2.1. Gastric Disease - Helicobacter Pylori Infection

Question 1

What type of Bacteria is Helicobacter Pylori?

Answer 1

Gram Negative

Question 2

What percentage of the Population are infected with this at some point?

Answer 2

50%

Question 3

When is Helicobacter Pylori infection acquired?

Answer 3

In childhood

Question 4

Where does Helicobacter Pylori colonize?

Answer 4

On the Surface of Gastric-type Mucosa

Question 5

Does the Helicobacter Pylori infection penetrate the Epithelium?

Answer 5

No

Question 6

Does the Helicobacter Pylori evoke an immune response?

Answer 6

Yes, even though it does not penetrate the Epithelium, an immune response still takes place

Question 7

Where does the Immune Response to Helicobacter Pylori take place?

Answer 7

In the Underlying Mucosa

Question 8

What is the Immune Response dependent on?

Answer 8

The Hosts Genetic Factors

Question 9

What does the Immune Response cause?

Answer 9

1. Chronic Gastritis
2. Peptic Ulceration
3. Gastric Cancer

Question 10

What percentage of the Immune Response leads to Asymptomatic Chronic Gastritis?

Answer 10

80%

Question 11

What percentage of the Immune Response leads to Chronic Atrophic Gastritis?

Answer 11

15-20%

Question 12

What occurs with Chronic Atrophic Gastritis?

Answer 12

Intestinal Metaplasia

Question 13

What percentage of the Immune Response leads to Peptic Ulceration?

Answer 13

15-20% - Continuation from Chronic Atrophic Gastritis

Question 14

What percentage of the Immune Response to Helicobacter Pylori, leads to Gastric Cancer?

Answer 14

Less than 1%

Question 15

What occurs with Gastric Cancer caused by Helicbacter Pylori?

Answer 15

Mucosa Associated Lymphoid Tissue (MALT)

Question 16

What does Helicobacter Pylori release?

Answer 16

Urease

Question 17

What is the action of Urease?

Answer 17

It breaks down Urea into:

1. CO2
2. Bicarbonate
3. Ammonium

Question 18

What does the Bicarbonate, released from the Urea, cause?

Answer 18

Localized increase in Gastric pH

Question 19

What does the localised increase in Gastric pH stimulate?

Answer 19

The production of more Gastric Acid throughout the Stomach - which can cause damage to the Gastric Epithelial Cells

Question 20

What are the Clinical Signs of Helicobacter Pylori infection?

Answer 20

1. A raised White Cell Count

2. Inflammatory markers in the blood (CRP and ESR)

Question 21

What symptoms will a person with a Helicobacter Pylori infection present with?

Answer 21

1. None - 80% are asymptomatic

2. Symptoms dependent on how the Disease progresses

Question 22

What investigations are needed for a Helicobacter Pylori infection?

Answer 22

1. Upper G.I. Endoscopy with Biopsy
2. Serology
3. ELISA test
4. Bacterial Cultures
5. Urea Breath Test

Question 23

What is the purpose of the Endoscopy with Biopsy?

Answer 23

1. To visualize the inside of the Gastric Lumen

2. This should be taken for a Rapid Slide Urease Test (CLO)

Question 24

What is the purpose of the Serology?

Answer 24

1. To look for IgG produced in response to the infection
2. To look for a raised WCC
3. To look for inflammatory markers (CRP and ESR)

Question 25

What is the purpose of the ELISA test?

Answer 25

This is stool antigen test is to look for the presence the associated antigens

Question 26

What is the purpose of the Bacterial Culture?

Answer 26

To identify the infective organism

Question 27

What is the purpose of the Urea Breath Test?

Answer 27

As the Ureas will break down Urea, ingestion of a radioactively marked Urea will show it being broken down and exhaled

Question 28

What is the name of the Treatment of Helicobacter Pylori infection?

Answer 28

Eradication Therapy

Question 29

What does Eradication Therapy consist of?

Answer 29

1 x Proton Pump Inhibitor

2 x Antibiotics

Question 30

What Proton Pump Inhibitor is used?

Answer 30

Omeprazole

Question 31

Which 2 Antibiotics are used?

Answer 31

1. Clarithromycin
2. Amoxicillin
   (Tetracycline if allergic to Penicillin)