Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach

Question 1

What happens to the quality of life for patients with refluc

Answer 1

It decreases and can be similar to quality of life of a patient with an acute coronary event

Question 2

Why does reflux occur

Answer 2

Incompetent Lower Oesophageal sphincter
Poor oesophageal clearance
Barrier/ function / Visceral senstitivity (some mucus for protection but if changed, an ulcer can form)

Question 3

What are the symptoms of reflux

Answer 3

Heartburn
Acid reflux 
Waterbrash
Dysphagia
Odynophagia
Weight loss
Chest pain
Hoarseness
Coughing

Question 4

What investigations are carried out for reflux

Answer 4

Endoscopy
Ba swallow
Oesophageal manometry (measures pressure) & pH studies (probe and leave down for 24-48 hours - they will confirm with a diary)
Nuclear studies

Question 5

How much of the population get reflux symptoms

Answer 5

40%

Question 6

Who should we investigate

Answer 6

Weight loss
Anaemia
Vomiting 
F/H UGI cancer
Barrett's (10% of patients reflux patients)
Pernicious Anaemia (association with cancer)
PUD surgery >20 years 
Dysphagia

Question 7

What are the grades for oesophagitis

Answer 7

Grade A -
Grade B =
Grade C
Grade D -

Question 8

What is achatsies ring?

Answer 8

Caused by acid reflux

Question 9

Who is most likely to get oesophageal carcinoma?

Answer 9

Males

Question 10

What are the treatment options for oesophageal carcinoma?

Answer 10

Radiotherapy
Surgery
Palliation (treat symptoms only)

Question 11

What is the 5 year survival rate?

Answer 11

5-10%

Question 12

What causes an increase in oesophageal adenocarcinoma?

Answer 12

More reflux

Question 13

What causes a decrease in squamous cell carcinoma?

Answer 13

I dont know

Question 14

What is the pathogenesis of adenocarcinoma

Answer 14

Normal
Oesophagitis (reversible)
Barrett’s (Irresversible?)
Adenocarcinoma (too late)

Question 15

What is the management of GORD

Answer 15

Doubling the dose of PPI therapy
Adding an H2RA at bedtime
Extending the length of treatment
Surgery

Question 16

What lifestyle modifications can be made for reflux?

Answer 16

Stop smoking
Lose weight if obese
Prop up the bed head
Avoid provoking factors

Question 17

GIve two types of H2 antagonists

Answer 17

Cinetidine

Ranitidine

Question 18

How does cinetidine work?

Answer 18

Rapid symptom relief

Less effective at healing than placebo

Question 19

How does ranitidine work?

Answer 19

Tolerance after 4 week therapy

Poor in preventing ….

Question 20

What are Proton pump inhibitors (PPI)

Answer 20

Block the hydrogen pump that makes the acid in the first place. It is irreversibly bound to it.

Question 21

What happens after 8 hours of taking a PPI

Answer 21

only half of the proton pumps remain blocked

Question 22

What do the proton pumps do?

Answer 22

Heal the mucosa

Relieve the symptoms

Question 23

What is the correct dose of Lansoprazole for healing and maintenance?

Answer 23

20mg or 30mg for healing and maintenance

Question 24

What are the benefits of surgery in GORD

Answer 24

Controls symptoms
Heals oesophagitis
Cost effective for Young patients (dont need to have them on PPI for a long period of time)
Severe / unresponsive disease

Question 25

What define's Barratts oesophagitus

Answer 25

Intestinal Metaplasia Irreversible Increased risk of adenocarcinoma

Question 26

How can we manage dysplasia

Answer 26

``` More frequent surveillance Optimise PPI (if on suboptimal dose) Endoscopic mucosal resection Radiofrequency abalation (HALO) to abalate the rest of the mucus. Argon ```

Question 27

What can a Hiatus hernia do?

Answer 27

Can be sliding or just push the oeophagus upwards causing reflex

Question 28

What is gastroparesis

Answer 28

Delayed gastric emptying with no physical obstruction

Question 29

What are the symptoms of gastroparesis

Answer 29

``` Feeling of fullness / bloating Nausea Vomiting Weight loss Upper abdominal pain ```

Question 30

What are the causes of gastroparesis

Answer 30

Idiopathic Diabetes mellitus Cannabis Medication e.g. opiates, anticholinergics Systemic diseases e.g. systemic sclerosis

Question 31

What investigations are done for gastroparesis

Answer 31

Gastric emptying studies (images of stomach using isotopes to calculate how long it takes to empty)

Question 32

WHat can we do to manage gastroparesis

Answer 32

Removal of precipitating factor se.g. drugs Liquid / slopy diet Eat little and often Promotility

Question 33

What is achalasia?

Answer 33

Relatively uncommon condition Lower OS is in spasm requires surgery cut longitudinally through sphincter, separate the fibres and pull them back Now can be dilated with a balloon but can be dangerous

Question 34

How do we manage achalasia ?

Answer 34

Use of Botulinum toxin