Gastroenterology Flashcards
Achalasia associated with which cancer
SCC (10x risk compared to general population)
Achalasia barium swallow findings
Bird’s beak
Which subtype of achalasia is most severe?
Type 1
Progression from Type 3 to Type 1
Which subtype of achalasia has the best treatment outcome?
Type 2
Oral Tx options for achalasia
CCB
Isosorbide dinitrate
(effective in 50-60%)
Complication with Botox injection for achalasia
Causes submucosal fibrosis and unable to do subsequent definitive surgical treatment
Efficacy of Balloon dilatation in achalasia
60-90% effective
Risk of perforation in 1-6%
Recurrence in 2-3 years
Treatment of choice for achalasia
POEM (PerOral Endoscopic Myotomy)
- Success similar to Lap Myotomy, but less recovery ime
- SE: Reflux ++
Classic endoscopic features of eosinophilic oesophagitis
- Oedema
- Longitudinal furrows
- White exudates
- Concentric rings
- Strictures and mucosal tearing
Treatment of eosinophilic oesophagitis
- PPI
- Aerosolised steroids
- Diet: Elemental; Eliminate milk, wheat, gluten, eggs, nuts, shellfish, soy
- Dilatations for strictures
- Esperimental: Budesonide, montelukast
Mucosa change in Barret’s oesophagus
Strafed squamous epithelium replaced by cardiac type mucus secreting columnar epithelium +/- intestinal metaplasia
Medical treatment shown to slow/stop progression of Barrett’s to adenocarcinoma
PPI and aspirin therapy
- AspECT trial
- Surgical therapy is no more effective than PPI
Survival with Oesophageal Adenocarcinoma
5 year survival <20%
Mx recommendation for low grade dysplasia in Barrett’s
If LGD confirmed on 2 occasions 6 months apart by two pathologists, then endoscopic RFA is recommended OR close surveillence
-Risk of progression to HGD
Risk of HGD in Barrett’s to progress to Adenocarcinoma
~10%
Mx of HGD in Barrett’s
- Oesophagectomy vs endoscopic resection
- Then RFA to rest of Barrett’s due to risk of transformation
- Annual Gscope annually for 5 years
Risk of recurrence of Barrett’s post surgical excision/RFA
~10%
Greatest in first year
Features suggestive of malignant dysphagia
Shorter duration Solids > liquids Constant and progressive Older age Accompanying alarm symptoms
Mx of refractory GORD
Failed PPI BD trial for 3 months
- Check compliance and lifestyle modifcations
- Trial nocte H2 antagonist
- Repeat scope and perform pH testing
Location of most gastric ulcers and duodenal ulcers
Junction of fundus and antrum along the lesser curvature
DU are usually in the 1st or 2nd part
Evidence of PPI therapy in GI bleeding
No mortality benefit
Reduction in need for endoscopic therapy compared to placebo
Forrest Ia
Spurter
Forrest IIa
Non bleeding visible vessel
Forrest IIb
Clot at base