H Pylori and Gastric Disease Flashcards
What are the layers of the stomach muscles from outer to inner
Longitudinal, circular, oblique
When to refer a patient to endoscopy?
(A)norexia (L)oss of weight (A)naemia (R)ecent onset if <55 years or persistent despite treatment (M)elaena/Haematemesis/Mass (S)wallowing problems - dyshpagia
what is risk of perforation in Endoscopy
1 in 2,000
Bloods for patients with dyspepsia?
FBC,Ferritin,LFTs,U&Es,calcium,glucose,coeliac serology/Serum IgA
What drugs common in dyspepsia patients
NSAIDS and steroids and biphosphonates
Symptomatic treatment of H pylori includes?
PPIs or H2R antagonists & lifestyle factors
What is H pylori
a gram negative, spiral shaped bacteria
What does H pylori do in the stomach?
It can only colonise gastric type mucosa and resides in the surface mucous area and can’t penetrate the epithelial layer. It evokes an immune response in the underlying mucosa depeding on the host’s genetic factors
What are the possible outcomes of an H pylori infection
asymptomatic, gastric/duodenal ulcer, chronic atrophoc gastritis, intestinal metaplasia, or Gastric cancer
Antral H pylori infection results in?
Increased acid secretion, Low risk of gastric cancer, duodenal ulcer disease
Corpus predominant gastritis causes:
High risk of gastric cancer, Decrease in acid secretion, Gastric atrophy
How to non invasively diagnose H pylori infection
- IgG serology against H pylori
- Urea breath test 13/14 carbon
- stool antigen test - ELISA
In order to carry out ELISA on a patient suspected to have H pylori, what should they not be on?
need to be off PPI for 2 weeks
What are the invasive tests to diagnose H pylori
Endoscopy -
Gastric biopsy stained for the bacteria
Cultures of gastric biopsies
Rapid slide urease test (CLO)
What does Urease do?
breaks down urea in ammonia and carbon dioxide
What is the basis of rapid slide urease test?
Checking for an increase of pH due to increase of ammonia from urea
What is gastritis
inflammation of the stomach mucosa
How is gastritis diagnosed
Histologically + clinical features seen at endoscopy
What are the three types of gastritis
(A)Utoimmune (parietal cells)
(B)acterial (H pylori)
(C)hemical (Bile/NSAIDS)
What types of ulcers are more common
Duodenal ulcers> Gastric ulcers
Majority of peptic ulcers caused by?
H pylori
What are other causes of peptic ulcers?
NSAIDS/ smoking
What are rarer causes of peptc ulcers
Crohn’s disease
Hyperparathyrodism
Zollinger-Ellison syndrome
what symptoms are associated with peptic ulcer?
- Epigastric pain (that might be relieved by antacids)
- Nocturnal/Hunger pain (More common in DU however)
- Back pain (suggesting penetration of a posterior DU)
- Nausea and occasionally vomiting
- Weight loss and anorexia
- Epigastric tenderness (Could be only sign)
- Melaena, Haematemesis, or anaemia if the ulcer bleeds
How do you treat a peptic ulcer?
Eradication therapy to get rid of the bacteria
- Antacid medication : PPI (omeprazole) or H2 receptr antagonists (ranitidine)
- If NSAIDs are involved, these have to be stopped or another protective agent is offered
- Surgery only offered in complicted Peptid ullcer disease
Eradication of H Pylori infection involves:
-Triple therapy for 7 days!
What is involved in triple therapy for seven days
- Clarithromycin -500 mg bd (2x a day)
- Amoxycillin- 1g bd OR metronidazole - 400 mg bd
- PPI : ex omeprazole 20 mg bd
What is the main reason for failure of eradication therapy?
Resistance to antibiotics and poor compliance
Complications of s peptic ulcer include?
- Acute bleeding - Melaena and haematemesis
- Chronic bleeding - iron deficiency anaemia
- Perforation
- Fibrotic stricture
- Gastric outlet obstruction - Oedema or stricture
What is gastric outlet obstruction associated with?
Vomiting that lacks bile and has fermented foodstuff
Early satiety, abdominal distention, weight loss,gastric splash ,dehydration and loss of H+ and cl- in stomach
Metabolic alkalosis
What is reflected in bloods of gastric outlet obstruction
Low CL, Low Na, Low K, renal impairment
How to diagnose GOO
Upper Gastrointestinal Endoscopy to identify cause - Stricture,ulcer,cancer
Treatment of GOO?
Balloon dilatation, surgery
What is the second most common malignancy worldwide?
Gastric cancer
What is the 5 year prognosis of gastric cancer
under 20% survival
Majority of gastric cancer are what histological type?
Adenocarcinoma
Symptoms of gastric cancer?
Dyspepsia, early satiety, gastric outlet obstruction, anaemia,bleeding, nasuea, vomiting, weight loss
