GORD

Question 1

What is the lining of the oesophagus vs stomach?

Answer 1

squamous epithelium vs columnar epithelium

Question 2

presentation of GORD?

Answer 2

dyspepsia- heartburn, acid regurgitation, retrosternal or epigastric pain, bloating, changes in bowel habit, nocturnal cough and hoarse voice

Question 3

2 week wait referral cancer GI?

Answer 3

dysphagia
age over 55
weight loss
upper abdominal pain/reflux
treatment resistant dyspepsia
nausea and vomiting
low haemoglobin
raised platelet count

Question 4

patients with meleana or coffee ground vomiting require what?

Answer 4

urgent admission and endoscopy

Question 5

lifestyle advice for GORD?

Answer 5

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

Question 6

Acid neutralising medication?

Answer 6

gaviscon rennie

Question 7

why would you give PPI in GORD?

Answer 7

reduce acid secretion in stomach: omeprazole, lansoprazole

Question 8

what is an alternative to PPI?

Answer 8

H2 receptor antagonist reduces stomach acid: ranitidine

Question 9

surgery for GORD?

Answer 9

laparoscopic fundoplication: tying the fundus around the lower sphincter

Question 10

HPylori?

Answer 10

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.

Question 11

Hpylori test offered to patients with dyspepsia?

Answer 11

urea breath test radiolabelled carbon 13
stool antigen test
rapid urease test

Question 12

rapid urease/ CLO test?

Answer 12

biopsy of stomach mucosa and urea added to sample. H pylori converts urea to ammonia making more alkali

Question 13

eradication therapy?

Answer 13

triple therapy: PPI, plus 2 antibiotics (amoxicillin and clarithromycin) for 7 days

Question 14

why do patients symptoms improve?

Answer 14

when squamous epithelium become columnar Baretts

Question 15

adenocarcinoma risk with baretts?

Answer 15

3-5%

Question 16

treatment of Baretts?

Answer 16

PPI, and with aspirin could reduce rate of adenocarcinoma

Question 17

for people with dysplasia what could you do?

Answer 17

photodynamic therapy, laser therapy, cryotherapy to destroy epithelium and replaced with normal cells.

Question 18

to test for Hpylori what should happen before?

Answer 18

stop PPI 2 weeks before

Question 19

what. is baretts divided into?

Answer 19

short<3cm and long more than 3cm

Question 20

histological features of baretts?

Answer 20

columnar epithelium look like cardiac of stomach or of small intestine (goblet cells and brush border)

Question 21

risk factor for baretts?

Answer 21

GORD
male
smoking
central obesity

Question 22

how often is endoscopy offered to people with baretts?

Answer 22

3-5 years

Question 23

if dysplasia is seen endoscopically then first line treatment would be?

Answer 23

radiofrequency ablation, endoscopic mucosal resection

Question 24

what are indications of upper GI endoscopy?

Answer 24

age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss

Question 25

if endoscopy for GORD negative then consider?

Answer 25

24 hour oesophageal pH monitoring (GOLD STANDARD)

Question 26

how to treat endoscopically proven oesophagitis?

Answer 26

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

Question 27

if endoscopically negative reflux disease?

Answer 27

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

Question 28

complications of GORD?

Answer 28

oesophagitis, ulcers, benign strictures, Barrettsm carcinoma, anaemia

Question 29

how does Hpylori disrupt gastric mucosa?

Answer 29

releases bacterial cytotoxins CagA toxin

Question 30

how associated is Hpylori with gastric and duodenal ulcers?

Answer 30

gastric- 75
duodenal- 95
gastric cancer
b cell lymphoma of MALT tissue
atrophic gastritis

Question 31

if penicillin allergic what is triple therapy?

Answer 31

PPI, clarithromycin and metronidazole