Gastritis & GORD

Question 1

Define gastritis

Answer 1

Inflammation of the stomach mucosal lining

Question 2

Gastritis classifications

Answer 2

• Antral or pangastritis
• Acute or chronic gastritis
• Erosive or non-erosive

Question 3

RFs for Gasritis

Answer 3

ALCOHOL
NSAIDs
HPylori
HLA-DR3 B8
Granulomas

Question 4

Acute gastritis

Answer 4

inflammation of the gastric mucosa

Question 5

Chronic gastritis

Answer 5

chronic inflammation of gastric mucosa → epithelial metaplasia, mucosal atrophy and gland loss. Metaplasia may also lead to dysplasia and so there is risk of cancer.

Question 6

Aetiology of acute gastritis

Answer 6

Helicobacter pylori
Alcohol abuse
Stress
NSAIDs

Question 7

Aetiology of chronic gastritis

Answer 7

H pylori 80%
Autoimmune gastritis

Question 8

How does H pylori cause gastritis

Answer 8

• Causes severe inflammatory response
• Gastric mucus degradation and increased mucosal permeability, which is directly cytotoxic to the gastric epithelium: since H.pylori produces urease which converts urea to ammonia and CO2 which is toxic since ammonia and H+ (from HCl) form ammonium which damages gastric mucosa resulting in less mucous production.

Question 9

What are the different types of gastritis

Answer 9

Type a -autoimmune
Type b- antral gastritis - h pylori
Reflux gastritis- bile refluxes into stomach
Erosive- due to nsaids
Stress ulceration- a result of mucosal ischaemia

Question 10

Explain the background of autoimmune chronic gastritis

Answer 10

Parietal cell antibodies
and intrinsic factor antibodies in fundus and body of stomach → reduce vit B12 absorption in terminal ileum → pernicious anaemia

Question 11

How doe NSAIDs like naproxen cause gastritis

Answer 11

Inhibit prostaglandins (which stimulate mucus production) via the inhibition of cyclo-oxygenase resulting in less mucus production and thus gastritis

Question 12

Signs and symptoms of gastritis

Answer 12

Dyspepsia
Epigastric pain
Anorexia
N&V

Question 13

Investigations for gastritis

Answer 13

Helicobacter pylori infection - Urea breath test
Biopsy
Stool antigen test - H pylori
Endoscopy
Autoimmune antibodies

Question 14

Differential diagnoses for gastritis

Answer 14

Peptic ulcer disease (PUD)
GORD
Gastric carcinoma

Question 15

Management of gastritis

Answer 15

H pylori eradication - triple therapy PPI and 2 antibiotics twice a day for 7 days
Stop nsaids
No alcohol

Question 16

First line management of gastritis if H pylori positive

Answer 16

PPI+ Amoxicillin. 1g + clarithromycin 500mg

Question 17

Complications of gastritis

Answer 17

Peptic ulcers
Bleeding and anaemia
MALT lymphoma
Gastric cancer
Vitamin B12 deficiency

Question 18

What happens once you lose mucin

Answer 18

Excess acid can enter the stomach lining this can cause an ulcer

Question 19

How would you reverse the mucosal ischamaie

Answer 19

Treat with colloids

Question 20

how would you reduce acid in stomach

Answer 20

hydrogen blocker
proton pump inhibitor

Question 21

What is GORD

Answer 21

Reflux of gastric contents into the oesophagus due to lower oesophageal sphincter relaxation

Question 22

Risk factors for GORD

Answer 22

Obesity
Pregnancy
Hiatus Hernias
NSAID’S
Alcohol

Question 23

Physiology of GORD

Answer 23

O propels food into stomach via perilstalsis > at gastro-o junction LOS relaxes so food can enter stomach > after entry contracts to prevent reflux of stomach contents

If LOS relaxes or becomes loose due to drop in pressure stomach content will wash back into oesophagus

Question 24

pathophysiology in GORD

Answer 24

• LOS pressure gets lower - reflux for longer - pathological
• Persistent acid reflux damages the oesophageal mucosa, causing local inflammation > oedema + erosion of mucosa
• As the epithelium is damaged, it is replaced by scar, making the walls thicker and the lumen narrower

Question 25

Signs and symptoms of GORD

Answer 25

- Heartburn - retrosternal burning chest pain - Regurgitation - epigastric pain - dysphagia

Question 26

Why is GORD worse when lying down

Answer 26

easier for acid to regurgitate

Question 27

In what patients with suspected gord would you use an urgent 2 week referral

Answer 27

Dysphagia or over 55 with weight loss and one of the following - Upper abdo pain - Reflux - Dyspepsia

Question 28

what may endoscopy show for GORD

Answer 28

- Oesophagitis - Barrets oesophagus

Question 29

Clinical investigations for GORD

Answer 29

-FBC -24HR pH monitoring - Upper GI Endoscopy

Question 30

Conservative management of GORD

Answer 30

- SMOKING CESSATION - reduce alcohol - lose weight - eat smaller meals

Question 31

Medical management of GORD

Answer 31

- GAVISCON - PPI or H2 receptor antagonists id CI Lifestyle changes - eat better dktn smoke dietery modifications

Question 32

What is a common complication of GORD

Answer 32

- metaplasia of stratified squamous to simple columnar epithelium

Question 33

Complications of GORD

Answer 33

- **Typical reflux syndrome** - **Reflux chest-pain syndrome** - **Barrett’s oesophagus** (premalignant condition in the oesophagus due to columnar metaplasia) - **Reflux cough syndrome** - **Reflux laryngitis syndrome:** reflux goes all the way up to throat and down the larynx - **Reflux asthma syndrom**

Question 34

Last resort management of GORD

Answer 34

Surgical tightening of LOS

Question 35

What is barrets oesophagus

Answer 35

metaplasia of stratified squamous non keratinising epithelia to simple columnar causes the oesophagus to be red and inflamed

Question 36

what does barrets oesophagus increase the likelihood of?

Answer 36

adenocarcinoma