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TCD 19 - Upper GI > GORD, Barrett's Oesophagus and Oesophageal cancer > Flashcards

GORD, Barrett's Oesophagus and Oesophageal cancer Flashcards

1
Q

What is dyspepsia?

A

Dyspepsia is a non-specific term to describe indigestion

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2
Q

What are the symptoms of dyspepsia?

A
  • Heartburn
  • Acid regurgitation
  • Retrosternal or epigastric pain
  • Bloating
  • Nocturnal cough
  • Hoarse voice
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3
Q

What are the risk factors for GORD?

A
  • Obesity
  • Trigger foods
  • Smoking
  • Alcohol
  • Coffee
  • Stress
  • Drugs
  • Pregnancy
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4
Q

What drugs are a risk factor for GORD and why?

A 
Decrease the lower oesophageal sphincter pressure 
o	CCB
o	Anticholinergics
o	Theophylline
o	Benzodiazepines
o	Nitrates
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5
Q

How do you treat endoscopically proven oesophagitis?

A

Full dose PPI for 1-2 months

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6
Q

How do you treat endoscopically negative reflux disease?

A

Full dose PPI for 1 month

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7
Q

How can you advise someone on lifestyle with GORD?

A 
o	Reduce tea, coffee and alcohol
o	Weight loss
o	Smoking cessation
o	Smaller, lighter meals
o	Avoiding heavy meals before bed
o	Stay upright after meals rather than lying flat
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8
Q

How can you advise someone on treatment for GORD?

A

Acid neutralisation

  • Gaviscon
  • Rennie

PPI

  • Omeprazole
  • Lansoprazole

H2RA
Ranitidine

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9
Q

When do you prescribe PPIs with caution?

A
  • At risk of osteoporosis

* At risk of hypomagnesaemia

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10
Q

What are the long-term effects of PPIs?

A
  • Hypomagnesaemia
  • Increased rx fractures
  • Clostridium difficile infection
  • Rebound acid hypersecretion syndrome
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11
Q

When would you half the daily dose of ranitidine?

A

If eGFR <50 half normal daily dose

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12
Q

What are the complications of GORD?

A
  • Oesophagitis
  • Ulcers
  • Anaemia
  • Benign strictures
  • Barrett’s oesophagus
  • Oesophageal carcinoma
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13
Q

What is Barrett’s oesophagus?

A

Premalignancy condition that increases the risk of oesophageal cancer

Change from the normal squamous epithelium of the oesophagus to columnar epithelium, similar to that normally found in the stomach

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14
Q

What are the risk factors for Barrett’s oesophagus?

A
  • Chronic GORD
  • Smoking
  • Obesity
  • Male gender
  • Hiatus hernia
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15
Q

What are the risk factors for progression of Barrett’s oesophagus to adenocarcinoma?

A
  • White males
  • Intestinal metaplasia
  • Duration of reflux history
  • Early age of onset of GORD
  • Family Hx
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16
Q

What investigations would you do for Barrett’s oesophagus?

A

Endoscopy with biopsy
o Visible columnisation

Endoscopic ultrasound
o When high-grade dysplasia or cancer is found on endoscopy US is advisable to evaluate for surgical resectability

17
Q

What are the lifestyle management for Barrett’s oesophagus?

A 
o	Reduce weight
o	Smoking cessation
o	Reduce alcohol
o	Raise head of bed at night
o	Take small, regular meals
o	Avoid hot drinks, alcohol and eating within 3hrs of going to bed
18
Q

What drugs do people with Barrett’s oesophagus need to avoid?

A

Avoid drugs that affect oesophageal motility:

  • Nitrates
  • Anticholinergics
  • Tricyclic antidepressants

Avoid drugs that damage the mucosa

  • NSAIDs
  • Potassium salts
  • Alendronate
19
Q

What is the pharmacological management of Barrett’s oesophagus?

A

High-dose PPI

20
Q

Who is screened for Barrett’s oesophagus?

A 
Chronic GORD symptoms + 3 risk factors:
o	>50yrs
o	White
o	Male
o	Obesity

Threshold of 3 rx is lowered in the presence of family hx (at least one 1st degree relative with Barrett’s oesophagus or oesophageal adenocarcinoma)

21
Q

What type of cancers are most commonly oesophageal?

A

Squamous cell carcinoma (SCC) or adenocarcinoma (ACA)

22
Q

Where is squamous cell carcinoma of the oesophagus most commonly located?

A

Lower 1/3 of oesophagus

23
Q

Where is adenocarcinoma of the oesophagus most commonly located?

A

Upper 2/3 of the oesophagus

24
Q

Who do you refer for a 2WW for oesophageal cancer?

A 
•	Dysphagia
•	Aged ≥ 55 and weight loss and:
o	Upper abdominal pain
o	Reflux
o	Dyspepsia
25
Q

Who would you consider for non-urgent direct access for upper GI endoscopy for oesophageal cancer?

A 
•	Haematemesis 
•	Treatment-resistant dyspepsia
•	Upper abdominal pain with low Hb
•	Raised platelet count with:
o	Nausea
o	Vomiting
o	Weight loss
o	Reflux
o	Dyspepsia
o	Upper abdominal pain
•	Nausea and vomiting with:
o	Weight loss
o	Reflux
o	Dyspepsia
o	Upper abdominal pain
26
Q

What is odynophagia?

A

Painful swallowing normally due to fungal infections usually thrush

27
Q

What investigations do you do for oesophageal cancer?

A 
•	OGD
•	Bloods
•	ECG/PFT/CXR
•	CT TAP
For staging
•	EUS
Ultrasound and endoscopy for staging
•	PET
•	Laparoscopy
Detects peritoneal disease 
•	CPx
Looks at fitness level before treatment
28
Q

What is the treatments for oesophageal cancer?

A 
•	Surgery 
o	Open vs laparoscopic
•	Chemotherapy 
•	Radiotherapy – SCC
•	Endoscopic
•	Combination
•	Palliative 
o	Stenting
o	PEG
o	PEJ
o	Jejunal feeding
o	Surgical bypass
o	Paracentesis
o	Drugs

TCD 19 - Upper GI (5 decks)

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