GORD, Dyspepsia and Ulcers Flashcards
What is GORD?
Gastro-oesopageal reflux disease
What may be the underlying cause of GORD?
- Incompetent lower oesophageal sphincter
- Poor oesophageal clearance
- Barrir function or visceral senstivity
What is dysphagia?
Difficulty swallowing
What may be the main symptoms of GORD?
- Dysphagia
- Chest pain
- Acid reflux
- Heartburn
- Weight loss
- Odynophagia - pain on swallowing
What investigations can be done for GORD?
Endoscopy
Barium swallow
Nuclear studies
Biopsies
What treatments are available for oesophageal carcinoma?
Radiotherapy
Surgery - Oesophagostomy
What is the name of the stage before adenocarcinoma in the oesophagus?
Barret’s oesophagus
How is GORD managed? (3)
- Symptom relief
- Heal oesophagitits
- Prevent complications
Which lifestyle factor changes are recommended for GORD?
- Smoking cessation
- Lose weight
- Prop up bed
- Avoid provoking factors such as spicy or fatty foods
*
Why are antacids useful in GORD?
They provide symptomatic relief
(they do not aid healing or further prevention)
Which histamine receptor will histamine antagonists block in the oesophagus?
H2
Which histamine receptor antagonist can aid healing?
Ranitidine
(less effective then omeprazole (a PPI))
What are the negative effects of ranitidine?
Tolerance
Poor in preventing relapse and complications
Which drug class is the best at reducing symptoms over a period of four weeks as well as having healing effects?
Proton pump inhibitors
Omeprazole is the most commonly used
(lansoprazole is also used)
When sould PPIs be taken so their effects are noticed?
Around 30 minutes before a meal
When would surgery be utilised for patients with GORD?
When PPIs fail to reduce symptoms
What is the main concern for patients with Barrett’s oesophagus?
They may go on to develop adenocarcinoma
What are the best ways for dysplasia in the oesophagus to be managed?
- Increased surveillance and optimised PPI doseage
- Endoscopic mucosal resection
- Radiofrequency ablation
- Argon beam ablation - can also be used to stop blood loss in surgery
Which types of hernia will most likely contribute to GORD?
Sliding and paraoesophageal herniae
What is gastroparesis?
Delayed emptying of stomach
(there is no physical obstruction)
What symptom is often present during gastroparesis?
Vomiting
(this is worse at the end of the day due to filling of the stomach)
What symptoms may be associated with gastroparesis?
- Feeling of fullness
- Nausea and vomiting
- Weight loss
- Upper abdominal pain
What can cause gastroparesis?
Idiopathic
Diabetes
Cannabis
Medication - opiates, anticholinergics
Systemic disease - systemic sclerosis
How can gastroparesis be investigated?
Gastric emptying study
How can gastroparesis be managed?
Removal of exacerbating factors
Liquid diet
Eat little and often
Promotility agents
Gastric pacemaker
What is achalasia?
Food will fill the oesophagus when consumed
How can achalasia be treated?
Botox can paralyse the lower oesophageal sphincter allowing food to pass
What is the problem and solution to using botox in order to treat achalasia?
Botox is associated with tolaerance as antibodies are produced against it
In order for its effectiveness to be mainatained, types must be switched frequently to avoid this tolerance
What is dyspepsia?
It is not a disease, but instead a range of symptoms describing:
- Epigastric pain or burning
- Postpradial fullness
- Gastric cancer
What are the two main branches of causes for dyspepsia?
- Organic
- Functional
What are some organic causes of dyspepsia?
Peptic ulcer disease
Drugs - NSAIDS, COX2 inhibitors
Gastric cancer
What are some functional causes of dyspepsia?
Idiopathic
Associated with other functional gut disorders such as IBS
What may be found on clinical examination for dyspepsia?
Epigastric tenderness
Cachexia
Mass
Evidence of gastric outflow obstruction and peritonism
How can dyspepsi be managed?
A faecal antigen test is required for H. pylori - if present it can be eradicated
If H. pylori is not present, a PPI is utilised
Otherwise, the the patient is referred to hospital (>55 years) or treated for functional dyspepsia (<55 years)
In peptic ulcer disease, when is the pain often relieved?
After eating
(Most peptic ulcers are duodenal)
When pain comes on after eating, which type of ulcer is usually associated?
Gastric ulcer
(more acid is produced to digest food because gastrin secretion increases)
What are the main causes of peptic ulcer disease?
H. pylori
NSAIDS
Gastric dysmotility or outflow obstruction
When in life is H. pylori often acquired?
Nursery, or during a young age
This is due to faecal-oral spread
As a bacterium, what are the properties of H. pylori?
Gram negative
Flagellated
Rod shaped, but not bacilli
Microaerophilic
What are the three options for the consequences of H. pylori?
Asymptomatic
Peptic ulcer disease
Gastric cancer
Which cells in the stomach release acid?
Parietal cells
What is the function of gastrin and where does it come from?
Comes from G cells
Sectreted to act on parietal cells to produce more acid
Which type of gastritis leads to duodenal ulcers and why?
Distal/antrum gastritis
Gastritis damages the duodenum and stomach antrium so G cells are damaged leading to increased acid production
What is a likely outcome of a body gastritis and why?
Gastric cancer
Gastritis damages gastric mucosa and parietal cells, this lowers HCl sectretion meaning a lot of gastrin is produced to no effect
This can lead to gastric cancer
Describe the pathway to a duodenal ulcer in relation to the role of the cytokines released and their role in the developing condition
Cytokines released
G cells release more gastrin
Somatostatin secretion is inhibited
Gastrin causes parietal proliferation and hypersecretion of acid
Duodenal tissue is damaged due to increased acid load
When a duodenal ulcer forms, gastric mucosa will often form there due to metaplasia, what does this mean in the presence of an H. pylori infection?
H. pylori can now infect here
Which drugs can cause duodenal ulcers?
NSAIDS
What is a gastritis termed if it is in the body of the stomach?
Body gastritis
or
Atrophic gastritis
What happens in an atrophic gastritis?
Inflammation induces parietl cell apoptosis and atrophy of gastric glands
This means there is a hyposecretion of acid (hypochlorhydria)
Continued damage may caus ethe development of a gstric ulcer
How can H. pylori be diagnosed?
Gastric biopsy - urease test, histology, culture
Urease breath test
Faecal antigen test
Serology - IgA antibodies - often inaccurate
What is the urease test?
This test works because H. pylori increase the pH of its environment
H. pylori secreted urease which can break down ammonium ions tand bicarbonate
This raises the stomach pH
This test detects the urease enzyme
How is peptic ulcer disease treated?
All require anti-secretory therapy - PPI - omeprazole
All tested for H. pylori - +ve, then eradicate, -ve, then PPI
Withdraw NSAID use
Improve lifestyle
Surgery - rare
Besides PPIs, what other option is there for anti-secretory therapy?
H2 receptor antagonists
Give an example of a H2 receptor antagonist
Ranitidine
H2 receptor antagonists can lead to the healing of what?
Duodenal ulcers
Which is the best treatment for:
a) Gastric ulcers
b) Duodenal ulcers
a) Omeprazole (or another PPI)
b) Ranitidine (or other H2RA)
What are some complications of peptic ulcer disease?
Anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction
Of the two ulcer types, gastric and duodenal, which will require a follow up after treatment?
Gastric
An endoscopy is performed 6-8 weeks after treatment to ensure there is no malignancy and to check healing
