Gastro-oesophageal Inflammation and Peptic Ulcers

Question 1

What is Achalasia?

Answer 1

decreased tone of lower oesophageal sphincter:

- can be caused by impaired by smooth muscle relaxation or oesophageal obstruction

Question 2

What is the Achalasia triad?

Answer 2

• incomplete LES relaxation
• increased LES tone
• aperistalsis of the oesophagus

Question 3

What are the causes of Achalasia?

Answer 3

Primary:

• neuronal or ganglion cell degeneration (related to vagus n.)
• familiar causes

Secondary:

• Chagas disease (destruction of myenteric plexus)
• diabetic autonomic neuropathy
• amyloidosis
• sarcoidosis
• polio
• Downs Syndrome
• Herpes Simplex infection

Question 4

What is the treatment for Achalasia?

Answer 4

• laparoscopic myotomy
• balloon dilation
• botox injection

Question 5

What are the acute and chronic causes of oesophageal inflammation?

Answer 5

Acute:
- infection in immunosuppressed patients (HSV, candida, CMV and corrosives)

Chronic:

• TB
• bullous pemphigoid
• epidermolysis bullosa
• Crohn’s Disease

Non-specific:
- reflex oesophagitis

Question 6

What is reflux oesophagitis and its causes?

Answer 6

• regurgitation of gastric contents due to incompetent gastro-oesophageal junction
• can be due to alcohol and tobacco, obesity, drugs, hiatus hernia and motility disorders

Question 7

What can GORD cause?

Answer 7

• eopsinophils epithelial infiltration
• basal cell hyperplasia
• chronic inflammation
• severe reflux can lead to ulceration which can lead to healing by fibrosis

Question 8

What is Barrett’s oesophagus?

Answer 8

• longstanding reflux where lower oesophagus becomes lined by columnar epithelium due to intestinal metaplasia
• premalignancy which increases risk of adenocarcinoma

Question 9

What are the acute and chronic causes of gastric inflammation (gastritis)?

Answer 9

Acute:
- chemical injury (NSAIDS/alcohol, can alsp be H pylori associated)

Chronic:

• active chronic is H. pylori associated
• can be autoimmune
• can be due to chemical reflux

Question 10

Describe the pathogenesis of H. pylori

Answer 10

• H.pylori produces urease which produces ammonia which neutralises pH of stomach allowing colonisation
• then causes mucosal damage which leads to inflammation and mucosal cell death

Question 11

What are the symptoms of an acute H. pylori infection?

Answer 11

• nausea
• dyspepsia
• malaise
• halitosis

Question 12

What happens in an acute H. pylori infection?

Answer 12

gastric mucosa is inflamed with neutrophils and inflammatory cells with marked persistent lymphocyte penetration

Question 13

Describe the 2 distribution patterns seen with H. pylori associated gastritis

Answer 13

diffuse involvement of antrum and body:

• atrophy, fibrosis and intestinal metaplasia
• associated with gastric ulcers and cancers

antral but no body involvement:

• gastric acid secretion is increased
• associated with duodenal ulcers

Question 14

What is chemical (reflux) gastritis and what is associated with it?

Answer 14

• irritation of the stomach caused by regurgitation of bile and alkaline duodenal secretion
• loss of epithelial cells with compensatory hyperplasia of gastric pits
• associated with defective pylorus or motility disorders

Question 15

What is autoimmune chronic gastritis and what is it associated with?

Answer 15

• autoimmune reaction to gastric parietal cells resulting in loss of acid secretion
• decreased stomach acid and intrinsic factor
• causes vitamin B12 deficiency (pernicious anaemia)
• associated with marked gastric atrophy and intestinal metaplasia

Question 16

What are peptic ulcerations?

Answer 16

• breach in mucosal lining of alimentary tract as a result of acid and pepsin attack

Question 17

Where are the major sites of peptic ulceration?

Answer 17

• first part of duodenum
• junction of antrum and body mucosa in stomach
• distal oesophagus
• gastro-enerostomy stoma

Question 18

What are the aetiological factors for peptic ulceration?

Answer 18

• hyperacidity
• H. pylori gastritis
• duodenal reflux
• NSAIDs
• smoking
• genetic factors
• Zollinger-Ellison syndrome

Question 19

What are some of the complications of peptic ulcers?

Answer 19

• haemorrhage
• penetration of adjacent organs
• perforation
• anaemia
• obstruction
• malignancy

Question 20

What are some defining features that differentiate between gastric and duodenal ulcers?

Answer 20

Duodenal:

• more common
• commonly blood group O
• acid levels are high or normal

Gastric:

• blood group A
• acid levels are low or normal

Question 21

What are some acute causes of peptic ulcers?

Answer 21

• acute gastritis
• stress response
• extreme acidity

Question 22

What is the pathogenesis of chronic peptic ulcers and where do they normally occur?

Answer 22

• patho-hyperacidity and mucosal defence defects

- most commonly occur at mucosal junctions

Question 23

Describe why chronic duodenal ulcers can occur?

Answer 23

• increased acid production

- reduced mucosal resistance

Question 24

What are the complications of ulcers?

Answer 24

• bleed, block or burst
• can have penetration of adjacent organs
• can have malignant changes altho rare in gastric ulcers and never in duodenal

Question 25

Describe the defined structure of ulcers

Answer 25

• granulation tissue at base
• underlying inflammation and fibrosis
• loss of muscularis propria