GORD

Question 1

What is GORD?

Answer 1

Acid from the stomach refluxes through lower oesophageal sphincter + irritates lining of the oesophagus

Question 2

Why is the oesophagus more sensitive to the effects of stomach acid?

Answer 2

• -> oesophagus lined w/ squamous epithelium

- -> stomach lined w/ columnar epithelium

Question 3

Presentation?

Answer 3

Dyspepsia (non-specific, indigestion):

(1) Heartburn
(2) Retrosternal OR epigastric pain
(3) Acid regurgitation
(4) Bloating
(5) Nocturnal cough
(6) Hoarse voice

Question 4

Action - if a patient also presents with a GI bleed (melaena or coffee ground vomiting)?

Answer 4

Admit for urgent endoscopy

Question 5

Action - if a patient also presents with signs of cancer?

Answer 5

Admit for 2-ww endoscopy (endoscopy within 2 weeks)

Question 6

Red flag features?

Answer 6

(1) DYSPHAGIA - 2ww independent of age
(2) >55yo - cut off between urgent vs. routine referral
(3) weight loss
(4) upper abdo pain + reflux
(5) indigestion resistant to treatment
(6) N&V
(7) Low Hb
(8) Raised platelet count

Question 7

Lifestyle advice?

Answer 7

• Reduce tea/coffee/alcohol
• Weight loss
• Avoid smoking
• Smaller, regular meals
• Avoid heavy meals before bed –> sit upright after eating

Question 8

Medication options?

Answer 8

(1) Acid neutralising –> gavison/rennie

(2) PPIs –> omeprazole/lansoprazole

Question 9

Alternative medication to PPI?

Answer 9

Ranitidine (H2 receptor antagonist)

Question 10

Surgical option (rare)

Answer 10

Laparoscopic fundoplication

Question 11

What is Helicobacter Pylori?

Answer 11

Gram negative aerobic bacteria that lives in the stomach.

Can damage lining causing gastritis, ulcers + increases stomach cancer risk

Question 12

How does in damage the stomach lining?

Answer 12

Enters and breaks gastric mucosa –> exposes epithelial lining to acid.
Produces ammonia –> directly damages epithelial lining

Question 13

Who do you test for H.Pylori?

Answer 13

Anyone with dyspepsia - requires 2 weeks without a PPI

Question 14

Tests for H.Pylori?

Answer 14

(1) Urea breath test (C-13)
(2) Stool antigen test
(3) Rapid urease test (CLO) - during endoscopy (alkaline pH)

Question 15

Eradication regime for H. Pylori?

Answer 15

TRIPLE THERPAY:
1x PPI (omeprazole)
2x antibiotics (amoxicillin + clarithromycin)

For 7 days

Question 16

What test can be used to test whether H.Pylori is eradicated?

Answer 16

C-13 breath test

Question 17

Cancer most associated with H.Pylori?

Answer 17

Gastric cancer

Question 18

Outline changes occur to Barretts oesophagus?

Answer 18

Lower oesophageal epithelium undergoes METAPLASIA from SQUAMOS epithelium to COLUMNAR

Question 19

What typically happens to reflux symptoms if Barrett’s oesophagus develops?

Answer 19

Symptoms improve!

Question 20

Barrett’s oesophagus puts you at risk of what?

Answer 20

Risk of columnar epithelium to progress to:

(1) low grade dysplasia
(2) high grade dysplasia
(3) ADENOCARCINOMA

Question 21

Treatment of Barrett’s oesophagus?

Answer 21

PPI (omeprazole) + Endoscopic/biopsy surveillance

Question 22

Treatment of Barrett’s if evidence of dysplasia?

Answer 22

Ablation treatment during endoscopy:

• endoscopic mucosal resection (EMR) OR
• radiotherapy ablation (photodynamic, laser, cryotherapy)

Question 23

Treatment option for high-grade dysplasia Barrett’s oesophagus?

Answer 23

Endoscopic mucosal resection (EMR) > oesophagectomy

Question 24

Most common type of oesophageal cancer in the UK/US?

Answer 24

Adenocarcinoma

Question 25

Most common type of oesophageal cancer in the developing world?

Answer 25

Squamous cell cancer

Question 26

Where are adenocarcinomas found in the oesophagus?

Answer 26

Near the gastro-oesophageal junction (lower 1/3)

Question 27

Where are squamous cell cancers found in the oesophagus?

Answer 27

upper 2/3rds

Question 28

Risk factors for adenocarcinoma (oesophagus)?

Answer 28

1) GORD –> Barrett’s oesophagus
2) Smoking
3) Achalasia
4) Obesity