Helicobacter Pylori and Gastric Disease

Question 1

what is dyspepsia?

Answer 1

pain or discomfort in the upper abdomen

Question 2

what symptoms does dyspepsia include?

Answer 2

> upper abdominal discomfort
> retrosternal pain
> anorexia
> nausea
> vomiting
> bloating
> fullness
> early satiety
> heart burn

Question 3

what are upper gi causes of dyspepsia?

Answer 3

> peptic ulcer
gastritis
non-ulcer dyspepsia
gastric cancer

Question 4

what are lower causes of dyspepsia?

Answer 4

> IBS

> colonic cancer

Question 5

how may the gall bladder cause dyspepsia?

Answer 5

formation of gallstones

Question 6

what systemic problems may cause dyspepsia?

Answer 6

> cardiac
drugs
psychological

Question 7

in dyspepsia when would you refer for an endoscopy?

Answer 7

Anorexia
Loss in weight
Anaemia
Recent onset >55 years
Melaena/haematemesis
Mass
Swallowing problems (dysphagia)

Question 8

what are the risks associated with upper gi endoscopy?

Answer 8

> 1:2000 risk perforation
bleeding
drug reaction

Question 9

what blood tests are carried out in dyspepsia?

Answer 9

> fbc
> ferritin
> lft's
> u and e's
> calcium
> glucose
> ceoliac serology/serum iga

Question 10

what would you look for in a drug history in patients with dyspepsia?

Answer 10

> nsaids
> steriods
> biphosphonates
> calcium antagonists
> nitrates
> throphyllines

Question 11

if a patient who is over 55 prsents with dyspepsia what would you carry out?

Answer 11

an upper gi endoscopy

Question 12

a patient who is less than 55 present with dyspepsia. what test would you carry out?

Answer 12

test for helicobacter pylori

Question 13

if the helicobacter pylori test is positive what is your next step?

Answer 13

eradication therapy and symptomatic treatment with PPIs or H2R antagonists.
if symptoms resist refer them to GI

Question 14

describe the helicobacter pylori bacterium

Answer 14

> gram negative
spiral shaped
microaerophilic
flagellated

Question 15

how much of the world population is infected with helicobacter pylori?

Answer 15

50%

Question 16

where does h. pylori colonise?

Answer 16

surface layer of gastric type mucosa. does not penetrate the epithelial layer.

Question 17

what does h. pylori invoke in the underlying mucosa?

Answer 17

host immune response

Question 18

what are the clinical outcomes of h. pylori?

Answer 18

> asymptomatic
> chronic gastritis
> chronic atrophic gastritis
> intestinal metaplasia
> gastric/duodenal ulcers
> gastric cancer

Question 19

what can the outcome of h. pylori depend on?

Answer 19

> site of colonisaton
characteristics of bacteria
host factors: genetics and enviroment

Question 20

what are the effects of antral dominant gastritis?

Answer 20

> increase in acid
low risk of gastric ca
duodenal disease

Question 21

what is the effect of a chronic h. pylori infection that leads to mild mixed gastritis?

Answer 21

this leads to normal acid production and no significant disease

Question 22

what is the effect of corpus predominant gastritis from chronic h. pylori infection?

Answer 22

> decrease in acid
gastric atrophy
leading to gastric ca

Question 23

how would you non-invasively diagnose h. pylori infection?

Answer 23

> serology: IgG
urea breath test
stool antigen test (need to be off ppi for 2 weeks)

Question 24

how may you invasivley diagnose h. pylori infection?

Answer 24

through and endoscopy.
> histology of gastric biopsies
> culture of gastric biopsies
> rapid slide urease test

Question 25

what carbon atoms are used in urease dependent diagnosis?

Answer 25

c13 and c14

Question 26

what is measured in breath tests to indicate h. pylori positive?

Answer 26

c13 or c14 labelled co2

Question 27

what is utilised in slide urease tests for h. pylori diagnosis?

Answer 27

> ammonia

Question 28

define gastritis

Answer 28

inflammation of gastric mucosa

Question 29

what are the causes of gastritis?

Answer 29

> autoimmune (parietal cells) > bacterial (H. pylori) > chemical (NSAIDs/bile)

Question 30

what are the majority of peptic ulcers caused by?

Answer 30

h. pylori infection

Question 31

what can cause peptic ulcers?

Answer 31

> h. pylori infection > NSAIDs > smoking

Question 32

what are some rare causes of peptic ulcers?

Answer 32

> zollinger-ellison syndrome > hyperparathyroidism > crohn's disease

Question 33

name some symptoms associated with peptic ulcers

Answer 33

``` > epigastric pain > nocturnal pain > back pain > nausea (vomiting) > weight loss > epigastric tenderness > bleeding: haematemesis, melaena, anaemia ```

Question 34

how would you treat an ulcer caused by h. pylori?

Answer 34

eradication therapy

Question 35

how may you treat a peptic ulcer?

Answer 35

> proton pump inhibitors > h2 antagonists > stopping nsaids if possible (or continued to recieve other protective agents following eradication therapy)

Question 36

describe eradication of h. pylori infection

Answer 36

triple therapy for 7 days: > clarithromycin 500mg bd > amoxicillin 1g bd > PPI (omeprazole) 20mg bd

Question 37

what are the main reason eradication of h. pylori fails?

Answer 37

> resistance to antibiotics | > poor compliance

Question 38

what are the complications of a peptic ulcer?

Answer 38

``` > acute bleeding > chronic bleeding > perforation > fibrotic stricture > gastric outlet obstruction ```

Question 39

describe the vomit in gastric outlet obstruction

Answer 39

> lacks bile | > fermented food stuffs

Question 40

what are the symptoms id gastric outlet obstruction?

Answer 40

``` > early satiety > abdominal distension > weight loss > gastric splash > dehydration ```

Question 41

why is dehydration an effect of gastric outlet obstruction?

Answer 41

there is loss of h+ ions and cl- ions in the vomit

Question 42

what changes would be seen in bloods in gastric outlet obstruction?

Answer 42

> low cl > low na > low k > renal impairment

Question 43

how would you diagnose gastric outlet obstruction?

Answer 43

UGIE: prolonged fast then aspiration of gastric contents. identifies cause

Question 44

how may gastric cancer patients present?

Answer 44

``` > dyspepsia > early satiety > nausea > weight loss > gi bleeding > iron deficiency > anaemia > gastric outlet obstruction ```

Question 45

why would you carry out endoscopy's and biopsies in a patient with gastric cancer?

Answer 45

to make a histological diagnosis

Question 46

what staging investigations might you carry out with gastric cancer?

Answer 46

> ct chest/abdomen

Question 47

who would be present in an MDT discussion about a patient with gastric cancer?

Answer 47

``` > gastroenterologist > pathologist > radiologist > upper gi surgeons > oncologists > specialist nurses ```