, chapter UPPER GASTROINTESTINAL
TRACT DISORDERS
1 QUESTIONS
1. A 46-year-old teacher presented with a 5-month history of profuse
diarrhoea despite fasting, and associated abdominal bloating.
She complained of increasing fatigue and appeared dehydrated.
Investigations:
haemoglobin 125 g/L (130–180)
serum sodium 138 mmol/L (137–144)
serum potassium 1.9 mmol/L (3.5–4.9)
serum urea 7.3 mmol/L (2.5–7.0)
serum creatinine 105 μmol/L (60–110)
plasma viscosity 1.76 mPa/s (1.50–1.72)
Which of the following is the most likely diagnosis?
A. Bile salt malabsorption
B. Coeliac disease
C. Irritable bowel syndrome
D. Ulcerative colitis
E. VIPoma
2. A 43-year-old housewife with a history of ischaemic heart disease and
a body mass index of 37 was referred for gastric bypass surgery. She
was included in a research study investigating the effects of satiety
hormones before Roux-en-Y gastric bypass.
Which of the following statements best describes the behaviour
of ghrelin before and after meal ingestion?
A. Ghrelin level falls before meal ingestion but gradually rises in the next 2 hours
B. Ghrelin level remains unchanged
C. Ghrelin level rises sharply before and remains high after meal ingestion
D. Ghrelin level sharply rises before and falls shortly after meal ingestion
E. Ghrelin level unchanged before meal ingestion and fall rapidly afterwards
,2 UPPER GASTROINTESTINAL TRACT DISORDERS QUESTIONS
3. A 46-year-old man was reviewed in clinic with troublesome symptoms
of reflux occurring at any time of day, for the last 2 years. He had
a gastroscopy six months ago which was normal. He had taken
omeprazole 40 mg BD and metoclopramide 10 mg TDS for eight
months. He had previously tried an H2-receptor antagonist in addition
to this, with no benefit. He had no lifestyle risk factors for reflux.
What is the next most appropriate management step?
A. Ambulatory oesophageal pH and manometry studies
B. Barium swallow
C. Fasting gastrin level
D. Peripheral blood eosinophil count
E. Repeat endoscopy
4. A 58-year-old man underwent an OGD for investigation of reflux
symptoms. Macroscopically he was found to have an area suggestive
of Barrett’s oesophagus. This was biopsied and his histology report was
returned to you.
Which of the following histological features best supports the
endoscopic diagnosis of Barrett’s oesophagus with no dysplasia?
A. Cardiac-type columnar cells bordering squamous mucosa
B. Columnar mucosa with nuclear pleomorphism in all cells seen
C. Gastric-type mucosa with a similarity in nuclear/cytological appearances in the crypt base
cells to those at the surface epithelium
D. Increased foci of mitotic activity seen at the gastro-oesophageal junction
E. Intestinal metaplastic glandular mucosa with adjacent oesophageal ducts
5. A 58-year-old woman under surveillance for Barrett’s oesophagus was
found to have high-grade dysplasia in four biopsies at gastroscopy.
Repeat gastroscopy and further biopsies confirmed this. The
Barrett’s segment appeared uncomplicated macroscopically, and was
circumferential and 5 cm in length (Prague C5M5). She was taking a
high-dose proton pump inhibitor. She declined surgical intervention.
Which of the following is the most appropriate management step?
A. Argon plasma coagulation
B. Endoscopic mucosal resection
C. Laser ablation
D. Multipolar electrocoagulation
E. Radio-frequency ablation
, UPPER GASTROINTESTINAL TRACT DISORDERS QUESTIONS 3
6. A 72-year-old man presented with a 3-week history of dysphagia and was
found to have a large oesophageal adenocarcinoma at 37 cm.
Which of the following is the most significant predisposing factor in
the pathogenesis of oesophageal adenocarcinoma?
A. Alcohol excess
B. Helicobacter pylori infection
C. Obesity
D. Smoking
E. Social deprivation
7. A 37-year-old Brazilian man who complained of chest pain was referred
to the gastroenterology clinic by cardiology. He had a history of episodic
dysphagia and occasional regurgitation; his GP had adequately trialled
PPI and prokinetics.
Investigations:
gastroscopy normal
oesophageal pH studies DeMeester score 11
oesophageal motility studies simultaneous high-amplitude contractions with 40% of
swallows, but intermittently normal peristaltic waves and
a high resting pressure at the lower oesophageal sphincter
(LOS). There is normal relaxation during swallowing
WS
100
Proximal
0
100
Mid
0
100
Distal
0
Figure 1.1 Oesophageal motility study result
Reproduced from Gut, Spechler SJ, Castell DO, ‘Classification of oesophageal motility abnormalities’, 49, 1, pp. 145–151. Copyright
2001, with permission from BMJ Publishing Group Ltd and British Society of Gastroenterology.
TRACT DISORDERS
1 QUESTIONS
1. A 46-year-old teacher presented with a 5-month history of profuse
diarrhoea despite fasting, and associated abdominal bloating.
She complained of increasing fatigue and appeared dehydrated.
Investigations:
haemoglobin 125 g/L (130–180)
serum sodium 138 mmol/L (137–144)
serum potassium 1.9 mmol/L (3.5–4.9)
serum urea 7.3 mmol/L (2.5–7.0)
serum creatinine 105 μmol/L (60–110)
plasma viscosity 1.76 mPa/s (1.50–1.72)
Which of the following is the most likely diagnosis?
A. Bile salt malabsorption
B. Coeliac disease
C. Irritable bowel syndrome
D. Ulcerative colitis
E. VIPoma
2. A 43-year-old housewife with a history of ischaemic heart disease and
a body mass index of 37 was referred for gastric bypass surgery. She
was included in a research study investigating the effects of satiety
hormones before Roux-en-Y gastric bypass.
Which of the following statements best describes the behaviour
of ghrelin before and after meal ingestion?
A. Ghrelin level falls before meal ingestion but gradually rises in the next 2 hours
B. Ghrelin level remains unchanged
C. Ghrelin level rises sharply before and remains high after meal ingestion
D. Ghrelin level sharply rises before and falls shortly after meal ingestion
E. Ghrelin level unchanged before meal ingestion and fall rapidly afterwards
,2 UPPER GASTROINTESTINAL TRACT DISORDERS QUESTIONS
3. A 46-year-old man was reviewed in clinic with troublesome symptoms
of reflux occurring at any time of day, for the last 2 years. He had
a gastroscopy six months ago which was normal. He had taken
omeprazole 40 mg BD and metoclopramide 10 mg TDS for eight
months. He had previously tried an H2-receptor antagonist in addition
to this, with no benefit. He had no lifestyle risk factors for reflux.
What is the next most appropriate management step?
A. Ambulatory oesophageal pH and manometry studies
B. Barium swallow
C. Fasting gastrin level
D. Peripheral blood eosinophil count
E. Repeat endoscopy
4. A 58-year-old man underwent an OGD for investigation of reflux
symptoms. Macroscopically he was found to have an area suggestive
of Barrett’s oesophagus. This was biopsied and his histology report was
returned to you.
Which of the following histological features best supports the
endoscopic diagnosis of Barrett’s oesophagus with no dysplasia?
A. Cardiac-type columnar cells bordering squamous mucosa
B. Columnar mucosa with nuclear pleomorphism in all cells seen
C. Gastric-type mucosa with a similarity in nuclear/cytological appearances in the crypt base
cells to those at the surface epithelium
D. Increased foci of mitotic activity seen at the gastro-oesophageal junction
E. Intestinal metaplastic glandular mucosa with adjacent oesophageal ducts
5. A 58-year-old woman under surveillance for Barrett’s oesophagus was
found to have high-grade dysplasia in four biopsies at gastroscopy.
Repeat gastroscopy and further biopsies confirmed this. The
Barrett’s segment appeared uncomplicated macroscopically, and was
circumferential and 5 cm in length (Prague C5M5). She was taking a
high-dose proton pump inhibitor. She declined surgical intervention.
Which of the following is the most appropriate management step?
A. Argon plasma coagulation
B. Endoscopic mucosal resection
C. Laser ablation
D. Multipolar electrocoagulation
E. Radio-frequency ablation
, UPPER GASTROINTESTINAL TRACT DISORDERS QUESTIONS 3
6. A 72-year-old man presented with a 3-week history of dysphagia and was
found to have a large oesophageal adenocarcinoma at 37 cm.
Which of the following is the most significant predisposing factor in
the pathogenesis of oesophageal adenocarcinoma?
A. Alcohol excess
B. Helicobacter pylori infection
C. Obesity
D. Smoking
E. Social deprivation
7. A 37-year-old Brazilian man who complained of chest pain was referred
to the gastroenterology clinic by cardiology. He had a history of episodic
dysphagia and occasional regurgitation; his GP had adequately trialled
PPI and prokinetics.
Investigations:
gastroscopy normal
oesophageal pH studies DeMeester score 11
oesophageal motility studies simultaneous high-amplitude contractions with 40% of
swallows, but intermittently normal peristaltic waves and
a high resting pressure at the lower oesophageal sphincter
(LOS). There is normal relaxation during swallowing
WS
100
Proximal
0
100
Mid
0
100
Distal
0
Figure 1.1 Oesophageal motility study result
Reproduced from Gut, Spechler SJ, Castell DO, ‘Classification of oesophageal motility abnormalities’, 49, 1, pp. 145–151. Copyright
2001, with permission from BMJ Publishing Group Ltd and British Society of Gastroenterology.
