Week 6 - Upper Gastrointestinal Disease Flashcards
What is chronic gastritis?
- ongoing inflammation of the stomach mucosa
- can provide an environment in which dysplasia and carcinoma can arise
How does chronic gastritis compare to acute gastritis?
Symptoms less severe but more persistent
What are the symptoms of chronic gastritis?
- upper abdominal pain
- indigestion or bloating
- N&V
- belching
- loss of appetite or weight loss
-may be asymptomatic
What are the causes for chronic gastritis?
Bacterial - helicobacter pylori infection
Chemical - alcohol, tobacco, caffeine
Autoimmune - can lead to pernicious anaemia
Psychological stress
What is helicobacter pylori?
- gram -ve bacterium found in the stomach, particularly antrum
- infects over half the worlds population by age 5
- infection probably acquired via faecal-oral route
- if untreated, infection persists throughout life
What is the clinical presentation of H.pylori?
- 80% asymptomatic
- 5-15% peptic ulcer disease
- 10% non-ulcer dyspepsia
- 1-3% gastric adenocarcinoma
- 0.5% gastric MALToma
What is the importance of H.pylori?
- strongly associated with chronic gastritis
- strongly associated with duodenal ulcer
- fairly strongly associated with gastric ulcer
- associated with gastric carcinoma
- associated with gastric MALT lymphoma
What are the effects of H.pylori infection?
- mild pan gastritis - no significant disease
- body-predominant (hypochlorhydria, gastric atrophy, intestinal metaplasia) - gastric cancer phenotype
- antrum-predominant (hyperchlorhydria) - DU phenotype
What is peptic ulcer disease?
Painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum
-most ulcers are solitary
Where does peptic ulcer disease usually occur?
-D1 or antrum (4:1)
What are common causes of peptic ulcer disease?
- H.pylori (80-100% DU, 65% gastric)
- NSAIDs
What are the symptoms of peptic ulcer disease?
- pain (gnawing, burning, aching)
- worse at night
- worse after meals
What are the complications of peptic ulcer disease?
- bleeding leading to iron deficiency anaemia
- massive haematemesis - vomiting of blood
- perforation leading to peritonitis
- long term cancer at edge of ulcer
What is Barrett’s oesophagus?
Normal lining of the oesophagus = stratified squamous epithelium
- in Barrett’s oesophagus - squamous epithelium is replaced by columnar epithelium with goblet cells (usually found lower in the GI tract)
- thought to be an adaptation to chronic acid exposure from reflux oesophagitis
What is the process of dysplasia in Barrett’s oesophagus?
- low grade to high grade to invasive carcinoma
- strong association 0.5% per patient per year) with oesophageal adenocarcinoma - need for surveillance