Day: March 14, 2024

Introduction Peptic ulcer disease (PUD) is an umbrella term for the development of two different ulcers: gastric ulcers and duodenal ulcers. PUD is a relatively common condition that frequently presents with dyspepsia, abdominal discomfort and nausea. It can be complicated by perforation, haemorrhage and gastric outlet obstruction. It is important to understand the difference between ulcers and erosions: Erosion – superficial/partial break within the epithelium or mucosal surface. Ulcer – deep break through the full thickness of the epithelium or mucosal surface. The most commonly identified aetiological factors are H.pylori infection and NSAID use. Upper GI endoscopy is used for diagnosis whilst management consists of H.pylori eradication therapy (when indicated),

Overview Oesophageal cancer is the 14th most common malignancy in adults in the UK. The oesophagus is a muscular tube that is situated within the thorax and runs from the pharynx to stomach. It is pivotal in the transfer of food material to the stomach and broadly divided into upper, middle and lower. There are two major types of cancer that arise from the oesophagus, depending on the cell of origin. Squamous cell carcinoma (SCC): usually located in the upper or middle oesophagus. Accounts for >90% of cases worldwide. Adenocarcinoma (AC): usually located in the lower oesophagus. Due to chronic reflux

Overview Lynch syndrome is an autosomal dominant inherited disorder associated with a high lifetime risk of developing CRC. Lynch syndrome (LS) is the most common colorectal cancer (CRC) predisposition syndrome accounting for > 3% of CRC cases. This refers to a genetic predisposition to the development of cancer due to certain inherited mutations. LS is strongly associated with the development of CRC, but also several extra-colonic malignancies. The most common of these is endometrial cancer, but ovarian, gastric, small bowel, urothelial, hepatobiliary and brain malignancies may also be seen. The estimated lifetime risk of CRC in LS is 40-60%, which depends on mutation type. Aetiology

Overview Irritable bowel syndrome is a chronic, functional bowel disorder characterised by abdominal pain and altered bowel habits. Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders (FGID). It is characterised by chronic abdominal pain and altered bowel habits (e.g. diarrhoea and/or constipation). The term ‘functional’ refers to a condition that is not associated with structural or biochemical abnormalities that are detectable with current routine diagnostic tests. Although the exact cause of FGIDs is unknown, it is thought to be due to dysregulation in communication between the gut and brain at multiple levels. This has led to

Overview A hiatus hernia refers to the herniation of part of the stomach through the diaphragmatic oesophageal hiatus. Hiatus hernia is an extremely common anatomical abnormality. It refers to the herniation of part of the stomach through an opening in the diaphragm known as the oesophageal hiatus. This opening functions to allow the oesophagus to pass through the diaphragm into the abdominal cavity. The majority of hiatal hernias are asymptomatic and found incidentally during endoscopy or imaging (e.g. CT or barium swallow). They may be associated with gastro-oesophageal reflux due to disruption of the lower oesophageal sphincter. Management depends on the

Overview GORD is a very common condition, which is characterised by symptoms of heartburn and regurgitation. Gastro-oesophageal reflux disease (GORD), is an extremely common condition. It is defined as reflux of stomach contents into the oesophagus, which is associated with troublesome symptoms and/or complications. In Western European and North American populations, the estimated prevalence is as high as 10-20%. Aetiology & pathophysiology Gastro-oesophageal reflux is a normal physiological phenomenon. Under normal circumstances, the oesophagus propels food into the stomach by peristalsis (involuntary muscle contraction). At the gastro-oesophageal junction (where the oesophagus and stomach meet), a physiology sphincter relaxes to allow food to enter the stomach. This

Overview Gastric (stomach) cancer is the 17th most common malignancy in adults in the UK. The stomach is a muscular organ that is part of the gastrointestinal (GI) tract. It is located at the distal end of the oesophagus beyond the gastro-oesophageal junction (GOJ). The stomach is essential for digestion. The stomach is divided into five anatomical components known at the cardia, fundus, body, antrum and pylorus. The pylorus marks the entry into the duodenum and the whole stomach is composed of columnar epithelium. For more information see our notes on gastrointestinal physiology. Over 90% of gastric cancers are adenocarcinoma, which is historically