a change in cell type: from esophageal squamous to specialized intestinal metaplasia Aetiology: Caused by chronic GE reflux Epidemiology: Surveillance screening – not supported Risk factors Other: Fhx of oesophageal adenocarcinoma &/or Barrett’s oesophagus  Associations Adenocarcinoma (30x  risk) Treatment High grade dysplasia  Follow up endoscopic surveillance (with biopsy) As…

Risk Factors Symptoms decrease the incidence of C. difficile by

Pathophysiology Presentation Diagnosis/ Investigations When to test for coeliac disease Option 1:  tTG-IgA   +  DGP-IgG Medicare Benefits Schedule (MBS) item number 71164 double antibody test ($39.90) is the preferred one-step approach.       Or Option 2:  tTG-IgA  +  Total IgA level  If the IgA level is low 🡪 preform DGP-IgG MBS…

Crohn’s Disease Ulcerative Colitis Epidemiology Younger people Smokers – 3-4 times more commonRacial preference: Jewish & Caucasian Younger peopleNon-smokers – smoking seems protective for UC (many patients with UC may present after smoking cessation) age Peak onset: 15-30 yearsCan also present in children – FFT and also in those in their 60’s…

Luminal Intrinsic narrowing Extrinsic compression  Large bolus Foreign body  Inflammatory condition causing edema and swelling Stomatitis Pharyngitisepiglottitis Esophagitis – Viral (herpes simplex, varicella-zoster, cytomegalovirus) – Bacterial – Fungal (candidal) – Mucocutaneous bullous diseases – Caustic, chemical, thermal injury  Webs and rings Pharyngeal (Plummer-Vinson syndrome) Esophageal (congenital, inflammatory) Lower esophageal mucosal ring (Schatzki ring)  Benign strictures Peptic Caustic and pill-induced Inflammatory (Crohn’s disease, candidal, mucocutaneous lesions) Ischemic Postoperative,…

Functional dyspepsia Symptoms red flag symptoms should prompt endoscopy: Diagnosis Differentials Pathophysiology Treatment Therapy Functional dyspepsia subtypes Epigastric pain syndrome Postprandial distress syndrome Reassurance, explanation and advice to reduce stressDepression should be excluded by asking simple screening questions + + Diet – regular low-fat meals, l ow FODMAP diet +…

H. pylori Testing: NPS – StePPIng the appropriate path with GORD medicines recommends testing for H. pylori before long-term PPI therapy in specific cases, while Australian Prescriber states that H. pylori eradication does not reduce GORD symptoms and is not routinely recommended. Gastro-oesophageal reflux disease (GORD) is a chronic condition…

Associated conditions Clinical Indications for Diagnosis and treat Test Mechanism Notes Invasive Rapid urease test Biopsy specimen is combined with urea and pH is measured H. pylori  converts urea to ammonia (NH3) + CO2 Test is positive for H. pylori if pH of the medium becomes more alkaline, indicated by…

At risk groups: Women Infants Elderly Athletes Vegetarians ↑requirement (pregnancy, breast feed)↑loss Fe (menstrual bleed, blood donation)Teenagers (menstrual loss, poor diet,growth) ↑requirement Fe Poor dietGI disease Poor dietGI bleed, urine & sweat loss Low Fe diet N.B. Dietary inadequacy alone is rarely a cause. History Examination Investigations If still no…

Criteria (Rome IV criteria for the diagnosis of irritable bowel syndrome): precipitate or aggravate GI symptoms by (Collectively called FODMAPs) Associated Conditions Differential diagnosis Risk Factors: Psychosocial Symptoms and Signs Red flags Treatment

Definition: Lactose Metabolism: Lactase Deficiency: Sources of Lactose: Symptoms of Lactose Intolerance: Behavioral Response: Common Confusion: Nutritional Considerations: Causes Epidemiology Pathophysiology History and Physical Medical Tests Treatment / Management Differential Diagnosis

Detailed Etiology and Pathophysiology Fat Malabsorption Carbohydrate Malabsorption Protein Malabsorption History Physical Examination Differential Diagnosis Overlapping Symptoms Among Malabsorption Syndromes Conditions Masquerading as Abdominal Pain Specific Differential Diagnoses Based on Syndrome or Symptom Management Strategies General Evaluation for Malabsorption Syndromes: More Specific Evaluation of Malabsorption Syndromes: Treatment and Management Special…

Common Risk Factors for Both Peptic and Duodenal Ulcers Indications for gastroscopy Other: Diagnostic clarification of symptoms Management 1st line: Lifestyle changes Other: avoid E&D 2-3hrs before bedtime or vigorous exercise, elevate head of bed if nocturnal symptoms, smoking cessation 2nd line: Antacids PRN 3rd line: Mild intermittent symptoms Frequent…