H. pylori and gastric disease

Question 1

List the functions of the stomach

Answer 1

o Food storage
o Initial digestive processes
o Acidic environment (digestion and defence)
o Secretion - gastric acid, gut hormones, intrinsic factor, pepsin

Question 2

Describe dyspepsia

Answer 2

• Dyspepsia describes a group of symptoms
• Pain or discomfort in the upper abdomen
• Upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn

Question 3

What are the ALARM(S) signs for endoscopy?

Answer 3

o Anorexia
o Loss of weight
o Anaemia – iron deficiency
o Recent onset, >55 years or persistent despite treatment
o Melaena/haematemesis (upper GI pathology) or Mass
o Swallowing problems - dysphagia

Question 4

What drugs are linked to GI symptoms?

Answer 4

NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophyllines, remember OTT

Question 5

Describe helicobacter pylori

Answer 5

• Gram negative bacteria
• Spiral-shaped
• Microaerophilic
• Flagellated

Question 6

What is the most common cause of peptic ulcers?

Answer 6

H. pylori infection

Question 7

List some causes of peptic ulcers

Answer 7

H. pylori infection
NSAIDs
Smoking
Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s disease

Question 8

What is the therapy given to eradicate H. pylori?

Answer 8

Triple therapy for 7 days
• Clarithromycin 500mg bd
• Amoxycillin 1g bd (or Metronidazole 400mg bd)
• (Tetracycline is given if penicillin allergy)
• PPI: e.g. omeprazole 20mg bd

Question 9

List 2 types of antacid medications

Answer 9

proton pump inhibitors (omeprazole)

H2 receptor antagonists (ranitidine)

Question 10

What are some complications of peptic ulcers?

Answer 10

• Acute bleeding – melaena and haematemesis
• Chronic bleeding – iron deficiency anaemia
• Perforation
• Fibrotic stricture (narrowing)
• Gastric outlet obstruction – oedema or stricture

Question 11

List some features of gastric outlet obstruction

Answer 11

• Recurrent vomiting – lacks bile, fermented foodstuffs (has sat in stomach for a couple of days sometimes)
• Early satiety, abdominal distension, weight loss, gastric splash
• Dehydration and loss of H+ and Cl- in vomit => Metabolic alkalosis
• Bloods – low Cl, low Na, low K, renal impairment

Question 12

What can cause gastric outlet obstruction?

Answer 12

Stricture
Ulcer
Cancer

Question 13

List some causes of gastric cancer

Answer 13

• Diet e.g. high salt diets, foods high in nitrates
• Genetic predisposition
• H. pylori infections
• Smoking
• History of peptic ulcers, GORD etc
• Other factors to consider – family history, previous gastric resection, biliary reflux, premalignant gastric pathology

Question 14

List 3 main inheritable gastric acid syndromes

Answer 14

o HDGC
o AD
o CDH-1 gene (E-cadherin)