GI

Question 1

What is the pathogenesis of H.Pylori?

Answer 1

Chronic inflammatory state causes decrease in number of somatostain producing D cells with in turn increases gastrin secretion, increasing gastric acid release which leads to gastritis/ulcer formation.

Question 2

When do you screen for H.Pylori?

Answer 2

Patients with epigastric pain and dyspepsia.
Family hx of gastric cancer or gastric MALT lymphoma.
Patients undergoing short or long term NSAID therapy.

Question 3

What percentage of ulcers are associated with H.Pylori?

Answer 3

80% Dudodenal, 60% Gastric.

10% life time risk of ulcers.

Question 4

What are the methods to investigate for H.Pylori?

What are the pros and cons of each one?

Answer 4

Invasive - Gastroscopy associated, rapid urease test, turns more alkaline or histology. Very specific and sensitive but histo much more expensive. Culture not sensitive.

Non invasive - Serology, high titre active infection, low colonisation. Not good for assessing post treatment outcome.
Urease breath test. Suitable for post test treatment, not good for detection. Not widely available.
Stool antigen specific and sensitive but uncomfortable collection style.

Question 5

What are the eradication therapies for H.Pylori?

Answer 5

First line:
nexium hp7 triple therapy (7 days)
esomeprazole 20mg BD
amoxicillin 1g BD
clarithromycin 500mg BD
or metronidazole 400mg BD

Areas of high clarithromycin resistance trial quadruple therapy for 7-14 days
esomeprazole 20mg BD
bismuth subsalicyate
tetracycline
metronidazole

Question 6

What are the new therapies?

Answer 6

Sequential therapy:
5 days of
esomeprazole 20mg BD
amoxicillin 1g BD
then 5 days of
esomeprazole 20mg BD
Tinidazole 500mg BD
clarithromycin 500mg BD

Salvage Therapy:
10 days of 
esomeprazole 20mg BD
amoxicillin 500mg BD
levofloxacin 500mg BD

Question 7

What are the common and infrequent SE of each drug?

Answer 7

Esomeprazole
C: cough, pharyingitis, abdo pain, diarrhoea
U: alopecia, paraesthesia, haemolytic anaemia

Amoxicillin
C: Rash, GI upset
U: anaphylaxis

Clarithromycin:
C: GI upset, altered taste sensation
U: anaphylaxis

Question 8

List the major red flag/ALARM symptoms for urgent gastroscopy.

Answer 8

Age >50-55
weight loss >10%
new anaemia
GIT bleeding
dysphagia
odynophagia
family hx of GIT/CRC cancer or barretts
chronic NSAID use
epigastric mass
persistant vomiting

Question 9

What is Troisier sign?

Answer 9

Enlarged supraclavicular LN - stomach cancer sign