H Pylori and Gastric Disease

Question 1

What are the layers of the stomach muscles from outer to inner

Answer 1

Longitudinal, circular, oblique

Question 2

When to refer a patient to endoscopy?

Answer 2

(A)norexia
(L)oss of weight 
(A)naemia 
(R)ecent onset if <55 years or persistent despite treatment 
(M)elaena/Haematemesis/Mass 
(S)wallowing problems - dyshpagia

Question 3

what is risk of perforation in Endoscopy

Answer 3

1 in 2,000

Question 4

Bloods for patients with dyspepsia?

Answer 4

FBC,Ferritin,LFTs,U&Es,calcium,glucose,coeliac serology/Serum IgA

Question 5

What drugs common in dyspepsia patients

Answer 5

NSAIDS and steroids and biphosphonates

Question 6

Symptomatic treatment of H pylori includes?

Answer 6

PPIs or H2R antagonists & lifestyle factors

Question 7

What is H pylori

Answer 7

a gram negative, spiral shaped bacteria

Question 8

What does H pylori do in the stomach?

Answer 8

It can only colonise gastric type mucosa and resides in the surface mucous area and can’t penetrate the epithelial layer. It evokes an immune response in the underlying mucosa depeding on the host’s genetic factors

Question 9

What are the possible outcomes of an H pylori infection

Answer 9

asymptomatic, gastric/duodenal ulcer, chronic atrophoc gastritis, intestinal metaplasia, or Gastric cancer

Question 10

Antral H pylori infection results in?

Answer 10

Increased acid secretion, Low risk of gastric cancer, duodenal ulcer disease

Question 11

Corpus predominant gastritis causes:

Answer 11

High risk of gastric cancer, Decrease in acid secretion, Gastric atrophy

Question 12

How to non invasively diagnose H pylori infection

Answer 12

• IgG serology against H pylori
• Urea breath test 13/14 carbon
• stool antigen test - ELISA

Question 13

In order to carry out ELISA on a patient suspected to have H pylori, what should they not be on?

Answer 13

need to be off PPI for 2 weeks

Question 14

What are the invasive tests to diagnose H pylori

Answer 14

Endoscopy -
Gastric biopsy stained for the bacteria
Cultures of gastric biopsies
Rapid slide urease test (CLO)

Question 15

What does Urease do?

Answer 15

breaks down urea in ammonia and carbon dioxide

Question 16

What is the basis of rapid slide urease test?

Answer 16

Checking for an increase of pH due to increase of ammonia from urea

Question 17

What is gastritis

Answer 17

inflammation of the stomach mucosa

Question 18

How is gastritis diagnosed

Answer 18

Histologically + clinical features seen at endoscopy

Question 19

What are the three types of gastritis

Answer 19

(A)Utoimmune (parietal cells)
(B)acterial (H pylori)
(C)hemical (Bile/NSAIDS)

Question 20

What types of ulcers are more common

Answer 20

Duodenal ulcers> Gastric ulcers

Question 21

Majority of peptic ulcers caused by?

Answer 21

H pylori

Question 22

What are other causes of peptic ulcers?

Answer 22

NSAIDS/ smoking

Question 23

What are rarer causes of peptc ulcers

Answer 23

Crohn’s disease
Hyperparathyrodism
Zollinger-Ellison syndrome

Question 24

what symptoms are associated with peptic ulcer?

Answer 24

• Epigastric pain (that might be relieved by antacids)
• Nocturnal/Hunger pain (More common in DU however)
• Back pain (suggesting penetration of a posterior DU)
• Nausea and occasionally vomiting
• Weight loss and anorexia
• Epigastric tenderness (Could be only sign)
• Melaena, Haematemesis, or anaemia if the ulcer bleeds

Question 25

How do you treat a peptic ulcer?

Answer 25

Eradication therapy to get rid of the bacteria

• Antacid medication : PPI (omeprazole) or H2 receptr antagonists (ranitidine)
• If NSAIDs are involved, these have to be stopped or another protective agent is offered
• Surgery only offered in complicted Peptid ullcer disease

Question 26

Eradication of H Pylori infection involves:

Answer 26

-Triple therapy for 7 days!

Question 27

What is involved in triple therapy for seven days

Answer 27

1. Clarithromycin -500 mg bd (2x a day)
2. Amoxycillin- 1g bd OR metronidazole - 400 mg bd
3. PPI : ex omeprazole 20 mg bd

Question 28

What is the main reason for failure of eradication therapy?

Answer 28

Resistance to antibiotics and poor compliance

Question 29

Complications of s peptic ulcer include?

Answer 29

• Acute bleeding - Melaena and haematemesis
• Chronic bleeding - iron deficiency anaemia
• Perforation
• Fibrotic stricture
• Gastric outlet obstruction - Oedema or stricture

Question 30

What is gastric outlet obstruction associated with?

Answer 30

Vomiting that lacks bile and has fermented foodstuff
Early satiety, abdominal distention, weight loss,gastric splash ,dehydration and loss of H+ and cl- in stomach
Metabolic alkalosis

Question 31

What is reflected in bloods of gastric outlet obstruction

Answer 31

Low CL, Low Na, Low K, renal impairment

Question 32

How to diagnose GOO

Answer 32

Upper Gastrointestinal Endoscopy to identify cause - Stricture,ulcer,cancer

Question 33

Treatment of GOO?

Answer 33

Balloon dilatation, surgery

Question 34

What is the second most common malignancy worldwide?

Answer 34

Gastric cancer

Question 35

What is the 5 year prognosis of gastric cancer

Answer 35

under 20% survival

Question 36

Majority of gastric cancer are what histological type?

Answer 36

Adenocarcinoma

Question 37

Symptoms of gastric cancer?

Answer 37

Dyspepsia, early satiety, gastric outlet obstruction, anaemia,bleeding, nasuea, vomiting, weight loss