Reflux disease, Barretts & dysmobility of oesophagus & stomach Flashcards
what is GORD?
gastro-oesophageal reflux disorder
when does GORD occur?
= incompetents lower oesophageal sphincter
Causing;
- poor oesophagus clearance
- barrier function/visceral sensitivity
what are symptoms of GORD?
- heartburn
- acid reflux
- water brash
- dysphagia
- odynophagia (pain swallowing)
- weight loss
- chest pain
- hoarseness
- coughing
what 4 things could you use to investigate GORD?
1) endoscopy
2) barium swallow
3) oesophageal manometry & pH studies
4) nuclear studies
what are 8 red flags?
1) dysphagia
2) weight loss
3) anaemia
4) vomiting
5) F/H UGI cancer
6) Barrett’s
7) pernicious anaemia
8) previous ulcer disease > 20years
who is at greater risk of getting oesophageal carcinoma?
Males > females
what are 3 treatments of oesophageal carcinoma?
1) radiotherapy
2) surgery
3) palliation
what is the pathogenesis of adenocarcinoma?
- normal
- oesophagiitiis (reversible)
- barrett’s (irreversible)
- adenocarcinoma (too late)
how would you treat GORD?
1) symptom relief
2) heal oesophagitis
3) prevents complications
what are 4 lifestyle modifications?
- stop smoking
- lose weight if obese
- prop up bed head
- avoid provoking factors
why are anti-acids used fro?
= symptomatic relief
NO BENEFIT:
= of healing or preventing complications
give 2 examples of H2 antagonists?
1) cimetidine
2) ranitidine
describe the role of cimetidine and ranitidine?
Cimetidine
= rapid symptom relief
- less effective a healing than placebo
Ranitidine
= tolerance after 4/52 therapy
= poor in preventing relapse and complications
what are 2 examples of proton pump inhibitors?
1) omeprazole
2) lansoprazole
when are proton pumps used?
= symptom relief
= healing (grade 1-II oesophagitis)
what dose of lansoprazole should be given?
= 30mg
what happens in surgery?
= naissent fundoplication
- controls symptoms
- heals oesophagitis
- young patients
- severe/unresponsive disease
is Barrett’s oesophagus reversible or irreversible?
= irreversible
what pathological change is found in Barrett’s oesophagus?
= intestinal metaplasia
how do you manage dysplasia?
- frequency surveillance
- optimise PPI dose
- endoscopic mucosal resection (EMR)
- radio frequency ablation (HALO)
- Argon
what is gastro-paresis?
= delayed gastric emptying
- no physical obstruction
what are 5 symptoms of gastro-paresis?
- feeling of fullness
- nausea
- vomiting
- weight loss
- upper abdominal pain
what are 5 causes of gastro-paresis?
1) idiopathic
2) diabetes mellitus
3) cannabis
4) medication e.g. opiates, anti-cholinergic
5) systemic diseases, e.. systemic sclerosis
how would you investigate possible gastro-paresis?
= gastric emptying studies
how would you manage gastro-paresis?
- removal of precipitating factors, e.g. drugs
- liquid/sloppy diet
- eat little and often
- promotability agens
- gastric pacemaker
wha tis achalasia?
= when the lower oesophageal sphincter fails to relax, preventing food from passing down causing dysphagia
