H. pylori and gastric disease

Question 1

What is dyspepsia?

Answer 1

Group of symptoms: retrosternal pain, bloating, fullness, early satiety, anorexia, heartburn, nausea, vomiting and upper abdominal discomfort

Question 2

What are the causes of dyspepsia?

Answer 2

gastritis, peptic ulcer, non-ulcer dyspepsia, gastric cancer, hepatic causes, gall stones, IBS, colonic cancer, coeliac disease, psychiatric, drugs, cardiac, metabolic and pancreatic disease

Question 3

What bloods do you take for dyspepsia?

Answer 3

FBCs, ferritin, LFTs, U and E’s, calcium, glucose and coeliac serology/IgG

Question 4

What are the changes to lifestyle that can help dyspepsia?

Answer 4

Diet, exercise, smoking, alcohol and weight reduction

Question 5

What are the ALARMS symptoms?

Answer 5

• If patient has ALARMS symptoms then send to endoscopy
  
  • Anorexia
  • Loss of weight
  • Anaemia
  • Recent onset, >55 or if it is persistent despite treatment
  • Melaena/ haematemesis
  • Swallowing difficulties

Question 6

What area are you more likely to get a peptic ulcer?

Answer 6

DU>GU

Question 7

What are the causes of peptic ulcer?

Answer 7

H. pylori (most common), NSAIDs, smoking, it is rare but other diseases can cause it as well

Question 8

What are the symptoms of peptic ulcer?

Answer 8

Epigastric pain, nocturnal hunger, back pain, nausea (occasional vomiting), weight loss, anorexia, epigastric tenderness. If the ulcer bleeds then there will also be haematemesis and/or melaena, anaemia

Question 9

What is the treatment of peptic ulcer?

Answer 9

• Treatment: eradication therapy (H. pylori), stop NSAIDs or add some sort of protection, if on antacid medication then use proton pump inhibitor (omeprazole) or H2 receptor antagonist
  
  • Surgery will only happen if there is a complicated PUD
    
    • Complications are treated as they arise

Question 10

What are the complications of peptic ulcer?

Answer 10

perforation, acute bleeding, chronic bleeding, gastric outlet obstruction and fibre stricture

Question 11

What are the symptoms of gastric outlet obstruction?

Answer 11

weight loss, dyspepsia, abdominal discomfort, early satiety, gastric splash, vomiting (loss of H+ and Cl-), dehydration, metabolic alkalosis

Question 12

What are the bloods of gastric outlet obstruction?

Answer 12

low K, low Na, low Cl-, renal impairment

Question 13

What are the causes of gastric outlet obstruction?

Answer 13

peptic ulcer, gastric cancer, strictures

Question 14

What is the treatment of gastric outlet obstruction?

Answer 14

endoscopic balloon dilatation or surgery

Question 15

What other tumours can you get in gastric cancer?

Answer 15

MALT and GIST

Question 16

What is the presentation of gastric cancer?

Answer 16

early satiety, weight loss, nausea, vomiting, GI bleeding, anaemia, dyspepsia and gastric outlet obstruction

Question 17

What is the aetiology of gastric cancer?

Answer 17

smoking, diet genetic, ulcer, H. pylori, family history, previous gastric reaction, biliary reflex and pre-malignant gastric pathology

Question 18

What is the diagnosis and management of gastric cancer?

Answer 18

• Staging: spread, using CT, discuss with MDT
  
  • MDT discussion: pathology, radiology, histology, patient fitness, management
  • Management: surgery and chemo

Question 19

Describe the role that H. pylori plays in gastric disease and what is the aetiology?

Answer 19

• H. Pylori infection
	- Colonises gastric mucous but does not penetrate the epithelium
	- Immune response
	- Depends on genetics
	• Aetiology
	- Genetics
	- Environmental factors (smoking)
	- Colonisation size
	- Character of bacteria