Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach Flashcards
What happens to the quality of life for patients with refluc
It decreases and can be similar to quality of life of a patient with an acute coronary event
Why does reflux occur
Incompetent Lower Oesophageal sphincter
Poor oesophageal clearance
Barrier/ function / Visceral senstitivity (some mucus for protection but if changed, an ulcer can form)
What are the symptoms of reflux
Heartburn Acid reflux Waterbrash Dysphagia Odynophagia Weight loss Chest pain Hoarseness Coughing
What investigations are carried out for reflux
Endoscopy
Ba swallow
Oesophageal manometry (measures pressure) & pH studies (probe and leave down for 24-48 hours - they will confirm with a diary)
Nuclear studies
How much of the population get reflux symptoms
40%
Who should we investigate
Weight loss Anaemia Vomiting F/H UGI cancer Barrett's (10% of patients reflux patients) Pernicious Anaemia (association with cancer) PUD surgery >20 years Dysphagia
What are the grades for oesophagitis
Grade A -
Grade B =
Grade C
Grade D -
What is achatsies ring?
Caused by acid reflux
Who is most likely to get oesophageal carcinoma?
Males
What are the treatment options for oesophageal carcinoma?
Radiotherapy
Surgery
Palliation (treat symptoms only)
What is the 5 year survival rate?
5-10%
What causes an increase in oesophageal adenocarcinoma?
More reflux
What causes a decrease in squamous cell carcinoma?
I dont know
What is the pathogenesis of adenocarcinoma
Normal
Oesophagitis (reversible)
Barrett’s (Irresversible?)
Adenocarcinoma (too late)
What is the management of GORD
Doubling the dose of PPI therapy
Adding an H2RA at bedtime
Extending the length of treatment
Surgery
What lifestyle modifications can be made for reflux?
Stop smoking
Lose weight if obese
Prop up the bed head
Avoid provoking factors
GIve two types of H2 antagonists
Cinetidine
Ranitidine
How does cinetidine work?
Rapid symptom relief
Less effective at healing than placebo
How does ranitidine work?
Tolerance after 4 week therapy
Poor in preventing ….
What are Proton pump inhibitors (PPI)
Block the hydrogen pump that makes the acid in the first place. It is irreversibly bound to it.
What happens after 8 hours of taking a PPI
only half of the proton pumps remain blocked
What do the proton pumps do?
Heal the mucosa
Relieve the symptoms
What is the correct dose of Lansoprazole for healing and maintenance?
20mg or 30mg for healing and maintenance
What are the benefits of surgery in GORD
Controls symptoms
Heals oesophagitis
Cost effective for Young patients (dont need to have them on PPI for a long period of time)
Severe / unresponsive disease
What define’s Barratts oesophagitus
Intestinal Metaplasia
Irreversible
Increased risk of adenocarcinoma
How can we manage dysplasia
More frequent surveillance Optimise PPI (if on suboptimal dose) Endoscopic mucosal resection Radiofrequency abalation (HALO) to abalate the rest of the mucus. Argon
What can a Hiatus hernia do?
Can be sliding or just push the oeophagus upwards causing reflex
What is gastroparesis
Delayed gastric emptying with no physical obstruction
What are the symptoms of gastroparesis
Feeling of fullness / bloating Nausea Vomiting Weight loss Upper abdominal pain
What are the causes of gastroparesis
Idiopathic
Diabetes mellitus
Cannabis
Medication e.g. opiates, anticholinergics
Systemic diseases e.g. systemic sclerosis
What investigations are done for gastroparesis
Gastric emptying studies (images of stomach using isotopes to calculate how long it takes to empty)
WHat can we do to manage gastroparesis
Removal of precipitating factor se.g. drugs
Liquid / slopy diet
Eat little and often
Promotility
What is achalasia?
Relatively uncommon condition
Lower OS is in spasm
requires surgery
cut longitudinally through sphincter, separate the fibres and pull them back
Now can be dilated with a balloon but can be dangerous
How do we manage achalasia ?
Use of Botulinum toxin
