GORD/peptic ulcer disease/Barrett's

Question 1

Squamous-columnar metaplasia of the lower oesophageal mucosa?

Answer 1

Barrett’s oesophagus

Question 2

Barrett’s oesophagus increases the risk of…

Answer 2

Adenocarcinoma of the oesophagus

Question 3

Barrett’s oesophagus is a complication of…

Answer 3

GORD

Question 4

Heartburn +Belching +Waterbrash + Odynophagia

Cough

Answer 4

GORD

Question 5

Investigation of long-standing GORD?

Answer 5

Upper GI endoscopy

Question 6

When might barium swallow be indicated in GORD?

Answer 6

To rule out/in hiatus hernia

Question 7

Lifestyle changes to manage GORD? (3)

Answer 7

Lose weight
Smoking cessation
Small, regular meals

Question 8

Management of GORD? (3)

Answer 8

Antacids or alginates (e.g. Gaviscon) relieve symptoms
Proton pump inhibitors
Endoscopic surveillance if Barrett’s

Question 9

ALARM Symptoms in dyspepsia? (6)

Answer 9

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena/haematemesis
Swallowing difficulty

Question 10

DDx dyspepsia? (4)

Answer 10

GORD/oesophagitis
Peptic ulcer
Gastritis/duodenitis
Gastric malignancy

Question 11

Risk factors for peptic ulcers?

Answer 11

H. pylori
Aspirin, NSAIDs
Smoking

Question 12

How to distinguish between gastric and duodenal ulcers?

Answer 12

Relationship to eating: duodenal relieved by eating, gastric made worse by eating

Question 13

Management of dyspepsia?

a) ALARM symptoms or older than 55
b) no alarm symptoms

Answer 13

a) upper GI endoscopy

b) stop any exacerbating drugs, lifestyle changes, OTC antacids (conservative)

Question 14

If no response to conservative therapy, what investigation should be ordered?

Answer 14

H pylori breath test

Question 15

H. pylori negative dyspepsia?

Answer 15

Trial PPI or H2 blocker for 4 weeks

Question 16

H. pylori positive dyspepsia?

Answer 16

H pylori eradication

PPI + amoxicillin + erythromycin

or PPI + erythromycin + metronidazole

Question 17

Complications of peptic ulcer disease? (3)

Answer 17

Bleeding
Perforation
Malignancy

Question 18

How long should antibiotics/antisecretory drugs be stopped before a urea breath test?

Answer 18

Abx- 4 weeks

antisecretory drugs- 2 weeks

Question 19

Gastric acid secretion is stimulated by…(3)

Answer 19

Acetylcholine, gastrin and histamine

Question 20

Gastric acid secretion is inhibited by…(3)

Answer 20

Somatostatin, secretin and cholecystokinin

Question 21

What features of a presentation suggest gastrinoma? (4)

Answer 21

Multiple gastric ulcers
Ulceration with diarrhoea
Refractive to therapy
Absence of H pylori

Question 22

Best test in suspected gastrinoma?

Answer 22

Serum gastrin levels

Question 23

Peptic ulcer disease associated with gastrinoma is also known as…

Answer 23

Zollinger-Ellison syndrome

Question 24

Gastric MALT lymphoma is associated with….and usually responds to….?

Answer 24

H pylori infection

H pylori eradication therapy