Upper Gastrointestinal Tract

Question 1

What is chronic gastritis?

Answer 1

• Ongoing inflammation of the stomach mucosa. - Can provide an environment in which dysplasia and carcinoma can arise.

Question 2

What are the symptoms of chronic gastritis?

Answer 2

• Upper abdominal pain - Indigestion or bloating. - N+V - Belching - Loss of appetite/weight loss - Can be asymptomatic.

Question 3

What are the causes of chronic gastritis?

Answer 3

• Autoimmune - can lead to pernicious anaemia. - Bacterial - ‘heliobacter pylori’ infection (faecal-oral route) - Chemical - alcohol, tobacco, caffeine. - Psychological stress.

Question 4

What is the clinical presentation of chronic gastritis?

Answer 4

• 80% asymptomatic - 5-15% peptic ulcer. - 10% non-ulcer dyspepsia. - 1-3% gastic adenocarcinoma.

Question 5

What is peptic ulcer disease?

Answer 5

• Occurs in DI or antrum - common causes H.pylori (80-100% DU, 65% gastric) and NSAIDs. - Symptoms - pain (worse at night + after meals.) - Complications - bleeding leading to iron deficiency anaemia, massive haematemesis, perforation leading to peritonitis, long term cancer at the end of ulcer.

Question 6

What is Barrett’s oesophagus?

Answer 6

• Normal lining of the oesophagus stratified squamous epithelium replaced by columnar epithelium with goblet cells (usually found in lower GIT) - Thought to be adaption to chronic acid exposure from reflux. - Process of dysplasia: low grade to high grade to invasive carcinoma.

Question 7

What are the types of Upper GI Malignancy?

Answer 7

• OESOPHAGUS - 1) squamous carcinoma 2) adenocarcinoma - STOMACH - 1) adenocarcinoma 2) GI stromal tumours - SMALL BOWEL- 1) lymphoma 2) GI stomach tumours 3) neuroendocrine tumours

Question 8

What is oesophageal carcinoma?

Answer 8

• Squamous cell carcinoma - Adults over 45, more common in males. - Risk factors - alcohol, tobacco, injury, achalasia. - Insidious onset with late symptoms - dysphagia, weight loss, haemorrhage, sepsis and respiratory fisture. - 5 year survival of 9%

Question 9

What is oesophageal adenocarcinoma?

Answer 9

• Largely from dysplastic change in Barrett’s oesophageal - more common in males. - Symptoms - dysphagia, weight loss, haematemesis, chest pain and vomiting. - 5 year survival of 25%.

Question 10

What is adenocarcinoma of the stomach?

Answer 10

• 90% of gastric malignancies. - Precursor legions: pernicious anaemia (atrophic gastritis), intestinal metaplasia, neoplastic polyps, heliobacter associated gastritis. - Early symptoms resemble gastritis. - Advanced symptoms - weight loss, anorexia, anaemia, haemorrhage. - 5 year survival of 30%.

Question 11

What is small bowel neoplasia?

Answer 11

• Relatively rare compared to other GI malignancies. - Subtypes - adenocarcinoma, GI stomal tumour, lymphoma, carcinoid tumour. - Risk factors - Crohns disease, coeliac disease, radiation exposure, hereditary GI cancer.

Question 12

What is Coeliac Disease?

Answer 12

• Extensive mucosal disease related to sensitivity to gluten. - Prevalence in white Europeans of 0.5-1%. - Symptoms - pain/discomfort, constipation/diarrhoea, failure to thrive, anaemia, fatigue. - Intestinal damage heals after gluten removed. - Leads to increased risk of adenocarcinoma and lymphoma of small bowel.