H. Pylori and Gastric Disease Flashcards
What is dyspepsia?
Indigestion/heartburn
What percentage of people presenting with dyspepsia will have no serious underlying disease?
80%
Give 5 typical presentations of common upper GI disorders
Dyspepsia Retrosternal pain Anorexia Nausea Vomiting Bloating Fullness Early satiety Abdominal pain
When should a referral for endoscopy be done in someone presenting with dyspepsia?
When there are alarms symptoms present
What are the alarms symptoms?
A - anorexia
L - loss of weight
A - anaemia, iron deficiency
R - recent onset, > 55 years of age or persistent despite treatment
M - melaena/haematemesis or abdominal mass
S - swallowing problems i.e. dysphagia
If a patient younger than 55 presents with dyspepsia, what should be done before an endoscopy/invasive investigation?
Test for H. pylori
What is gastritis?
Inflammation of the gastric mucosa
What are the three possible causes of gastritis?
Autoimmune
Bacterial
Chemical
What are the majority of peptic ulcers caused by?
H. pylori
What are two chemical causes of peptic ulcers?
Smoking
NSAIDs
Give three conditions which, rarely, can be responsible for peptic ulcers
Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s disease
Give 5 clinical features of peptic/duodenal ulcers?
Epigastric pain Nocturnal/hunger pain Back pain Nausea and vomiting Weight loss and anorexia Epigastric tenderness Haematemesis/melaena/anaemia
What might cause haematemesis, melaena or anaemia in a patient with a peptic or duodenal ulcer?
Haemorrhage of the ulcer
What are the possible treatments of peptic/duodenal ulcers?
Eradication therapy if caused by H. pylori
Antacid medication - PPIs or H2R antagonists
Stop NSAIDs if possible or give protective agents
Treat any arising complications
Surgery in complicated peptic ulcer disease
What are the possible complications of peptic/duodenal ulcers?
Acute bleeding Chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction
What are the clinical features of a gastric outlet obstruction?
Vomiting Early satiety Abdominal distension Weight loss Gastric splash Dehydration and loss of H and Cl ions due to vomiting Metabolic alkalosis Low Cl, Na, K and renal impairment
What is the treatment of a gastric outlet obstruction?
Endoscopic dilation or surgery
How is a H. pylori infection eradicated?
Triple therapy for 7 days
Clarithromycin - 500mg bd
Amoxycillin - 1g bd
PPI e.g. omeprazole - 20mg bd
If penicillin allergic:
Metronidazole - 400mg bd or tetracyclin
What risk factors are associated with gastric cancer?
Smoking
High salt diet, food high in nitrates
H. pylori infection
What is the main histological type of gastric cancer?
Adenocarcinoma
What is the management of gastric cancer?
UGIE and biopsies
Staging investigations - CT chest/abdo
Surgical treatment and chemo
Palliative care
What kind of organism is helicobacter pylori?
Gram negative
What factors determine the outcome of a H. pylori infection?
Site of colonisation
Characters of the bacteria
Host factors
What percentage of people infected with H. pylori will be asymptomatic or have chronic gastritis?
> 80%
What percentage of people infected with H. pylori will have intestinal metaplasia or chronic atrophic gastritis?
15-20%
What percentage of people infected with H. pylori will develop gastric cancer or MALT lymphoma?
< 1%
H. pylori can only colonise what mucosa?
Gastric type mucosa
What investigations are done to diagnose H. pylori?
Serology - IgG against H. pylori Urea breath test Stool antigen test Gastric biopsy - histology and culture Rapid slide urease test
What outcomes can chronic H. pylori infection lead to?
Antral predominant gastritis, increased acid and duodenal disease
Mild mixed gastritis with normal acid levels and no significant disease
Corpus predominant gastritis, decreased acid and gastric atrophy progressing to gastric cancer
