Introduction, Pathophysiology and Gastric cytoprotection

Question 1

What do the main upper GI conditions relate to?

Answer 1

Presence of acid

Either wrong location (reflux into the oesophagus or overspill into the duodenum)
Over production
Faults with protective mechanisms (pyloric or lower oesophagus sphincter) or gastro-cytoprotection
Dyspepsia

Question 2

What is dyspepsia?

Answer 2

Dyspepsia is an umbrella term for a group of upper abdominal symptoms categorised by the following:
Functional dyspepsia / non-ulcer dyspepsia (indigestion)
Gastro-oesophageal reflux disease (GORD/heart burn)
Gastritis
Duodenal ulcers
Gastric ulcers

Question 3

What are some of the symptoms associated with dyspepsia?

Answer 3

Nausea and vomiting
Abdominal pain (location, nature depends on specific diagnosis) - burning
Bloating
Belching
Flatulence
Premature satiety
Acidic taste in the mouth or throat

Question 4

If a patient presents with dyspeptic like symptoms what is the most common diagnosis?

Answer 4

Functional dyspepsia

Question 5

If a patient presents with dyspeptic like symptoms what are some unlikely causes?

Answer 5

Medicine induced
Ulcers
IBS
Biliary disease

Question 6

If a patient presents with dyspeptic like symptoms what are some rare causes?

Answer 6

Oesophageal and gastric cancer
Atypical angina

Question 7

What are the main treatment goals for upper GI conditions?

Answer 7

Prevent acid relocating
Reduce production or neutralising it
Treating or removing the cause

Question 8

What is the prevalence of GI conditions?

Answer 8

20-40%

A quarter of these patients have peptic ulcer disease

Question 9

How do patients tend to manage upper GI conditions?

Answer 9

90% self treat
9% see a GP
1% see a consultant

Question 10

What is the incidence rate of gastric cancer in the UK and EU?

Answer 10

10 per 100,000 UK
8.6 per 100,000 EU

Question 11

How many people are diagnosed with and die from gastric cancer each year in the UK?

Answer 11

6,500 people are diagnosed and 4,400 die from gastric cancer each year

Question 12

What is the 1,5 and 10 year survival for gastric cancer in the UK?

Answer 12

1 year survival is more than 45% (42%)
5 year survival is more than 20% (19%)
10 year survival is more than 15%

Question 13

What are some of the statistics regarding gastric cancer?

Answer 13

7/10 cases are diagnosed in the late stage
Gastric cancer is the 17th most common type of cancer
54% of cases are preventable

Question 14

Describe the risk factors and causes for gastric cancer.

Answer 14

40% (32%) of cases linked to H.pylori infection (due to prolonged inflammation, ulcer formation)
Age (50% in the over 75s)
Men are more likely than women
Overweight or obesity (5% linked to)
Alcohol
Work chemicals
Family history
Previous peptic ulcer
High salt intake (increase H pylori extent, damage stomach tissue)

Question 15

Why might the rate of gastric cancer fallen since the 1990s?

Answer 15

Greater awareness of health and safety measures in the workplace such as reducing exposure to asbestos and other harmful work chemicals.
Rise of veganism and vegetarians which has shown to have reduced prevalence of gastric cancer
Better understanding of healthy lifestyles and diet
Changes in food preparation (no longer using salt as a preservative)

Question 16

In which demographics may you suspect gastric cancer and hence refer patients?

Answer 16

In patients between the ages of 40-50 years that are presenting with dyspeptic like symptoms for the first time

Question 17

What are the ALARM symptoms that could warrant referral and indicate cancer?

Answer 17

A - anaemia (tiredness, shortness of breath, pale complexion)
L- loss of weight
A-anorexia
R- recent onset of progressive symptoms
M- melaena (black, tarry faeces), dysphagia (difficulty swallowing), haematemesis (vomiting blood)

Question 18

Describe the trends in diagnosis of gastric cancer for men and women.

Answer 18

Male rates of gastric cancer are roughly double the rate of female cases but this narrows with age
There is an uplift of cases between 60-70 years in both males and females and this is when there is the greatest difference between gender

Question 19

What us the incidence of each of the dyspeptic conditions?

Answer 19

Functional dyspepsia / non-ulcer dyspepsia (indigestion) 30%
Gastro-oesophageal reflux disease (GORD/heart burn) 10-20%
Gastritis 30%
Duodenal ulcers and Gastric ulcers 10-25%

Oesophageal and gastric cancer 2%