Gastric Ulcers

Question 1

What are gastric ulcers?

Answer 1

Sores that develop in the stomach lining

Question 2

What are the symptoms of gastric ulcers?

Answer 2

Indigestion, heartburn, nausea ~ can be asymptomatic

Question 3

What is the most common cause of gastric ulcers?

Answer 3

Helicobacter pylori (H. pylori) infection, use of NSAID (e.g. aspirin & ibuprofen)

Question 4

What is H. pylori?

Answer 4

Pleomorphic Gram negative fastidious bacterium, common in developing countries (faecal matter in water)

Question 5

Who suffers from H. pylori infection?

Answer 5

People of low socioeconomic background, people in developing countries, poor hygiene, poor quality drinking water, smoking, restaurant food, high meat/fish diet

Question 6

What risk factors lead to H. pylori ulcers?

Answer 6

Diet, alcohol, smoking, family history, increased age

Question 7

Diagnosis of gastric ulcers

Answer 7

Oesophagogastrodudenoscopy (OGD), antigen tests, urea breath test, culture plates, PCR, serology, histology

Question 8

Antigen test - gastric ulcers

Answer 8

Stool sample - tested for presence/absence of antigen specific to the bacterium, cheap & fast, not very sensitive

Question 9

Urea breath test - gastric ulcers

Answer 9

Breath sample @ 0 mins, C13 urea tablet taken, sample 2 @15/30 mins, if H. pylori is present urease will break down urea, increase in C13 measured using mass spectrometer, expensive, false negatives (antacids, antibiotics, PPIs taken)

Question 10

Culturing of H. pylori

Answer 10

Difficult to grow from gastric juices, biopsy taken - placed in a special culture medium & grown in specific conditions (low yield)

Question 11

PCR test (Polymerase Chain Reaction) - gastric ulcers

Answer 11

More popular - non invasive ( no stool sample needed), detects genes unique to bacterium and multiplies the DNA many times, sensitive, specific and cheap, can identify resistance to antibiotics e.g. clarithromycin (reduces need for gastric biopsy for susceptibility testing)

Question 12

Serology: gastric ulcers

Answer 12

Detection of Immunoglobulin G antibodies specific to the bacterium, not commonly used (poor sensitivity and specificity)

Question 13

Histology of gastric ulcers

Answer 13

Biopsy taken and stained, highlight different levels of each bacterium, most specific & sensitive, requires expertise and time consuming

Question 14

Treatment of gastric ulcers

Answer 14

Triple therapy (PPIs, clarithromycin, & amoxicillin)

Question 15

Resistant H. pylori

Answer 15

Rise in clarithromycin resistance - limited options - biopsy for susceptibility testing or PCR test

Question 16

Complications of gastric ulcers

Answer 16

Bleeding (50,000 - 70,000 A&E emissions a year - 5-10% die from gastric bleeding - monitored using full blood counts, clotting factors, and liver panels), perforation (hole in stomach), penetration (hole in stomach spreads to pancreas/liver), obstruction of GI tract (inflammation and scaring) causing pyloric stenosis (narrowing of pylorus)

Question 17

Gastric Ulcers & cancer

Answer 17

Commonly caused by adenocarcinoma, affects mucosal cells, 70% 5 year survival rate, late diagnosis as symptoms overlap with gastric ulcers