Chicago classification of Achalasia

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Here I am discussing the Chicago classification and its clinical significance

 

This is based on high resolution manometry (HRM) 

Manometry evaluates the swallowing response, and weather the LES sphincter relaxation is absent or incomplete.

There are three types of Achalasia and all have incomplete LES relaxation

Type I - Body - Aperistalsis  and no pressurization

Type II Body - aperistalsis and panesophageal pressurization 

Type III - Spastic contractions and distal contractility integral (DCI) over 450 mm HG

 Type 2 achalasia had the best positive response to treatment, and type 3 the least favorable response to treatment.

The best initial treatment option for types 1 and 2 are conservative measures such as pneumatic dilatation and surgical myotomy,

while type 3 achalasia appears to respond better to initial treatment with peroral endoscopic myomectomy

Hormones released from duodenum

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Q. Which of the following hormones are not released in the duodenum?
a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY
Correct Answer: d) Pancreatic YY

  • Gastrin – secreted mainly by G-cells in the stomach, and in small amounts from the duodenum.
  • Motilin – secreted by M cells in the duodenum and jejunum.
  • Somatostatin – secreted by D-cells throughout the GI tract, including the duodenum.
  • Pancreatic YY (PYY) – secreted by L-cells in the ileum and colon, not in the duodenum.
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Esophagus MCQ

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Q) 60 yrs anemic male with dyspgagia,  crepts and foul smelling breath (AIIMS 2019 GI)

a) Plumer vinson
b) Zenkers
c) Schatzki

Bevacizumab

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Bevacizumab MCQ
Q) Not true about use of Bevacizumab
a) It is a humanized monoclonal antibody against VEGF A
b) Bevacizumab is a first-line treatment in metastatic nonsquamous non-small cell lung cancer.
c) Bevacizumab is a first-line or second-line therapy for metastatic colorectal cancer
d) Its major advantage is that it has replaced combination chemotherapy
Correct Answer: d) Its major advantage is that it has replaced combination chemotherapy
Explanation: a) True – Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), thereby inhibiting angiogenesis. b) True – Bevacizumab is used as first-line treatment in combination with chemotherapy for metastatic nonsquamous non-small cell lung cancer (NSCLC). c) True – Bevacizumab is used as first-line and second-line therapy in combination with chemotherapy for metastatic colorectal cancer. d) Not true – Bevacizumab is not a replacement for combination chemotherapy. Instead, it is used in combination with standard chemotherapy regimens to improve efficacy. It is not used as a monotherapy in most settings.