H Pylori Flashcards
(15 cards)
Indications of h.pylori investigation
1-Active peptic ulcer disease
2- Confirmed history of peptic ulcer disease
(without prior therapy)
3-Low grade gastric MALT lymphoma
4-After endoscopic resection of early gastric cancer
5- Uninvestigated dyspepsia (non-endoscopic
testing in patients without indication for EGD)
6-Functional dyspepsia (collect biopsies during
EGD if H. pylori not already tested)
7-Long term NSAIDS users
الخلاصة
٢ dyspepsia+٢ اورام+
٢ ulcers + nsaids
Refractory peptic ulcer s
Is these are ulcers which don’t heal completely in spite of 8 to 12 weeks of continuous treatment
Causes of refractory peptic ulcer s
1-Persistent H. pylori infection *due to antibiotic resistance or drug noncompliance
*Reinfection of h.pylori.
2-Medications that delay healing
*Corticosteroids (controversial alone, but worse with NSAIDs).
*Bisphosphonates (used for osteoporosis).
*Antiplatelet drugs (like clopidogrel).
3-Continued NSAID use
4-Gastric acid hypersecretion states
*Zollinger–Ellison syndrome (gastrinoma producing high levels of gastrin).
*Hyperparathyroidism (secondary hypercalcemia stimulates gastrin release).
5-Other infections: tb,syphilis, herpes, Cytomegalovirus (CMV) infection, especially in immunocompromised patients.
6-giant ulcers gastric ulcer over 3centimeter or dudenal ulcer over 2 cm.
7- gastric cancers.
8-chronic diseases such as liver cell failure chronic renal disease
يعني الدوا مش هيشتغل
9- systemic diseases as Crohn’s disease
Management
1- correction of the cause
*Check the drug compliance
*Check that the patient stopped
NSAIDs
*Check that the patient stopped smoking.
*Check the H.pylori status
* Make sure that the patient don’t have other hypersecretory status as zollinger elison syndrome or hyperparathyroidism
*Check for possible malignancy
*Check for other infections..
Cmv,herps,tb
Management
2-anti-secretory drugs:
Double the dose of ppi or change to another type of ppi
3-surgical treatment
Causes of gastric ulcers
The main causes of gastric ulcers (stomach ulcers) include:
- Helicobacter pylori infection.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Excess stomach acid production Conditions like Zollinger-Ellison syndrome cause overproduction of acid, leading to ulcers.
- Smoking
- Alcohol consumption.
- Stress (physical stress, such as severe illness, surgery, trauma)
- Dietary factors
Spicy foods, caffeine, and highly acidic foods don’t directly cause ulcers but can worsen symptoms. - Genetic predisposition
Family history may slightly increase the risk of developing ulcers.
A known case of GERD presented to you with test of positive H. pylori stool antigen. Would you treat him?
Yes, I would treat him.
Regardless of the GERD diagnosis, a positive H. pylori test (such as a stool antigen) should be treated.
H. pylori eradication is important because it can lead to peptic ulcer disease, gastric cancer, and lymphoma.
Eradication might also improve dyspeptic symptoms, although the effect on GERD is variable. Therefore, eradication therapy (triple or quadruple therapy) should be given.
A case with bleeding duodenal ulcer. During upper GI endoscopy what test will you choose to diagnose H. pylori?
The best choice is a rapid urease test (CLO test) and/or histological biopsy.
During endoscopy, biopsy-based tests are recommended:
Rapid urease test (RUT) is quick and highly sensitive if no recent PPI or antibiotic use.
Gasteroparesis
Definition
Delayed gastric emptying
Gasteroparesis
Causes
تحشيشةPID
1-Diabetic gastroparesis: especially uncontrolled type 1
2-Idiopathic gastroparesis
o 90% of patients are women. Depression and anxiety are common in these patients.
o Ask about a viral prodrome preceding the onset of symptoms of gastroparesis. This suggests post
viral gastroparesis, which resolves in 80% of patients after 1 year.
3-Post-surgical gastroparesis can result from gastrojejunostomy, vagotomy for peptic ulcer disease,
pancreaticoduodenectomy (Whipple procedure), and laparoscopic fundoplication.
4- Drugs …TCA,Tramadol, marijuana,glp1 receptor agonist
5-other disease: hypothyroidism,hypoparathyrodism,addison, scleroderma
Gasteroparesis
Diagnosis
1-Scintigraphic gastric emptying (SGE) of solids (low fat, egg white meal) is the recommended test for diagnosis.
*The percentage of meal retained at 4 hours is used to diagnose and grade the severity of gastroparesis:
o Mild (11-20%), moderate (21-35%), severe (36-50%), and very severe (> 50%).
2-The wireless motility capsule is FDA approved for evaluation of suspected gastric emptying and is an
alternative to SGE1
. However, this technology is not widely available.
3- Stable isotope breath testing is a relatable test for the evaluation os gastroparesis.
Gasteroparesis
DD
Differential diagnosis:
* gastric outlet obstruction, *functional dyspepsia constipation associated with nausea and
vomiting, narcotic bowel,
*cyclic vomiting syndrome *rumination syndrome
Gasteroparesis
Treatment
1-treatment of coexisting constipation, as it can exacerbate gastroparesis symptoms.
2- Correct fluid and electrolyte imbalances.
3- Optimize glycemic control in diabetic gastroparesis.
4-Stop offending medications.
5- Diet: small, low fat, low residue meals.
6-metoclopramide..
Pripheral and central dopamine antagonist.
7-Dompridone… pripheral dopamine antagonist
8-erythromycine
9-Antiemetics
10-G-POEM
11-GES(Gastric Electric Stimulation) in refractory gastroparesis
Dumping syndrome
This complication occurs most commonly after RYGB.
Early manifestations (within 15 minutes of eating) result from the rapid emptying of large amount of
sugars and nutrients into the duodenum, leading to large fluid shifts. Patients develop abdominal
distension, pain, nausea, vomiting, diarrhea, flushing, and tachycardia.
Late manifestations (after 2-3 hours of eating) result from the sudden hyperglycemia (due to rapid
delivery of simple sugars and carbohydrates to the small intestine) with subsequent high insulin secretion,
eventually leading to hypoglycemia.Patients develop symptoms of hypoglycemia such as dizziness,
confusion, sweating, and flushing.
Treatment consists of dietary changes such as decreasing simple sugars and increasing protein, complex
carbohydrates and fiber. Patients should be instructed to separate solid and liquid intake.
Dumping syndrome usually resolves within the first year after surgery.
Complications of barietric surgery
1-Metabolic
↓ Ca
↓ K,Na
↓ phosphorus
Pts routine supply of Ca++ (1200-1500mg/day) & twice daily multivitamin + minerals
2-Nutritional
↓ of Ca++, K, D, A, B12, folic acid, iron, zinc, copper, selenium, B1 (thiamine deficiency)
*B1 (thiamine) deficiency should be suspected in pts. w intractable vomiting & neurological manifestations: confusion, ophthalmoplegia,
3- Complications related to operation
* Anastomotic leak
at G-J or J-J anastomosis
* Anastomotic stricture
* Band related complications
* Band stenosis
* GI bleeding
* wound infection
* DVT / PE
* Marginal ulcer
