H Pylori and Gastric Disease

Question 1

What are the 3 types of peptic ulcers?

Answer 1

Gastric Ulcers
Duodenal Ulcers
NSAIDs ulcers

Question 2

What is dyspepsia?

Answer 2

Pain or discomfort in the upper abdomen

Question 3

What 9 types of dyspepsia are there?

Answer 3

Upper abdomen discomfort, Retrosternal pain, Anorexia, Nausea, Vomiting, Heartburn, Bloating, Fullness & Early Satiety

Question 4

What is the approach to dyspepsia?

Answer 4

Review meds
Lifestyle advice
Test for H. pyloria
Consider non-gastro-duodenal causes

Question 5

When do you refer dyspepsia patients?

Answer 5

Unexplained weight loss
Persistent vomiting
Iron def anaemia
Progressive dysphagia
Epigastric mass
Abnormal imaging
>55 years with persistent dyspepsia

Question 6

What is dysphagia?

Answer 6

Difficulty swallowing

Question 7

Are peptic ulcers more common in men or women?

Answer 7

Men

Question 8

How are peptic ulcers caused?

Answer 8

Imbalance between the damaging effect of acid/pepsin and the protective effect of mucosal defences such as mucus, bicarbonate and prostaglandins

Question 9

What hormone increases when the food hits the stomach?

Answer 9

Gastrin

Question 10

What anti-platelet drug can cause NSAID ulcers?

Answer 10

Aspirin

Question 11

What are the clinical features of peptic ulcers?

Answer 11

Main feature - Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea
Anorexia and Weight loss
Haematemesis and/or Malaena or Anaemia if ulcer bleeds

Question 12

What is haematemesis?

Answer 12

Vomiting blood

Question 13

What is melaena?

Answer 13

Partly digested blood in the faeces

Very offensive

Question 14

What blood tests should be done for peptic ulcers?

Answer 14

H. pylori serology

FBC

Question 15

Apart from blood tests, what other investigation should be done for peptic ulcers?

Answer 15

Urea breath test
Upper GI endoscopy - Biopsy of gastric ulcers to exclude malignancy
Barium studies - Not commonly done now

Question 16

Are ulcers in the duodenum malignant or benign?

Answer 16

Benign

Question 17

Why does H. pylori grow well in children?

Answer 17

They produce less acid so thus the environment isn’t harsh to thrive in

Question 18

What conditions are associated with H. pylori infections?

Answer 18

Gastritis
Pectic ulcer disease
Gastric neoplasia
Non-ulcer dysplasia

Question 19

How does a urease test work?

Answer 19

Patient will breath out either Carbon Dioxide or Ammonia and if H. pylori is present the CLO test slide will change colour

Question 20

What parts of stomach does H. pylori colonise and what effect does this have?

Answer 20

Only the gastric type mucosa residing in the surface mucous layer - Doesn’t penetrate the epithelial layer
Causes powerful inflammatory reaction which becomes chronic

Question 21

How does the stomach become messy?

Answer 21

If inflammation occurs in the acid producing part of the stomach - Acid secretions start to decrease

Question 22

What is most likely to result from an H. pylori infection in the antrum of the stomach?

Answer 22

Duodenal Ulcer disease

Question 23

What is most likely to result from an H. pylori infection in the corpus (Fundus + Body) of the stomach?

Answer 23

Gastric Cancer

Question 24

What happens in Duodenal Ulcer Disease (DUD)?

Answer 24

Increased duodenal acid load leading to:

Gastric metaplasia, HP colonisation & Ulceration

Question 25

What happens when there is an increased acid response to gastrin?

Answer 25

Increased parietal cell mass | Sensitivity is unimpaired because of the absence of corpus gastritis

Question 26

What causes an increased Gastrin release?

Answer 26

Decreased in somatostatin and CagA+ve is greater than CagA-ve

Question 27

Eradicating H.pylori causes what four things?

Answer 27

Gastrin levels to return to normal Reduced acid secretion in the corpus Normalisation of gastrin and somatostatin in the antrum Decreased acid load and increased bicarbonate in the duodenum

Question 28

When should surgery be done for PUD?

Answer 28

Only in complicated cases

Question 29

how long should H. pylori eradication drugs be used for and what three should be prescribed?

Answer 29

Clarithromycin 500mg bd Amoxycillin 1g bd Tetracycline if penicillin allergy *PPI*

Question 30

7 indications for H. pylori disease?

Answer 30

``` Patient wishes - Anxiety Peptic ulcer disease MALT lymphoma Non-ulcer dyspepsia FDR of gastric cancer patient Long-term use of PPI therapy ```

Question 31

What are the possible complications of Peptic ulcers?

Answer 31

Perforation Acute Bleeding Ulcer in the pylorus may scar

Question 32

What surgery may be required if there is an ulcer that has scarred in the pylorus?

Answer 32

Balloon dilatation