Gastro-oesophageal pathology

Question 1

What is the aetiology of hiatus hernia?

Answer 1

• Increased intra-abdominal pressure (e.g. obesity, pregnancy, trauma, low residue diet).
• Diaphragmatic laxity (e.g. previous surgery, connective tissue disorders)

Question 2

What is Barrett’s oesophagus?

Answer 2

Metaplasia of the epithelial cells of the lower part of the oesophagus. (columnar- lined oesophagus).

Question 3

What are the symptoms of acute gastritis?

Answer 3

Dyspepsia, heartburn, nausea, vomiting, epigastric pain

Question 4

What is the aetiology of gastritis?

Answer 4

Alcohol, smoking, aspirin, NSAIDs, chemotherapy, H. Pylori, HSV, CMV, stress, trauma, burns.

Question 5

What are the symptoms of chronic gastritis?

Answer 5

Usually symptoms are absent or mild (without complications)- episodic pain, nausea +/- vomiting

Question 6

What percentage of peptic ulcers are duodenal?

Answer 6

75%

Question 7

What percentage of peptic ulcers are gastric?

Answer 7

25%

Question 8

What is peptic ulcer disease?

Answer 8

Ulceration of the GI mucosa caused by exposure to the action of gastric acid and pepsin.

Question 9

Complications of peptic ulcers?

Answer 9

Bleeding, perforation, fibrosis, stricture, obstruction, anaemia, pain, increased risk of malignancy.

Question 10

Stomach cancer is particularly common in which country?

Answer 10

Japan (due to diet)

Question 11

Where do GI cancers classically metastasise to?

Answer 11

Liver and lungs

Question 12

What is achalasia?

Answer 12

Loss of nitrergic ‘relaxing’ neurons, causing an aperistaltic oesophagus.

Achalasia is primarily a disorder of motility of the lower oesophageal or cardiac sphincter - food often gets stuck and is brought back up.

Question 13

How do we treat achalasia?

Answer 13

Treatment is aimed at disrupting the lower oesophageal sphincter:

• Botulinum toxin
• Dilatation
• Surgery

Question 14

What is functional dyspepsia?

Answer 14

Pain or discomfort in the upper abdomen with no definite structural or biochemical explanation.
Treated with CBT, tricyclics.

Question 15

Where are the 3 narrow points of the oesophagus?

Answer 15

1) Cricopharyngeal sphincter
2) Where it is crossed by the arch of the aorta and the Left main bronchus.
3) Where it passes through the diaphragm

Question 16

How is dysphagia in cancer different from other causes of dysphagia?

Answer 16

Progression from dysphagia of solids to dysphagia of liquids (over time).

Question 17

What is a Mallory Weiss tear? What are the causes?

Answer 17

A tear in the mucosa at the junction between the oesophagus and the stomach.

Caused by severe alcoholism, retching, coughing or vomiting.

Question 18

What are the two complications of GORD?

Answer 18

Oseophageal stricture formation

Barrett’s oesophagus

Question 19

What causes odynophagia?

Answer 19

Oesophagitis (due to GORD)
Infections of oesophagus (HSV, candida)
Drugs, such as slow release potassium and bisphosphonates

Question 20

How can we treat Barrett’s oesophagus?

Answer 20

1) oesophagectomy (young fit patients)
2) endoscopic mucosal resection (localised areas)
3) endoscopic ablative therapies (e.g. photodynamic therapy, radiofrequency ablation)

Question 21

How do we treat achalasia?

Answer 21

Surgical:
Endoscopic balloon dilatation OR Heller’s cardiomyotomy: surgical division of the LOS.

Medical (in e.g. elderly and frail who cannot undergo surgery): oral nitrates, nifedipine, endoscopic botulinum toxin injection into the LOS.

Question 22

What are the two types of hiatus hernia? How common is each type?

Answer 22

1) Sliding (where the gastro-oesophageal junction slides up and lies above the diaphragm). ~95%.
2) Rolling/para-oesophageal (where the gastric fundus rolls up alongside the oesophagus, leaving the G-O junction below the diaphragm). Uncommon.