GORD Flashcards
What is the lining of the oesophagus vs stomach?
squamous epithelium vs columnar epithelium
presentation of GORD?
dyspepsia- heartburn, acid regurgitation, retrosternal or epigastric pain, bloating, changes in bowel habit, nocturnal cough and hoarse voice
2 week wait referral cancer GI?
dysphagia
age over 55
weight loss
upper abdominal pain/reflux
treatment resistant dyspepsia
nausea and vomiting
low haemoglobin
raised platelet count
patients with meleana or coffee ground vomiting require what?
urgent admission and endoscopy
lifestyle advice for GORD?
Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
Avoid heavy meals before bed time
Stay upright after meals rather than lying flat
Acid neutralising medication?
gaviscon rennie
why would you give PPI in GORD?
reduce acid secretion in stomach: omeprazole, lansoprazole
what is an alternative to PPI?
H2 receptor antagonist reduces stomach acid: ranitidine
surgery for GORD?
laparoscopic fundoplication: tying the fundus around the lower sphincter
HPylori?
gram negative aerobic bacteria: forces its way through mucosa causing breaks which exposes epithelial cells to acid and produces ammonia which damages the epithelial cells.
Hpylori test offered to patients with dyspepsia?
urea breath test radiolabelled carbon 13
stool antigen test
rapid urease test
rapid urease/ CLO test?
biopsy of stomach mucosa and urea added to sample. H pylori converts urea to ammonia making more alkali
eradication therapy?
triple therapy: PPI, plus 2 antibiotics (amoxicillin and clarithromycin) for 7 days
why do patients symptoms improve?
when squamous epithelium become columnar Baretts
adenocarcinoma risk with baretts?
3-5%
treatment of Baretts?
PPI, and with aspirin could reduce rate of adenocarcinoma
for people with dysplasia what could you do?
photodynamic therapy, laser therapy, cryotherapy to destroy epithelium and replaced with normal cells.
to test for Hpylori what should happen before?
stop PPI 2 weeks before
what. is baretts divided into?
short<3cm and long more than 3cm
histological features of baretts?
columnar epithelium look like cardiac of stomach or of small intestine (goblet cells and brush border)
risk factor for baretts?
GORD
male
smoking
central obesity
how often is endoscopy offered to people with baretts?
3-5 years
if dysplasia is seen endoscopically then first line treatment would be?
radiofrequency ablation, endoscopic mucosal resection
what are indications of upper GI endoscopy?
age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss
if endoscopy for GORD negative then consider?
24 hour oesophageal pH monitoring (GOLD STANDARD)
how to treat endoscopically proven oesophagitis?
full dose PPI for 1-2 months, if there is a response then low dose treatment, if no response then double dose PPI for 1 month
if endoscopically negative reflux disease?
full dose PPi for 1 month, if response then low dose treatment ( limited number of prescriptions), if not then H2RA or prokinetic for one month
complications of GORD?
oesophagitis, ulcers, benign strictures, Barrettsm carcinoma, anaemia
how does Hpylori disrupt gastric mucosa?
releases bacterial cytotoxins CagA toxin
how associated is Hpylori with gastric and duodenal ulcers?
gastric- 75
duodenal- 95
gastric cancer
b cell lymphoma of MALT tissue
atrophic gastritis
if penicillin allergic what is triple therapy?
PPI, clarithromycin and metronidazole
