Gastro-oesophageal reflux disease and dysmobility of oesophagus Flashcards
what type of medication is used for reflux?
proton pump inhibitor (PPI)
what does reflux quality of life compare to?
acute coronary syndrome
what is GORD?
gastro-oesophageal-reflux disease
what does GORD cause?
incompetent lower oesophageal sphincter
poor oesophageal clearance
Barrier function/visceral sensitivity
what are the symptoms of GORD?
heart burn/acid reflux waterbrash dysphagia odynophagia weight loss chest pain hoarseness coughing
how is GORD investigated?
endoscopy
Ba swallow
oesophageal manometry and pH studies
nuclear studies
what symptoms of reflux would cause alarm?
dysphagia weight loss anaemia vomiting F/H UGI cancer Barrets oesophagus pernicious anaemia PUD surgery >20 years
what can be done for oesophageal carcinoma?
radiotherapy
surgery
palliation
what is the prognosis of oesophageal adenocarcinoma?
perioperative = 5-10% mortality
5 year survival = 5-10%
subclinical = 80-90%
what is the trend in oesophageal adenocarcinoma incidence?
increasing
what is the trend in squamous cell carcinoma incidence?
decreasing
what is the pathogenesis of adenocarcinoma?
normal > oesophagitis (reversible) > barrets (irreversible) > adenocarcinoma (too late)
how is GORD managed?
symptom relief
heal oesophagitis
Prevent complications
what lifestyle modifications can improve GORD?
stop smoking
loose weight
prop up bed head
avoid provoking factors
what do antacids do?
symptomatic relief for majority of reflux patients
no healing/preventative effects
what is cimetidine?
H2 antagonist
rapid symptom relief
what is ranitidine?
H2 antagonist
reduces stomach acid
tolerance after 4 weeks
what is omeprazole?
proton pump inhibitor
effective symptom relief and healing of oesophagitis
what is nissen fundoplication?
surgery which controls symptoms and heals oesophagitis in young patients and severe/unresponsive disease
how common is barrets oesophagus?
10% of GORD patients
what is Barrets oesophagus?
irreversible intestinal metaplasia
barrets oesophagus increases risk of adenocarcinoma, true or false?
true
how is dysplasia managed?
frequent surveillance optimise PPI dose endoscopic mucosal resection (EMR) radiofrequency ablation (HALO) Argon
what 2 types of hiatus hernia exist?
sliding hiatus hernia = hernia from stomach up into oesophagus
Paraoesophageal hiatus hernia = hernia from stomach pushes up beside oesophagus
what is gastroparesis?
delayed gastric emptying
no physical obstruction
what are the symptoms of gastroparesis?
feeling of fullness nausea vomiting weight loss upper abdominal pain
what can cause gastroparesis?
idiopathic diabetes mellitus cannabis medication opiates, anticholinergics) systemic diseases (eg. sarcoidosis)
how is gastroparesis investigated?
gastric emptying studies
how is gastroparesis managed?
remove precipitating factors (eg. drugs) liquid/sloppy diet eat little and often promotility agents gastric pacemaker
which dose of lansoprazole is best, 15mg or 30mg?
30mg
which drug is best, ranitidine or omeprazole?
omeprazole
