H. Pylori and Gastric Disease Flashcards
(42 cards)
What is dyspepsia?
Describes a group of symptoms - pain or discomfort in the upper abdomen
Name the different types of symptoms that may be experienced in dyspepsia
- Upper abdominal discomfort
- Retrosternal pain
- Anorexia
- Nausea
- Vomiting
- Bloating
- Fullness
- Early satiety
- Heartburn
What are the two different types of dyspepsia?
Organic vs functional
Define organic dyspepsia
Definite pathology that can be identified, with structural abnormality being the cause
Define functional dyspepsia
Cells or structure completely normal but does not function properly
Give upper GI causes of dyspepsia
- Peptic ulcer
- Gastritis
- Non ulcer dyspepsia
- Gastric cancer
Give lower GI causes of dyspepsia
IBC, colonic cancer, coeliac disease
What are the alarms symptoms of dyspepsia which indicate you should refer to endoscopy?
- Anorexia
- Loss of weight
- Anaemia
- Recent onset > 55yrs or persistent despite treatment
- Melaena/haematemesis (GI bleeding) or mass
- Swallowing problems – dysphagia
What is melaena?
Production of dark faeces as a result of internal bleeding or swallowing of blood
What is haematemesis?
Blood in vomit
What investigations are used for dyspepsia?
Bloods:
FBC, ferritin (anaemia), LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA
What do you ask in the history/examination of dyspepsia?
If patient has alarm symptoms
What do you look for in the drugs history of dyspepsia?
NSAIDs, steroids (cause inflammation), bisphosphonates, Ca antagonist, nitrates, theophyllines, remember OTT (over counter) – all these drugs can aggravate the upper GI tract
Describe the steps in the investigation of dyspepsia causes
- Alarm features?
Yes = UGIE - No = > 55yrs –> UGIE, <55yrs –> no UGIE, test for H. Pylori
What are the next steps if H. Pylori test is positive when investigating dyspepsia?
- Eradication therapy
* Symptomatic treatment with PPIs or H2R antagonists and lifestyle factors
What is a H2R antagonist?
Histamine H2 receptor blockers
What is a PPI?
Proton pump inhibitor
Describe H. Pylori
Gram negative, spiral shaped, microaerophilic, flagellated bacteria which infects 50% of the world population. It is usually acquired in childhood via faecal-oral route.
Describe the H. pylori infection
- Can only colonise in gastric type mucosa
- It resides in the surface mucous layer and does not penetrate the epithelial layer
- Evokes immune response in underlying mucosa – dependent on host genetic factors
How does H. Pylori protect itself against gastric acid?
Flagellum prevents it being stopped by the mucus layer as it helps it to burrow through. It burrows into the mucus layer to get away from the gastric acid and produces urease (enzyme) which creates a halo of alkalinity (modifies microenvironment for survival)
Name four different possible outcomes of H. Pylori Infections
- Asymptomatic or chronic gastritis
- Chronic atrophic gastritis
- Gastritis or duodenal ulcer
- Gastric cancer
What are the three divergent responses to H. pylori infection which leads to DU disease or gastric Ca?
- Antral predominant gastritis -> high acid, low risk of gastric Ca = DU disease
- Mild mixed gastritis -> normal acid = no significant disease
- Corpus predominant gastritis -> decrease acid, gastric atrophy = gastric Ca
Dependent of where the H. Pylori infection colonises in the gastric mucosa, what are the most likely outcomes?
If in antrum: more prone to ulcers in duodenum of first part of the small bowel
If in fundus: more prone to develop cancer
Describe the non-invasive approach of diagnosing H. pylori infection
- Serology: IgG against H. pylori
- C13/14 urea breath test
- Stool antigen test: ELISA (must stop PPI for 2 weeks)
