H Pylori and Gastric Disease Flashcards
What are the 3 types of peptic ulcers?
Gastric Ulcers
Duodenal Ulcers
NSAIDs ulcers
What is dyspepsia?
Pain or discomfort in the upper abdomen
What 9 types of dyspepsia are there?
Upper abdomen discomfort, Retrosternal pain, Anorexia, Nausea, Vomiting, Heartburn, Bloating, Fullness & Early Satiety
What is the approach to dyspepsia?
Review meds
Lifestyle advice
Test for H. pyloria
Consider non-gastro-duodenal causes
When do you refer dyspepsia patients?
Unexplained weight loss Persistent vomiting Iron def anaemia Progressive dysphagia Epigastric mass Abnormal imaging >55 years with persistent dyspepsia
What is dysphagia?
Difficulty swallowing
Are peptic ulcers more common in men or women?
Men
How are peptic ulcers caused?
Imbalance between the damaging effect of acid/pepsin and the protective effect of mucosal defences such as mucus, bicarbonate and prostaglandins
What hormone increases when the food hits the stomach?
Gastrin
What anti-platelet drug can cause NSAID ulcers?
Aspirin
What are the clinical features of peptic ulcers?
Main feature - Epigastric pain Nocturnal/hunger pain Back pain Nausea Anorexia and Weight loss Haematemesis and/or Malaena or Anaemia if ulcer bleeds
What is haematemesis?
Vomiting blood
What is melaena?
Partly digested blood in the faeces
Very offensive
What blood tests should be done for peptic ulcers?
H. pylori serology
FBC
Apart from blood tests, what other investigation should be done for peptic ulcers?
Urea breath test
Upper GI endoscopy - Biopsy of gastric ulcers to exclude malignancy
Barium studies - Not commonly done now
Are ulcers in the duodenum malignant or benign?
Benign
Why does H. pylori grow well in children?
They produce less acid so thus the environment isn’t harsh to thrive in
What conditions are associated with H. pylori infections?
Gastritis
Pectic ulcer disease
Gastric neoplasia
Non-ulcer dysplasia
How does a urease test work?
Patient will breath out either Carbon Dioxide or Ammonia and if H. pylori is present the CLO test slide will change colour
What parts of stomach does H. pylori colonise and what effect does this have?
Only the gastric type mucosa residing in the surface mucous layer - Doesn’t penetrate the epithelial layer
Causes powerful inflammatory reaction which becomes chronic
How does the stomach become messy?
If inflammation occurs in the acid producing part of the stomach - Acid secretions start to decrease
What is most likely to result from an H. pylori infection in the antrum of the stomach?
Duodenal Ulcer disease
What is most likely to result from an H. pylori infection in the corpus (Fundus + Body) of the stomach?
Gastric Cancer
What happens in Duodenal Ulcer Disease (DUD)?
Increased duodenal acid load leading to:
Gastric metaplasia, HP colonisation & Ulceration
What happens when there is an increased acid response to gastrin?
Increased parietal cell mass
Sensitivity is unimpaired because of the absence of corpus gastritis
What causes an increased Gastrin release?
Decreased in somatostatin and CagA+ve is greater than CagA-ve
Eradicating H.pylori causes what four things?
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
When should surgery be done for PUD?
Only in complicated cases
how long should H. pylori eradication drugs be used for and what three should be prescribed?
Clarithromycin 500mg bd
Amoxycillin 1g bd
Tetracycline if penicillin allergy
PPI
7 indications for H. pylori disease?
Patient wishes - Anxiety Peptic ulcer disease MALT lymphoma Non-ulcer dyspepsia FDR of gastric cancer patient Long-term use of PPI therapy
What are the possible complications of Peptic ulcers?
Perforation
Acute Bleeding
Ulcer in the pylorus may scar
What surgery may be required if there is an ulcer that has scarred in the pylorus?
Balloon dilatation
