Upper GI Diseases

Question 1

What is GORD?

Answer 1

Reflux of acid through the lower oesophageal sphincter causing oesophageal irritation

Question 2

Risk factors for GORD?

Answer 2

NSAIDs, steroids, bisphosphonates, smoking, alcohol, caffeine, high BMI, hiatus hernia, pregnancy

Question 3

Symptoms of GORD?

Answer 3

• dyspepsia
• retrosternal/epigastric pain
• sore throat/ hoarse voice
• acid regurgitation
• dysphagia
• N&V
• bloating

Question 4

Diagnosis of GORD?

Answer 4

Clinical diagnosis

Question 5

Investigations for GORD? (3)

Answer 5

1. H.pylori testing (in anyone with dyspepsia)
2. Endoscopy (red flag symptoms/ complications)
3. 24-hour pH monitoring

Question 6

What are the 3 main ways to test for H.pylori?

Answer 6

1. Stool antigen test
2. C13 urea breath test
3. Rapid urease test

Question 7

What does the Urea Breath test involve?

Answer 7

Patient drinks a fluid containing urea with radioactive C13. If H.pylori is present, it will convert the urea into ammonia and CO2. The CO2 (with the C13 attached) is released into the blood and excreted by the lungs.

Question 8

How does H.pylori cause damage?

Answer 8

Buries into the stomach/duodenum mucosa to avoid the acidic stomach and exposes the underlying epithelium to the acid environment. The ammonia produced by the H.pylori also damages the cells.

Question 9

Management of GORD? (4)

Answer 9

1. Lifestyle advice - do not eat close to bedtime and remain upright after eating. Avoid alcohol, caffeine, NSAIDs.
2. Antacids/Alginates - Gavison or Rennie
3. PPIs (e.g. Omeprazole)
4. H2 receptor antagonist - Ranitidine

Question 10

Surgical management of GORD? What does this procedure entail?

Answer 10

Laparoscopic Nissen Fundoplication - reinforces a lower oesophageal sphincter by wrapping part of the stomach around the lower oesophagus

Question 11

Complications of GORD? (3)

Answer 11

1. Barrett’s oesophagus (columnar metaplasia)
2. stricture
3. erosive oesophagitis

Question 12

What is Barrett’s oesophagus?

Answer 12

Columnar metaplasia - the oesophagus’s squamous cells turns into the stomach’s columnar cells. Premalignant condition to adenocarcinoma

Question 13

What is a peptic ulcer?

Answer 13

Ulceration of the mucosa in the stomach or duodenum

Question 14

Difference between an erosion and an ulcer?

Answer 14

Erosion - superficial break within the epithelium/mucosal surface
Ulcer - deep break through the full thickness of the epithelium/mucosal surface

Question 15

Symptoms of simple peptic ulcer?

Answer 15

• dyspepsia
• epigastric pain
• nausea and vomiting

Question 16

Symptoms of a bleeding peptic ulcer? (3)

Answer 16

• haematemesis
• melaena
• anaemia (iron-deficiency)
• shock

Question 17

Symptoms of a perforated peptic ulcer?

Answer 17

• generalised tenderness, rigidity, guarding

- shock

Question 18

Which type of peptic ulcer worsens with food?

Answer 18

Gastric

Question 19

Which type of peptic ulcer improves with food?

Answer 19

Duodenal

Question 20

Investigations for peptic ulcer?

Answer 20

1. Bedside: ECG (rule out cardiac pathology)
2. Bloods: FBC (anaemia), LFTs (liver pathology), U&E (electrolyte imbalances)
3. H.pylori testing
4. Imaging: upper GI endoscopy (OGD)

Question 21

Management of peptic ulcer with H.pylori present?

Answer 21

Triple therapy for 7 days:

1. PPI
2. Amoxicilin (or Metronidazole is allergic)
3. Clarythromycin

Question 22

Complications of peptic ulcer?

Answer 22

1. stricture –> GOO/pyloric stenosis
2. bleeding
3. perforation

Question 23

Main 2 causes of peptic ulcer?

Answer 23

1. increase in acid production (e.g. due to stress, caffeine, alcohol, smoking)
2. damage to the protective barrier (mucus and bicarbonate)

Question 24

Management of perforated peptic ulcer?

Answer 24

1. high dose PPI
2. Adrenaline injections
3. Cauterisation (or clips)