Management of Esophagitis and Peptic Ulcer Disease

Question 1

OLDSCARS

Answer 1

Onset
Location
Duration
Severity
Character
Aggravating
Relieving
Associated symptoms

Question 2

Effect of opioids on intestinal transit

Answer 2

Delay intestinal transit

Question 3

Symptom vs sign

Answer 3

Symptom: subjective evidence of disease (experienced by individual)
Sign: objective evidence of disease (can be detected by someone other than the individual)

Question 4

5 red flags with GI problems

Answer 4

Vomiting
Weight loss
Bleeding (overt or occult)
Anorexia
Dysphagia

Question 5

Reflux esophagitis
(What is it, what 3 things does it cause)

Answer 5

Acid damage to esophagus

Causes increased abdominal pressure, increased volume of regurgitant, decreased esophageal clearance

Question 6

Fundoplication

Answer 6

Wrap the stomach around the lower esophagus
Try to augment the compression of the esophagus using a band of stomach
Treatment for reflux esophagitis (severe)

Question 7

What medication choice for reflux esophagitis has a ceiling effect?

Answer 7

Histamine receptor antagonists

If you give more, eventually you wont get more effects

Question 8

Treatment path when predominant symptom is heartburn/regurg

Answer 8

Treat with PPI or H2RA, reassess at 4 weeks
Symptoms resolved, stop therapy
If not, switch to PPI for 4-8 weeks, or double PPI dose for 4-8 weeks or consider investigation
Symptoms resolved, stop therapy
If not, investigate

Question 9

Regurgitation definition

Answer 9

Passive retrograde movement of food

Question 10

3 rare side effects from PPIs

Answer 10

Hypomagnesemia
Acute interstitial nephritis
B12 deficiency

Question 11

Retrosternal burning can be associated with problems in which 3 body systems

Answer 11

GI
Cardiac
Pulmonary

Question 12

3 general classes of esophagitis

Answer 12

Infectious (HSV, CMV, Candida)
Inflammatory (eosinophilic)
Trauma (pill)

Question 13

HSV and CMV esophagitis characteristics

Answer 13

Odynophagia (VERY painful)
Often immunosuppressed
Multiple areas of ulcerations
Well circumscribed

Question 14

Candida esophagitis characteristics

Answer 14

Dysphagia (not odynophagia)
May or may not have thrush
Usually immunosuppressed (diabetic, HIV, chemo)

Question 15

Eosinophilic esophagitis

Answer 15

Dysphagia
Entire length of esophagus
Often have a history of atopy
Furrows, rings, exudates
Treat with viscous budesonide (steroid) and PPI
6 food elimination diet (wheat, milk, eggs, soy, nuts, shellfish)

Question 16

Pill esophagitis

Answer 16

Odynophagia

Common in elderly (take a lot of pills and have impaired esophageal clearance)

Question 17

Routine pills that cause pill esophagitis

Answer 17

NSAIDS
K+
Alendronate
Antibiotics (like tetracycline and doxy)

Question 18

Dyspepsia definition

Answer 18

Stomach ache

Should have one or more of: post-prandial fullness, epigastric pain or burning, early satiety

Question 19

Red flags with dyspepsia

Answer 19

VWBAD (vomiting, weight loss, bleeding, anorexia, dysphagia)
Early satiety
Change in bowel habit

Question 20

Positive red flags for dyspepsia, what investigations would you do?

Answer 20

Endoscopy recommended

In the interim, you could do an abdominal ultrasound +/- barium swallow

Question 21

Does H pylori cause dyspepsia, reflux, or both?

Answer 21

Only dyspepsia

Causes a low amount of stomach acid - so if you treat the H pylori you can sometimes get extreme reflux afterwards

Question 22

Gastritis vs Gastropathy

Answer 22

Gastritis: inflammation of gastric mucosa associated with injury (H pylori, autoimmune, alcohol)
Gastropathy: epithelial damage and regeneration WITHOUT inflammation (NSAIDs, bile reflux, congestion)

Question 23

Can get H pylori in what two patterns of distribution in the stomach? Do they increase or decrease acid secretion? What can each of these lead to?

Answer 23

Antrum (increases acid secretion - leads to duodenal ulcer disease)
Whole stomach (decreases acid secretion - leads to distal gastric carcinoma - decreases GERD, Barretts, esophageal adeno)

Question 24

Antral based gastritis

Answer 24

Infection increases gastrin secretion
Increased parietal cell acid production, causes duodenal damage, causes gastric metaplasia in duodenum, H pylori can move into duodenum and cause ulcers
Low pH in body of stomach means that H py does not move into the body as readily

Question 25

Corpus-predominant atrophic gastritis (pan-gastritis)

Answer 25

Genetically lower acid output
Easier for Hp to move into body
Pangastritis
Risk factor for gastric ulcers as well as intestinal metaplasia that can lead to gastric ca

Question 26

Peptic ulcer disease definition

Answer 26

Damage to the mucosal lining of the intestinal surface where acid is implicated in pathogenesis
Ranges from normal, to erosion (superficial to muscularis mucosae), to ulcer (into muscularis mucosae)

Question 27

4 complications of PUD

Answer 27

Pain
Penetration/perforation
Bleeding
Obstruction