H Pylori and Gastric Disease Flashcards
What are the 2 main components of the upper GIT?
- Oesophagus
- Stomach
What are the 2 main components of the lower GIT?
- Small intestine
- Large intestine
What are the functions of the stomach?
- Food storage
- Initial digestive processes
- Acidic environment
- Secretion
What does the stomach secrete?
- Gastric acid
- Gut hormones
- Intrinsic factor
- Pepsin
What does dyspepsia literally mean?
-Bad digestion
What does dyspepsia describe?
A group of symptoms
What symptoms are classed as dyspepsia?
- Pain or discomfort in the upper abdomen
- Retrosternal pain
- Anorexia
- Nausea
- Vomiting
- Bloating
- Fullness
- Early satiety
- Heartburn
Organic
Relating to or rising in a bodily organ
Functional
Impairment of a normal body function when everything looks normal
What upper GI causes of dyspepsia are there?
- Peptic ulcer
- Gastritis
- Non ulcer dyspepsia
- Gastric cancer
What can cause dyspepsia other than the upper GIT?
- Hepatic causes
- Gallstones
- Pancreatic disease
- Lower GI
- Coeliac disease
- Other systemic disease
- Drugs
- Psychological
What lower GIT causes of dyspepsia are there?
- IBS
- Colonic cancer
What are the red flag symptoms for referral to endoscopy?
- Anorexia
- Loss of weight
- Anaemia
- Recent onset >55 years or persistent despite treatment
- Melaena/haematemesis or mass
- Swallowing problems
What is involved in an upper GI endoscopy?
- Diagnosis/therapeutic
- Local anaesthetic or sedation
- Day case
- Fasted
- Consent
What are the risks of upper GI endoscopy?
- Perforation
- Bleeding
- Reaction to drugs
What is key when a patient presents with dyspepsia?
History and examination
What bloods should be carried out when a patient presents with dyspepsia?
- FBC
- Ferritin
- LFT
- U+E
- Calcium
- Glucose
- Coeliac serology
- Serum IgA
What drugs are important in the history of someone with dyspepsia?
-NSAIDs Steroids -Bisphosphonate -Ca antagonists -Nitrates -Theophylline
What is important to ask about lifestyle in the history od someone with dyspepsia?
- Alcohol
- Diet
- Smoking
- Exercise
- Weight reduction
What are the characteristics of helicobacter pylori?
- Gram negative
- Spiral shaped
- Microaerophilic
- Flagellated
When is H pylori usually acquired?
Childhood
What is the only type of mucosa that H pylori can colonise?
Gastric
Where does H pylori reside?
In the surface mucous layer and does not penetrate the epithelial layer
What does H pylori do to the underlying mucosa?
Evokes an immune response
What are the clinical outcomes of H pylori infection?
- Asymptomatic or chronic gastritis
- Chronic atrophic gastritis intestinal metaplasia
- Gastric or duodenal ulcer
- Gastric cancer MALT lymphoma
What are the outcomes of H pylori infection dependent on?
- Site of colonisation
- Characteristics of bacteria
- Host factors
Give 2 brackets of host factors.
- Susceptibility
- Environmental
Describe the response to antral predominant gastritis by chronic H pylori infection
- Increase in acid
- Low risk of gastric cancer
- Duodenal disease
Describe the response to corpus predominant gastritis by chronic H pylori infection.
- Decrease in acid
- Gastric atrophy
- Gatric cancer
Describe the response to mild mixed gastritis by chronic H pylori infection.
- Normal acid
- No significant disease
What are the non-invasive ways of diagnosing H pylori infection?
- Serology: IgG against H pylori
- 13c/14c urea breath test
- Stool antigen test: ELISA: need to be off PPI for 2 weeks
What are the invasive ways of diagnosing H pylori infection?
Requires endoscopy
- Histology: gastric biopsies stained for bacteria
- Culture of gastric biopsies
- Rapid slide urease test (CLO)
What is it that is utilised in slide urease tests?
Ammonia
What is gastritis?
Inflammation in the gastric mucosa
How is gastritis diagnosed?
- Histological diagnosis
- Clinical features seen at endoscopy
What are the 3 types of gastritis?
- Autoimmune (protein produced by stomach against parietal cells)
- Bacterial (H pylori)
- Chemical (bile/NSAIDs)
What is the prevalence of peptic ulcers?
- DU>GU
- Men>women
- Elderly
What are the majority of peptic ulcers caused by?
H pylori infection
What other causes of peptic ulcers are there?
- NSAIDs
- Smoking
- Other conditions (Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease)
What symptoms are associated with peptic ulcer?
- Epigastric pain
- Nocturnal/hunger pain
- Back pain
- Nausea and occasionally vomiting
- Weight loss and anorexia
- Haematemesis/maelena/anaemia if ulcer bleeds
What is the treatment for peptic ulcers?
- H pylori caused= eradication therapy
- Antacids: PPI or H2 antagonists
- NSAID caused= stopped
- Complications treated as they arise
- Surgery only if perforated
What does eradication therapy for H pylori include?
Triple therapy for 7 days
- Clarithromycin 500mg bd
- Amoxycillin 1g bd
- PPI
What are the main reasons fro failure of triple therapy?
- Resistance to antibiotics
- Poor compliance
What are the complications of peptic ulcer?
- Acute bleeding (haematemesis/maelena)
- Chronic bleeding (anaemia)
- Perforation
- FIbrotic stricture
- Gastric outlet obstruction (oedema/stricture)
What are the symptoms of gastric outlet obstruction?
- Vomiting (lacks bile, fermented foodstuffs)
- Early satiety
- Abdominal distension
- Weight loss
- Gastric splash
What does vomiting lead to?
Dehydration
Why does metabolic alkalosis occur with gastric outlet obstruction?
Loss of H and Cl in vomit
What would show up in the bloods of someone with gastric outlet obstruction?
- Low Cl
- Low Na
- Low K
- Renal impairment
How is gastric outlet obstruction diagnosed?
- UGIE (prolonged fast/aspiration of gastric contents)
- Identify cause (stricture, ulcer, cancer)
How is gastric outlet obstruction treated?
- Endoscopic balloon dilatation
- Surgery
What are the majority of gastric cancers?
Adenocarcinomas (MALT/GIST)
How do patients with gastric cancer present?
- Dyspepsia
- Early satiety
- Nausea and vomiting
- Weight loss
- GI bleeding
- Iron deficiency anaemia
- Gastric outlet obstruction
What is the aetiology of gastric cancer?
- Diet
- Genetics
- Smoking
- H pylori infection
Give an example of a heritable gastric cancer syndrome?
HDGC: AD CDH-1 gene (E-cadherin)
How is a histological diagnosis of gastric cancer made?
Endoscopy and biopsy
What staging investigations are carried out with gastric cancer?
- CT chest/abdo
- MDT meeting
What is the treatment for gastric cancer?
- Surgery
- Chemotherapy
