrett’s Esophagus  \n• Long standing reflux  \n• Tongues of raised, salmon colored tissue extending up from GE junction  \n– Columnar metaplasia  \n• Medical Tx: PPI  \n• High grade dysplasia requires frequent (q3 monthly) endoscopies with 4 quadrant biopsies  \n– Consider radiofrequency ablation – destroys superficial tissue  \n• Decreases rate of progression to cancer compared to surveillance alone  \n– Cryotherapy (cold)  \n– EMR – resection down to submucosa, can obtain depth of invasion  \n• Esophagectomy considered for persistent HGD or if progresses to CA  \nEsophageal Cancer  \n• Adenocarcinoma most common in US – lower 1/3  \n• Spreads quickly along lymphatic channels  \n– Nodal status most important prognostic factor  \n• Symptoms that indicate likely unresectability:  \n– Hoarseness, Horner’s syndrome, phrenic nerve invasion, pleural effusions , fistulas  \n• Dx: Endoscopy  \n• Tx:  \n– Pre-op chemo-XRT can downstage tumors and make them resectable , post-op chemo for node positive disease  \n– Esophagectomy  \n• Right gastroepiploic artery – primary blood supply to gastric conduit  \n• Complications: Leaks, strictures, chylothorax","cbCaiexvjnTDSOni","https://ap.wps.com/l/cbCaiexvjnTDSOni","pdf",540818,"English","# Esophagus\n## Achalasia\n## Hiatal Hernias\n## Esophageal Perforation\n## Caustic Esophageal Injury\n## GERD\n## Barrett’s Esophagus\n## Esophageal Cancer","[{\"question\":\"What are the hallmark findings and symptoms of achalasia, and how is it diagnosed?\",\"answer\":\"Achalasia presents with dysphagia, regurgitation of undigested food, and cough. It features no peristalsis and failure of LES relaxation, with esophogram showing a tortuous, dilated esophagus (bird’s beak) and manometry demonstrating high pressure without relaxation.\"},{\"question\":\"How are hiatal hernias classified, and which types carry the highest risk?\",\"answer\":\"Hiatal hernias include type 1 sliding hernia, type 2 paraesophageal, type 3 combined, and type 4 containing the entire stomach plus an additional organ in the chest. Type 2–4 have increased risk of incarceration and strangulation.\"},{\"question\":\"What treatment strategies are emphasized for Barrett’s esophagus and esophageal cancer?\",\"answer\":\"Barrett’s is treated with PPI, while high-grade dysplasia requires frequent endoscopic surveillance with biopsies and consideration of radiofrequency ablation or cryotherapy; EMR may help define invasion depth. Esophageal cancer management includes endoscopy for diagnosis, and treatment with pre-op chemo-XRT to downstage when needed, followed by esophagectomy and post-op chemo for node-positive disease.\"}]","Cunningham - SSAT: ABSITE Prep Upper and Lower GI - Esophagus & Related Disorders | PDF",76]