Gastro-oesophageal reflux disease and dysmobility of oesophagus

Question 1

what type of medication is used for reflux?

Answer 1

proton pump inhibitor (PPI)

Question 2

what does reflux quality of life compare to?

Answer 2

acute coronary syndrome

Question 3

what is GORD?

Answer 3

gastro-oesophageal-reflux disease

Question 4

what does GORD cause?

Answer 4

incompetent lower oesophageal sphincter
poor oesophageal clearance
Barrier function/visceral sensitivity

Question 5

what are the symptoms of GORD?

Answer 5

heart burn/acid reflux
waterbrash
dysphagia
odynophagia
weight loss
chest pain
hoarseness
coughing

Question 6

how is GORD investigated?

Answer 6

endoscopy
Ba swallow
oesophageal manometry and pH studies
nuclear studies

Question 7

what symptoms of reflux would cause alarm?

Answer 7

dysphagia
weight loss
anaemia
vomiting
F/H UGI cancer
Barrets oesophagus
pernicious anaemia
PUD surgery >20 years

Question 8

what can be done for oesophageal carcinoma?

Answer 8

radiotherapy
surgery
palliation

Question 9

what is the prognosis of oesophageal adenocarcinoma?

Answer 9

perioperative = 5-10% mortality
5 year survival = 5-10%
subclinical = 80-90%

Question 10

what is the trend in oesophageal adenocarcinoma incidence?

Answer 10

increasing

Question 11

what is the trend in squamous cell carcinoma incidence?

Answer 11

decreasing

Question 12

what is the pathogenesis of adenocarcinoma?

Answer 12

normal > oesophagitis (reversible) > barrets (irreversible) > adenocarcinoma (too late)

Question 13

how is GORD managed?

Answer 13

symptom relief
heal oesophagitis
Prevent complications

Question 14

what lifestyle modifications can improve GORD?

Answer 14

stop smoking
loose weight
prop up bed head
avoid provoking factors

Question 15

what do antacids do?

Answer 15

symptomatic relief for majority of reflux patients

no healing/preventative effects

Question 16

what is cimetidine?

Answer 16

H2 antagonist

rapid symptom relief

Question 17

what is ranitidine?

Answer 17

H2 antagonist
reduces stomach acid
tolerance after 4 weeks

Question 18

what is omeprazole?

Answer 18

proton pump inhibitor

effective symptom relief and healing of oesophagitis

Question 19

what is nissen fundoplication?

Answer 19

surgery which controls symptoms and heals oesophagitis in young patients and severe/unresponsive disease

Question 20

how common is barrets oesophagus?

Answer 20

10% of GORD patients

Question 21

what is Barrets oesophagus?

Answer 21

irreversible intestinal metaplasia

Question 22

barrets oesophagus increases risk of adenocarcinoma, true or false?

Answer 22

true

Question 23

how is dysplasia managed?

Answer 23

frequent surveillance
optimise PPI dose
endoscopic mucosal resection (EMR)
radiofrequency ablation (HALO)
Argon

Question 24

what 2 types of hiatus hernia exist?

Answer 24

sliding hiatus hernia = hernia from stomach up into oesophagus
Paraoesophageal hiatus hernia = hernia from stomach pushes up beside oesophagus

Question 25

what is gastroparesis?

Answer 25

delayed gastric emptying | no physical obstruction

Question 26

what are the symptoms of gastroparesis?

Answer 26

``` feeling of fullness nausea vomiting weight loss upper abdominal pain ```

Question 27

what can cause gastroparesis?

Answer 27

``` idiopathic diabetes mellitus cannabis medication opiates, anticholinergics) systemic diseases (eg. sarcoidosis) ```

Question 28

how is gastroparesis investigated?

Answer 28

gastric emptying studies

Question 29

how is gastroparesis managed?

Answer 29

``` remove precipitating factors (eg. drugs) liquid/sloppy diet eat little and often promotility agents gastric pacemaker ```

Question 30

which dose of lansoprazole is best, 15mg or 30mg?

Answer 30

30mg

Question 31

which drug is best, ranitidine or omeprazole?

Answer 31

omeprazole