H Pylori and Gastric disease

Question 1

What is H Pylori?

Answer 1

Gram negative bacteria (spiral-shaped, microaerophilic, flagellated)

Infects 50% world

Question 2

Whatrole does H Pylor have in gastric disease?

Answer 2

A lot. Evokes immune response in underlying mucosa .Common cause of gastritis, ulcers (esp more when antrum is infected) and can lead to gastric cancer (more when the body is infected)

Question 3

How do we test for H Pylori and what symnptoms would we test?

Answer 3

Invasive and non-invasive methods:

Invasive:
CLO slide, utilises the urease that the bacteria produce!
Gastric biopsies/endoscopy

Non-invasive:
Urea breath test, C13/C14
Serology (IgG)

Question 4

How do we treat a H Pylori infection?

Answer 4

Antibiotics! Tripple therapy for 7 days

Clairithromycin (500mg bd) with Axomycillin (1mg bd)

Also with a PPI eg omeprazole (20mg bd)

Question 5

What is the common presentation of common gastric disorders?

Answer 5

DYSPEPSIA!!!
Any sort of upper abdominal pain/bloating/discomfort for 4 weeks (Rome criteria is 12 weeks)

inc. pain, discomfort, nausea, vomiting, bloating, fullness, early satiety, heart burn

Question 6

Upper vs lower GI

Answer 6

Upper is stomach and above, lower is duodenum and below

Question 7

What is dyspepsia?

Answer 7

Any sort of upper abdominal pain/bloating/discomfort for 4 weeks (Rome criteria is 12 weeks)

inc. pain, discomfort, nausea, vomiting, bloating, fullness, early satiety, heart burn

Question 8

Important factors/ things to ask if someone presents with dyspepsia

Answer 8

History, how long, where (SOCRATES), associated symptoms.

Examintaion - physical and general and bmi

Drug history (NSAIDs, sterois, nitrates, over the counter, recreational)

Lifestyle: alcohol, diet, smoking, exercise, weight reduction

Bloods, not as important but good to know if they have Iron deficient anaemia! (SO still do FBC, ferritin, LFT, U and E, calciuum, glucose)

Question 9

What are he red flag symptoms to refer for patient for endoscopy

Answer 9

ALARMMS!!!

Anorexia
Loss of Weight
Anaemia (IRON DEFICIENT ANAEMIA)
Recent Onset, over 55 or perseistant dispite treatment
Melaena/haematemesis (GI bleed)
Mass
Swallowing problem (Dysphagia

Question 10

Dyspepsia pathway

Answer 10

red flag - urgent endoscopy

If not then trial antacid/lifestyle info, maybe H2 receptor antagonist

H Pylori test, if positive -> eradicate H.Pylori, if still symptomatic then test fr H Pylori with breath test

If Ngeative then One month PPI trail. If works then step down therapy.

If PPI doesnt work -> if over 55 urgent referal, if not PPI and/or H2A therapy and if still not good enough then routine referral.

Question 11

What are the 3 types of gastritis and what are they caused by?

Answer 11

A- autoimmune (parietal cells)
B - Bacterial (H. Pylori)
C - Chemical - Bile/NSAIDS

Question 12

Symptoms of a peptic ulcer

Answer 12

Epigastric pain is the main feature (pointing sign, may be relieved by antacids)
Nocturnal/hunger pain (more common in DU)
Back pain (may suggest penetration of a posterior DU)
Nausea and occasionally vomiting
Weight loss and anorexia
Only sign may be epigastric tenderness
If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia

Question 13

How do you treat a peptic ulcer?

Answer 13

Antacids, PPI(omeprazole)/H2A(ranitidine). Stop NSAIDS if poss

Question 14

What are the complications of a peptic ulcer?

Answer 14

Acute bleeding – melaena and haematemesis
Chronic bleeding – iron deficiency anaemia
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction – oedema or stricture

Question 15

How is gastric outlet obstruction treated?

Answer 15

endoscopic balloon dilatation, surgery

Question 16

Gastric cancer presentation

Answer 16

Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction

Question 17

What are – MALT, GIST

Answer 17

Types of gastric tumours