Gastroesophageal Reflux Disease (GERD) Overview

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Questions and Answers

What is the primary role of urease produced by H. pylori in relation to gastric ulcers?

To break down glycoproteins in gastric mucus

To attract neutrophils to the site of infection

To protect the bacteria from gastric acid (correct)

To damage epithelial cells

Which of the following conditions is primarily associated with NSAID use?

Duodenal ulcers occurring three hours post-meal

Ulcers exclusively due to H. pylori infection

Gastric ulcers on the lesser curvature

Gastric ulcers greater curvature or not in the antrum (correct)

What symptom is commonly associated with duodenal ulcers?

Relief of pain upon eating (correct)

Vomiting blood due to gastric ulcers

Pain occurring immediately after meals

Foul-smelling feces without blood

Which enzyme's inhibition by NSAIDs is responsible for reducing protective mucus secretion in the gastric mucosa?

Cyclooxygenase 1 (COX-1) Signup and view all the answers

What main complication may arise from severe or continuing vomiting in gastric ulcer patients?

Gastrointestinal bleeding leading to hematemesis Signup and view all the answers

What is the most common type of colon cancer?

Adenocarcinoma Signup and view all the answers

What age group has the peak incidence of colon cancer?

60 - 79 years Signup and view all the answers

Which of the following is NOT a known risk factor for colon cancer?

Increased physical activity Signup and view all the answers

Which part of the colon is most commonly affected by cancer?

Sigmoid colon Signup and view all the answers

What percentage of colon cancer cases occur before age 50?

Less than 20% Signup and view all the answers

What is a common symptom of right-sided colon carcinoma?

Anemia and vague abdominal pain Signup and view all the answers

What is the 5-year survival rate for colon cancer patients?

40% - 60% Signup and view all the answers

Which method is commonly used for screening for colon cancer?

Colonoscopy Signup and view all the answers

What is the primary cause of gastroesophageal reflux disease (GERD)?

Decreased efficiency of esophageal antireflux mechanisms Signup and view all the answers

Which symptom is commonly associated with GERD and may be confused with myocardial infarction?

Heartburn Signup and view all the answers

Which of the following is NOT a risk factor for developing GERD?

Increased protein intake Signup and view all the answers

What histological feature is associated with Barrett’s esophagus in GERD patients?

Transformation from squamous to columnar epithelium Signup and view all the answers

What is the most common cause of peptic ulcers?

Helicobacter pylori infection Signup and view all the answers

Which medication type is effective for treating GERD?

H2 receptor antagonists Signup and view all the answers

Which condition is characterized by multiple peptic ulcers due to excess gastrin secretion?

Zollinger-Ellison syndrome Signup and view all the answers

What is a common manifestation of peptic ulcers?

Epigastric pain Signup and view all the answers

Signup and view all the answers

Study Notes

Gastroesophageal Reflux Disease (GERD)

Definition: Most common cause of esophagitis due to reflux of gastric or duodenal contents into the lower esophagus. Esophageal squamous epithelium is vulnerable to acid damage.
Etiology: Decreased efficiency of esophageal antireflux mechanisms (especially lower esophageal tone), increased risk with alcohol and other central nervous system depressants, delayed gastric emptying, hypothyroidism, pregnancy, sliding hiatal hernia, and tobacco use.
Clinical Features: Symptoms include heartburn, dysphagia (difficulty swallowing), and pain that can be mistaken for myocardial infarction. Endoscopy may reveal linear ulcers at the distal esophagus, often with exudate, erythema, or edema. In 50-60% of symptomatic patients, endoscopy is normal. Biopsy is required if clinically suggestive of reflux esophagitis, even if endoscopy is normal.
Diagnosis: Clinical presentation (heartburn, regurgitation), endoscopy, and histological examination are used.
Histopathology: Common findings include basal cell hyperplasia, intraepithelial inflammatory cells, and Barrett's esophagus (transformation of squamous epithelium into columnar epithelium, which can transform to cancer).
Treatment: Motility promoting drugs, H2 receptor antagonists, proton pump inhibitors, and surgery to reduce hiatal hernia.

Peptic Ulcer (PU)

Definition: An erosion of GI epithelium caused by acid-peptic juices. It is typically chronic and solitary.
Causes: Helicobacter pylori infection, Nonsteroidal anti-inflammatory drug (NSAID) use, Zollinger-Ellison syndrome (gastrin-secreting tumor), alcohol, smoking, and corticosteroids.
Pathophysiology:
- H. pylori related ulcers: Produces urease (protection from acid), protease (breaks down glycoproteins in gastric mucus), and phospholipase (damages epithelial cells, may release leukotrienes). Attracts neutrophils, resulting in epithelial cell destruction.
- NSAIDs induced ulcers: Gastric mucosa protects itself from acid with a mucus layer, stimulated by prostaglandins. NSAIDs block cyclooxygenase-1 (COX-1), essential for prostaglandin production.
Common Sites: Duodenum, antrum, lesser curvature, gastroesophageal junction (GE junction). Duodenum is the most common site, 4 times more likely than the stomach.
Clinical Picture: Abdominal pain (typically epigastric), strongly correlated with mealtimes. Pain relief by eating, nausea and vomiting, weight gain (duodenal ulcer), hematemesis, and melena.
Treatment: Antibiotics (if H. pylori induced), proton pump inhibitors, discontinuation of NSAIDs and corticosteroids, and smoking cessation.

Colon Cancer

Definition: Primary epithelial malignancy arising in the colorectum. Adenocarcinomas are the most prevalent type.
Prevalence: Second or third most common cancer and cause of cancer deaths in men and women (98% adenocarcinomas).
Demographics: More common in men than women. Peak age is 60-79 years, < 20% of cases occur before age 50. Rare before age 40, unless predisposing syndromes exist.
Sites: Sigmoid colon and rectum are most common sites.
Etiology: Risk factors include older age, obesity, physical inactivity, alcohol consumption, inflammatory bowel disease, family history of colorectal neoplasia, dietary risk factors (low vegetable fiber, increased beef, reduced vitamins A, C, and E), and some polyposis syndromes (APC gene).
Pathophysiology: Low fiber prolongs transit time allowing toxic by-products to stay in contact with colonic mucosa. Beef consumption increases bile acid production, potentially converted to carcinogens.
Clinical Features: Screening includes colonoscopy and occult blood tests. Symptoms can include right-sided tumors causing anemia, vague abdominal pain, left-sided tumors causing changes in bowel habits (diarrhea or constipation), and rectal bleeding.
Metastases: 60% of patients have lymph node or distant metastases at diagnosis. Common metastatic sites are regional lymph nodes, liver, peritoneum, lung, and ovaries.
Prognosis: 5-year survival rate is 40-60%, with most recurrences within 2 years.
Treatment: Surgical excision followed by chemotherapy and/or radiotherapy.

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Description

This quiz explores the key aspects of Gastroesophageal Reflux Disease (GERD), including its definition, etiology, clinical features, and diagnosis. Test your understanding of how GERD affects the esophagus and the common symptoms associated with it.