Gastro-oesophageal reflux disease and hiatus hernia
Gastro-oesophageal reflux disease (GORD) is a common disorder with an increasing prevalence in the UK. The presence of a hiatus hernia is the strongest risk factor for developing GORD, although it is not essential. The most common symptoms experienced by patients with GORD are heartburn and acid regurgitation. The diagnosis of GORD is usually made from the clinical history. Endoscopy and ambulatory pH monitoring are adjunctive tests that can influence management decisions. The main goals of treatment are symptom control and the prevention of complications such as Barrett's oesophagus and peptic stricture. (Source: Medicine)
Source: Medicine - February 12, 2024 Category: Internal Medicine Authors: Estefania Moreno, Philip Woodland Tags: Mouth and oesophagus Source Type: research
Disorders of the mouth
This article presents common lesions affecting the oral cavity and outlines how to formulate a differential diagnosis appropriate for each lesion. (Source: Medicine)
Source: Medicine - February 9, 2024 Category: Internal Medicine Authors: Shalini Nayee, Martyn Ormond, Jeremy D. Sanderson, Michael P. Escudier Tags: Mouth and oesophagus Source Type: research
Eosinophilic oesophagitis: practical management and novel therapeutics
Eosinophilic oesophagitis (EoE) is a chronic type 2 allergic inflammatory disease of the oesophagus, with a rising prevalence in adults and children. Intermittent dysphagia and/or food impaction occurs in the presence of eosinophilic infiltration of the oesophagus. Patients tend to have a history of atopy. The underlying cause of EoE is an antigen-driven effect occurring only in the oesophagus, with food the most likely source of antigens. All adults with dysphagia or food bolus obstruction require endoscopy and at least six biopsies from the lower, mid- and upper oesophagus if they have signs associated with EoE or have a...
Source: Medicine - February 9, 2024 Category: Internal Medicine Authors: Radu Ionut Rusu, Terry Wong Tags: Mouth and oesophagus Source Type: research
Coeliac disease
(CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. (Source: Medicine)
Source: Medicine - February 6, 2024 Category: Internal Medicine Authors: Jeffrey Butterworth, Louis Los Tags: Malabsorption Source Type: research
Helicobacter pylori infection and peptic ulcers
Nearly all peptic ulcers are caused by either Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, including ulcers complicated by gastrointestinal (GI) bleeding. Only about 15% of H. pylori-infected individuals develop an ulcer, with the risk determined by the virulence of the H. pylori strain, host genetics and environment (particularly smoking). (Source: Medicine)
Source: Medicine - February 5, 2024 Category: Internal Medicine Authors: Debabrata Majumdar, Shi Looi Tags: Stomach Source Type: research
Contents
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Source: Medicine - January 31, 2024 Category: Internal Medicine Source Type: research
Editorial Board
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Source: Medicine - January 31, 2024 Category: Internal Medicine Source Type: research
Drug-induced gastrointestinal disorders
Adverse drug effects on the gastrointestinal (GI) tract can occur: (1) as a predictable result of a drug's mode of action; (2) by direct injury; (3) through compromising GI mucosal integrity; or (4) as a consequence of changes in colonic microbiota. Non-steroidal anti-inflammatory drugs are the most common cause of gastroduodenal injury, owing to an inhibition of prostaglandin synthesis, and increase the risk of serious GI complications. Low d oses of aspirin are associated with an increased risk of upper GI haemorrhage. (Source: Medicine)
Source: Medicine - January 27, 2024 Category: Internal Medicine Authors: Anthony J Norman, Veena Gopakumar Tags: Stomach Source Type: research
Barrett's oesophagus and oesophageal adenocarcinoma
Barrett's oesophagus (BO) is an intestinal metaplastic change of the oesophageal mucosa that typically occurs in response to gastro-oesophageal acid reflux. BO is the only recognized precursor to oesophageal adenocarcinoma (OAC), which has dramatically increased in incidence in the Western world over the past four decades. Currently, upper gastrointestinal endoscopy is the gold standard to diagnose BO, but newer and less invasive screening modalities (e.g. office-based transnasal endoscopy, non-endoscopic cell collection devices, breath testing) are emerging as alternatives. (Source: Medicine)
Source: Medicine - January 24, 2024 Category: Internal Medicine Authors: W. Keith Tan, Anjui Wu, Massimiliano di Pietro Tags: Mouth and oesophagus Source Type: research
Gastric tumours
encompass adenocarcinoma, the most common type, as well as gastrointestinal stromal tumours, neuroendocrine tumours and gastric lymphoma. They are typically difficult to diagnose early as the ‘red flag’ features of gastric cancer tend to be associated with advanced disease. As a result, survival outcomes of gastric cancer are poor, with 5-year survival in the UK currently at 20%. There have been significant breakthroughs in systemic therapy and surgical technology to increase chances of cure and improve survival. (Source: Medicine)
Source: Medicine - January 24, 2024 Category: Internal Medicine Authors: Nikhil M. Patel, Sacheen Kumar Tags: Stomach Source Type: research
Intestinal failure and short bowel syndrome
Intestinal failure is a rare condition characterized by the inability of the gut to absorb sufficient nutrients and/or fluids and electrolytes to maintain health. These patients require parenteral (intravenous) supplementation. Short bowel syndrome is the most common cause and is typically secondary to extensive surgical resection. Intestinal failure requires management by a multidisciplinary team to provide nutritional support and facilitate intestinal rehabilitation. This involves surgery to restore intestinal continuity where possible, dietary modifications and medical therapies to modify motility and secretions, and in...
Source: Medicine - January 23, 2024 Category: Internal Medicine Authors: Amy Woods, Simon Lal Tags: Malabsorption Source Type: research
Small bowel transplantation – the latest developments
The outcomes of intestinal transplantation have significantly improved over time and there have been many developments, both medical and surgical. Because of advances in surgical techniques, improvements in immunosuppressive regimens and more aggressive vascular access support, results have significantly improved. Moreover, multicentre multidisciplinary team discussions are leading to earlier referrals and transplants, which reduce morbidity on the waiting list. In the UK, the survival rate of isolated intestinal transplant patients is now comparable to that of home parenteral nutrition patients, even though the former oft...
Source: Medicine - January 23, 2024 Category: Internal Medicine Authors: Emilio Canovai, Htar Htar Hlaing, Lisa Sharkey Tags: Malabsorption Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - January 22, 2024 Category: Internal Medicine Tags: Self-assessment/cpd answers Source Type: research
Squamous cell carcinoma of the oral cavity, oropharynx and upper oesophagus
Squamous cell carcinomas of the oral cavity, oropharynx and oesophagus are relatively common and are classically associated with heavy alcohol and tobacco use. The dramatic increase in incidence of oropharyngeal cancers over the past three decades has been attributed to human papillomavirus (HPV) infection. These cancers often remain clinically silent until they are locally advanced, although many can still be treated radically with multimodality treatment. The prognosis depends upon the stage of the disease, and the age and fitness of the patient, their smoking history and whether or not the tumour is HPV driven. (Source: Medicine)
Source: Medicine - January 20, 2024 Category: Internal Medicine Authors: Elinor R. Gatfield, William H.J. Ince, Sarah J. Jefferies Tags: Mouth and oesophagus Source Type: research
Iron deficiency anaemia – modern investigation and management
Iron deficiency anaemia (IDA) is common, affecting up to 30% of the world's population. The main causes of iron deficiency include poor dietary intake, malabsorption of dietary iron and chronic blood loss. However, approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly a gastroenterological disorder. Therefore, the management of IDA requires investigation to establish the underlying cause as well as iron replacement therapy. (Source: Medicine)
Source: Medicine - December 30, 2023 Category: Internal Medicine Authors: Alexandra Marley, Matthew J. Brookes Tags: Symptoms and signs Source Type: research
