The Specialty certificate in Gastroenterology SCE covers the whole of the curriculum of the specialty training in gastroenterology in the UK. Preparation for this exam requires a wide breadth of knowledge around the curriculum . As knowledge is constantly advancing , awareness of current and updated guidelines is important.This blog is an attempt to pool all resources in one site with regular updates.
Dr Elmuhtady Said
Curriculum for Specialty Certificate Examination in Gastroenterology
The patient has achalasia, which has been associated with squamous cell carcinoma (SCC) of the esophagus. Cancer has been felt to be secondary to chronic food stasis, leading to chronic inflammation, epithelial hyperplasia, multifocal dysplasia, and eventually SCC. High risk patients should be identified and have endoscopic surveillance. Surveillance endoscopy is generally thought to begin 10 years after the onset of the first symptom and be performed annually thereafter. It does not appear that successful endoscopic therapy for achalasia alters the risk. The patient is also a smoker which puts him at further risk of esophageal cancer but of itself does not lead to a recommendation for surveillance for SCC. It should be noted that this recommendation is based on weak evidence primarily based on expert opinion and uncontrolled case series.
fluticasone 220 microgm/puff, two puffs BID. This is a therapeutic course and should be understood as not a cure as almost 70% will be back on steroids within three years, 28% will have food impactions and 22% will need further dilations. Indefinite use is not a current recommendation. Esophageal candidiasis has been reported as a relatively frequent complication of this therapy. For rare intermittent choking with no history of aspiration, dilation may not be advised at this time, although it may be effective for fixed rings with more frequent food obstruction as there is thought to be a component of fibrosis that will not respond to therapy with anti-inflammatory agents.
I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the liver already present. I started on antiviral medications which reduced the viral load initially. After a couple of years the virus became resistant. I started on HEPATITIS B Herbal treatment from ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their treatment totally reversed the virus. I did another blood test after the 6 months long treatment and tested negative to the virus. Amazing treatment! This treatment is a breakthrough for all HBV carriers.
The patient has achalasia, which has been associated with squamous cell carcinoma (SCC) of the esophagus. Cancer has been felt to be secondary to chronic food stasis, leading to chronic inflammation, epithelial hyperplasia, multifocal dysplasia, and eventually SCC. High risk patients should be identified and have endoscopic surveillance. Surveillance endoscopy is generally thought to begin 10 years after the onset of the first symptom and be performed annually thereafter. It does not appear that successful endoscopic therapy for achalasia alters the risk. The patient is also a smoker which puts him at further risk of esophageal cancer but of itself does not lead to a recommendation for surveillance for SCC. It should be noted that this recommendation is based on weak evidence primarily based on expert opinion and uncontrolled case series.
ReplyDeletefluticasone 220 microgm/puff, two puffs BID. This is a therapeutic course and should be understood as not a cure as almost 70% will be back on steroids within three years, 28% will have food impactions and 22% will need further dilations. Indefinite use is not a current recommendation. Esophageal candidiasis has been reported as a relatively frequent complication of this therapy. For rare intermittent choking with no history of aspiration, dilation may not be advised at this time, although it may be effective for fixed rings with more frequent food obstruction as there is thought to be a component of fibrosis that will not respond to therapy with anti-inflammatory agents.
ReplyDeleteI was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.