GORD, Barrett's Oesophagus and Oesophageal cancer Flashcards
What is dyspepsia?
Dyspepsia is a non-specific term to describe indigestion
What are the symptoms of dyspepsia?
- Heartburn
- Acid regurgitation
- Retrosternal or epigastric pain
- Bloating
- Nocturnal cough
- Hoarse voice
What are the risk factors for GORD?
- Obesity
- Trigger foods
- Smoking
- Alcohol
- Coffee
- Stress
- Drugs
- Pregnancy
What drugs are a risk factor for GORD and why?
Decrease the lower oesophageal sphincter pressure o CCB o Anticholinergics o Theophylline o Benzodiazepines o Nitrates
How do you treat endoscopically proven oesophagitis?
Full dose PPI for 1-2 months
How do you treat endoscopically negative reflux disease?
Full dose PPI for 1 month
How can you advise someone on lifestyle with GORD?
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
How can you advise someone on treatment for GORD?
Acid neutralisation
- Gaviscon
- Rennie
PPI
- Omeprazole
- Lansoprazole
H2RA
Ranitidine
When do you prescribe PPIs with caution?
- At risk of osteoporosis
* At risk of hypomagnesaemia
What are the long-term effects of PPIs?
- Hypomagnesaemia
- Increased rx fractures
- Clostridium difficile infection
- Rebound acid hypersecretion syndrome
When would you half the daily dose of ranitidine?
If eGFR <50 half normal daily dose
What are the complications of GORD?
- Oesophagitis
- Ulcers
- Anaemia
- Benign strictures
- Barrett’s oesophagus
- Oesophageal carcinoma
What is Barrett’s oesophagus?
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
What are the risk factors for Barrett’s oesophagus?
- Chronic GORD
- Smoking
- Obesity
- Male gender
- Hiatus hernia
What are the risk factors for progression of Barrett’s oesophagus to adenocarcinoma?
- White males
- Intestinal metaplasia
- Duration of reflux history
- Early age of onset of GORD
- Family Hx
What investigations would you do for Barrett’s oesophagus?
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
What are the lifestyle management for Barrett’s oesophagus?
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
What drugs do people with Barrett’s oesophagus need to avoid?
Avoid drugs that affect oesophageal motility:
- Nitrates
- Anticholinergics
- Tricyclic antidepressants
Avoid drugs that damage the mucosa
- NSAIDs
- Potassium salts
- Alendronate
What is the pharmacological management of Barrett’s oesophagus?
High-dose PPI
Who is screened for Barrett’s oesophagus?
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)
What type of cancers are most commonly oesophageal?
Squamous cell carcinoma (SCC) or adenocarcinoma (ACA)
Where is squamous cell carcinoma of the oesophagus most commonly located?
Lower 1/3 of oesophagus
Where is adenocarcinoma of the oesophagus most commonly located?
Upper 2/3 of the oesophagus
Who do you refer for a 2WW for oesophageal cancer?
• Dysphagia • Aged ≥ 55 and weight loss and: o Upper abdominal pain o Reflux o Dyspepsia
Who would you consider for non-urgent direct access for upper GI endoscopy for oesophageal cancer?
• 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
What is odynophagia?
Painful swallowing normally due to fungal infections usually thrush
What investigations do you do for oesophageal cancer?
• 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
What is the treatments for oesophageal cancer?
• 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
