H.pylori & gastric disease Flashcards by Michael Alcorn

What is dyspepsia?

Pain / discomfort in the upper abdomen (indigestion)

Also includes symptoms such as bloating, anorexia etc

For 4 weeks

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How common is dyspepsia?

Very common

80% of people get it at some point

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What tends to cause dyspepsia?

Upper GI problems

Hepatic causes & gallstones

Pancreatic disease

Coeliac disease

Psychological

Drugs

Systemic/other illness

Lower GI rarely

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What investigations can be done for a patient presenting with dyspepsia?

FBC

Ferritin

LFTs

U&Es

Calcium

Glucose

Coeliac serology/serum IgA

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What aspects of a history are particularly important for patients with dyspepsia?

Drug history

Lifestyle

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What drugs are linked to causing dyspepsia?

NSAIDs

Steroids

Bisphosphonates

Ca antagonists

Nitrates

Theophyllines

Remember OTT?

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What symptoms are ALARMS?

A - Anorexia

L - Loss of weight

A - Anaemia

R - Recent onset >55

M - Melaena/haematemesis*
S - Swallowing problems (dysphagia)

*Persistent vommiting is also serious

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What would be done for a patient with ALARMS signs/symptoms?

Refer for endoscopy

(urgent investigation for cancer)

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For a patient without ALARMS symptoms, what is the next course of action?

Lifestyle advice

Offer antacid medication such as Gaviscon

Offer H2 receptor antagonist: Ranitidine

H.Pylori SA test

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What type of bacteria is Helicobacter pylori?

Gram negative, spiral-shaped, microaerophilic, flagellated Gram –ve bacteria

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How common is infection by H.pylori?

Infects 50% of the world population

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Where can H.pylori colonise in the GI tract?

H.pylori can only colonise gastric type mucosa

It resides in the mucous layer, and does not penetrate the mucosal epithelium

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What determines whether or not someone with H.pylori in their stomach will actually get sick?

Host genetic factors determine whether or not an immune response happens

Site of colonisation, characteristics of the bacteria

Environmental factors as well - eg smoking

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What are the possible outcomes of infection by H.pylori

>80% - Asymptomatic or chronic gastritis

15-20% - Chronic atrophic gastritis, intestinal metaplasia or Gastric/duodenal ulceration

<1% - Gastric cancer, MALT lymphoma

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What happens when there is chronic H. pylori infection in the Antrum of the stomach?

Antral predominent gastritis can lead to increased Acid production by parietal cells

Increased acidity causes duodenal ulceration, but has lower risk for cancer

(antral infection = ulcers)

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What happens when there is chronic H.pylori infection which exists more in the corpus area of the stomach?

Corpus predominent gastritis leads to decreased acid production and gastric atrophy

This causes an increased risk of cancer

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How is H.pylori infection investigated/diagnosed?

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Stool antigen (ELISA) test

Serology: IgG antibody against H.pylori

¹³C/¹⁴C urea breath test

Endoscopy:

Biopsy for staining
Biopsy for Culture
Rapid slide Urease test (CLO)

How does a rapid slide urease test work?

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Detects urease, an enzyme which is secreted by H.pylori

Red = positive

Yellow = negative

(Urease is also what makes the urea breath test work)

What is gastritis and how is it diagnosed?

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Inflammation of the gastric mucosa

Diagnosed histologically (needs biopsy)

What are the causes of gastritis?

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Think ABC

A - Autoimmune (parietal cells)

B - Bacterial (H.pylori)

C - Chemical (bile/NSAIDs)

What type of peptic ulcer is most common?

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Duodenal ulcers are more common than gastric ulcers

What causes the majority of Peptic ulcers?

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H.pylori infection

What other conditions/things can cause Peptic ulcers?

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Zollinger-Ellison syndrome

Hyperparathyroidism

Crohn’s disease

(NSAIDs & Smoking are risk but i cba asking that by itself)

How do age and gender affect your likelihood of getting peptic ulcers?

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Men > women

Old > young

How are Gastric and duodenal ulcers diagnosed?

Through endoscopy (through mouth)

Peptic ulcer symptoms?

**Epigastric pain** Nocturnal hunger/pain Nausea / vomitting Anorexia / weight loss GI bleeding symptoms

Peptic ulcer clinical **signs**?

Epigastric tenderness (GI bleeding may cause anaemia)

How do you treat peptic ulcers?

H.pylori eradication therapy Antacid (Omeprazole, Ranitidine) **Stop** NSAIDs (or protect against them) Treat complications Surgery only if complicated/serious enough

What type of drug is Omeprazole?

Proton pump inhibitor Type of antacid

What type of drug is Ranitidine?

H2 receptor antagonist Type of antacid

Describe the process of H.pylori eradication

7 days **Triple therapy** 1. Clarithromycin 500mg bd 2. Amoxycillin 1g bd\* 3. PPI eg Omeprazole 20mg bd \*or Metronidazole 400mg bd OR Tetracycline if allegic to penicillin

What are the complications of peptic ulcers?

Acute bleeding - **Melaena/haematemesis** Chronic bleeding - Iron deficiency **anaemia** **Perforation** Fibrotic **stricturing** Gastric outlet obstruction - oedema or strictures

What are the symptoms of gastric outlet obstruction?

Vomitting Early satiety (feel full quickly) Weight loss Abdo distension

What signs on examination indicate gastric outlet obstruction?

Dehydration Gastric splash Metabollic alkalosis

What investigations should be done for gastric outlet obstruction and why?

**Bloods** - these would show Low Cl-, low K+, low Na+, renal impairment Upper GI **endoscopy** - will identify any ulcer/stricture/cancer causing the problem

What are the different types of Gastric tumours?

**Adenocarcinoma** (epithelial cells) - most common **MALT** lymphoma (mucosa-associated lymphoid tissue) **GIST** (gastrointestinal stroma tumour) - type of sarcoma

What is the prognosis for gastric cancer?

5 year survival \< 20%

What are the symptoms/signs of gastric cancer?

Dyspepsia Early satiety (fullness when eating) Nausea & vommiting Weight loss GI bleeding ID anaemia Gastric outlet obstruction

What are the risk factors for gastric cancer?

Diet Smoking Genetics History of H.pylori infection Others: family history, previous gastric resection, biliary reflux, premalignant gastric pathology

What is the Correa hypothesis?

The histological pathway from H.pylori infection to various subtypes of gastric cancer

H.pylori & gastric disease Flashcards

(40 cards)