H Pylori and Gastric Disease

Question 1

What are the 2 main components of the upper GIT?

Answer 1

• Oesophagus

- Stomach

Question 2

What are the 2 main components of the lower GIT?

Answer 2

• Small intestine

- Large intestine

Question 3

What are the functions of the stomach?

Answer 3

• Food storage
• Initial digestive processes
• Acidic environment
• Secretion

Question 4

What does the stomach secrete?

Answer 4

• Gastric acid
• Gut hormones
• Intrinsic factor
• Pepsin

Question 5

What does dyspepsia literally mean?

Answer 5

-Bad digestion

Question 6

What does dyspepsia describe?

Answer 6

A group of symptoms

Question 7

What symptoms are classed as dyspepsia?

Answer 7

• Pain or discomfort in the upper abdomen
• Retrosternal pain
• Anorexia
• Nausea
• Vomiting
• Bloating
• Fullness
• Early satiety
• Heartburn

Question 8

Organic

Answer 8

Relating to or rising in a bodily organ

Question 9

Functional

Answer 9

Impairment of a normal body function when everything looks normal

Question 10

What upper GI causes of dyspepsia are there?

Answer 10

• Peptic ulcer
• Gastritis
• Non ulcer dyspepsia
• Gastric cancer

Question 11

What can cause dyspepsia other than the upper GIT?

Answer 11

• Hepatic causes
• Gallstones
• Pancreatic disease
• Lower GI
• Coeliac disease
• Other systemic disease
• Drugs
• Psychological

Question 12

What lower GIT causes of dyspepsia are there?

Answer 12

• IBS

- Colonic cancer

Question 13

What are the red flag symptoms for referral to endoscopy?

Answer 13

• Anorexia
• Loss of weight
• Anaemia
• Recent onset >55 years or persistent despite treatment
• Melaena/haematemesis or mass
• Swallowing problems

Question 14

What is involved in an upper GI endoscopy?

Answer 14

• Diagnosis/therapeutic
• Local anaesthetic or sedation
• Day case
• Fasted
• Consent

Question 15

What are the risks of upper GI endoscopy?

Answer 15

• Perforation
• Bleeding
• Reaction to drugs

Question 16

What is key when a patient presents with dyspepsia?

Answer 16

History and examination

Question 17

What bloods should be carried out when a patient presents with dyspepsia?

Answer 17

• FBC
• Ferritin
• LFT
• U+E
• Calcium
• Glucose
• Coeliac serology
• Serum IgA

Question 18

What drugs are important in the history of someone with dyspepsia?

Answer 18

-NSAIDs
Steroids
-Bisphosphonate
-Ca antagonists
-Nitrates
-Theophylline

Question 19

What is important to ask about lifestyle in the history od someone with dyspepsia?

Answer 19

• Alcohol
• Diet
• Smoking
• Exercise
• Weight reduction

Question 20

What are the characteristics of helicobacter pylori?

Answer 20

• Gram negative
• Spiral shaped
• Microaerophilic
• Flagellated

Question 21

When is H pylori usually acquired?

Answer 21

Childhood

Question 22

What is the only type of mucosa that H pylori can colonise?

Answer 22

Gastric

Question 23

Where does H pylori reside?

Answer 23

In the surface mucous layer and does not penetrate the epithelial layer

Question 24

What does H pylori do to the underlying mucosa?

Answer 24

Evokes an immune response

Question 25

What are the clinical outcomes of H pylori infection?

Answer 25

- Asymptomatic or chronic gastritis - Chronic atrophic gastritis intestinal metaplasia - Gastric or duodenal ulcer - Gastric cancer MALT lymphoma

Question 26

What are the outcomes of H pylori infection dependent on?

Answer 26

- Site of colonisation - Characteristics of bacteria - Host factors

Question 27

Give 2 brackets of host factors.

Answer 27

- Susceptibility | - Environmental

Question 28

Describe the response to antral predominant gastritis by chronic H pylori infection

Answer 28

- Increase in acid - Low risk of gastric cancer - Duodenal disease

Question 29

Describe the response to corpus predominant gastritis by chronic H pylori infection.

Answer 29

- Decrease in acid - Gastric atrophy - Gatric cancer

Question 30

Describe the response to mild mixed gastritis by chronic H pylori infection.

Answer 30

- Normal acid | - No significant disease

Question 31

What are the non-invasive ways of diagnosing H pylori infection?

Answer 31

- Serology: IgG against H pylori - 13c/14c urea breath test - Stool antigen test: ELISA: need to be off PPI for 2 weeks

Question 32

What are the invasive ways of diagnosing H pylori infection?

Answer 32

Requires endoscopy - Histology: gastric biopsies stained for bacteria - Culture of gastric biopsies - Rapid slide urease test (CLO)

Question 33

What is it that is utilised in slide urease tests?

Answer 33

Ammonia

Question 34

What is gastritis?

Answer 34

Inflammation in the gastric mucosa

Question 35

How is gastritis diagnosed?

Answer 35

- Histological diagnosis | - Clinical features seen at endoscopy

Question 36

What are the 3 types of gastritis?

Answer 36

- Autoimmune (protein produced by stomach against parietal cells) - Bacterial (H pylori) - Chemical (bile/NSAIDs)

Question 37

What is the prevalence of peptic ulcers?

Answer 37

- DU>GU - Men>women - Elderly

Question 38

What are the majority of peptic ulcers caused by?

Answer 38

H pylori infection

Question 39

What other causes of peptic ulcers are there?

Answer 39

- NSAIDs - Smoking - Other conditions (Zollinger-Ellison syndrome, hyperparathyroidism, Crohn's disease)

Question 40

What symptoms are associated with peptic ulcer?

Answer 40

- Epigastric pain - Nocturnal/hunger pain - Back pain - Nausea and occasionally vomiting - Weight loss and anorexia - Haematemesis/maelena/anaemia if ulcer bleeds

Question 41

What is the treatment for peptic ulcers?

Answer 41

- H pylori caused= eradication therapy - Antacids: PPI or H2 antagonists - NSAID caused= stopped - Complications treated as they arise - Surgery only if perforated

Question 42

What does eradication therapy for H pylori include?

Answer 42

Triple therapy for 7 days - Clarithromycin 500mg bd - Amoxycillin 1g bd - PPI

Question 43

What are the main reasons fro failure of triple therapy?

Answer 43

- Resistance to antibiotics | - Poor compliance

Question 44

What are the complications of peptic ulcer?

Answer 44

- Acute bleeding (haematemesis/maelena) - Chronic bleeding (anaemia) - Perforation - FIbrotic stricture - Gastric outlet obstruction (oedema/stricture)

Question 45

What are the symptoms of gastric outlet obstruction?

Answer 45

- Vomiting (lacks bile, fermented foodstuffs) - Early satiety - Abdominal distension - Weight loss - Gastric splash

Question 46

What does vomiting lead to?

Answer 46

Dehydration

Question 47

Why does metabolic alkalosis occur with gastric outlet obstruction?

Answer 47

Loss of H and Cl in vomit

Question 48

What would show up in the bloods of someone with gastric outlet obstruction?

Answer 48

- Low Cl - Low Na - Low K - Renal impairment

Question 49

How is gastric outlet obstruction diagnosed?

Answer 49

- UGIE (prolonged fast/aspiration of gastric contents) | - Identify cause (stricture, ulcer, cancer)

Question 50

How is gastric outlet obstruction treated?

Answer 50

- Endoscopic balloon dilatation | - Surgery

Question 51

What are the majority of gastric cancers?

Answer 51

Adenocarcinomas (MALT/GIST)

Question 52

How do patients with gastric cancer present?

Answer 52

- Dyspepsia - Early satiety - Nausea and vomiting - Weight loss - GI bleeding - Iron deficiency anaemia - Gastric outlet obstruction

Question 53

What is the aetiology of gastric cancer?

Answer 53

- Diet - Genetics - Smoking - H pylori infection

Question 54

Give an example of a heritable gastric cancer syndrome?

Answer 54

HDGC: AD CDH-1 gene (E-cadherin)

Question 55

How is a histological diagnosis of gastric cancer made?

Answer 55

Endoscopy and biopsy

Question 56

What staging investigations are carried out with gastric cancer?

Answer 56

- CT chest/abdo | - MDT meeting

Question 57

What is the treatment for gastric cancer?

Answer 57

- Surgery | - Chemotherapy