H. pylori and Gastric Disease

Question 1

What is the dyspepsia?

Answer 1

Pain or discomfort in the upper abdomen

Question 2

What symptoms are considered dyspepsia?

Answer 2

Upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn

Question 3

What Upper GI problems can cause dyspepsia?

Answer 3

Peptic ulcer, gastritis, non-ulcer and gastric cancer

Question 4

What other causes (apart from upper GI) can cause dyspepsia?

Answer 4

Hepatic causes, gallstones, pancreatic disease, lower GI (IBS, colonic & cancer), coeliac disease, drugs, psychological and other systemic disease

Question 5

With regard to dyspepsia when should the patient be referred to endoscopy?

Answer 5

A-anorexia
L-loss of weight
A - anaemia
R - recent onset, over 55yrs and persistent despite treatment
M - Melaena/haematemesis (GI bleeding) or mass
S - Swallowing problems

Question 6

What are the main features of helicobacter pylori?

Answer 6

Gram negative, spiral-shaped, microaerophilic and flagellated

Question 7

What effect does H. pylori on the mucosal layer of the stomach?

Answer 7

It resides in the surface of the mucosa and evokes an immune response

Question 8

What consequence does increased acid have on the antrum of the stomach?

Answer 8

Duodenal Ulcers

Question 9

What consequence does increased acid have on the corpus of the stomach?

Answer 9

Gastric Cancer

Question 10

What are the investigations used to diagnose H. pylori infection?

Answer 10

Serology, stool antigen test and endoscopy (biopsy)

Question 11

What is gastritis?

Answer 11

Inflammation in the gastric mucosa

Question 12

What are the causes of peptic ulcers?

Answer 12

H. pylori, NSAIDS and smoking

Question 13

What symptoms are associated with peptic ulcers?

Answer 13

Epigastric pain, nocturnal/hunger pain, back pain, nausea/vomiting, weight loss/anorexia, haematemesis/melaena and anaemia

Question 14

What is the treatment for a peptic ulcer?

Answer 14

Antacid medication - Proton Pump Inhibitors (Omeprazole)

Question 15

What is the eradication therapy for H. pylori infection?

Answer 15

Clarithromycin - 500mg bd
Amoxycillin - 1g bd
PPI e.g. omeprazole 20mg bd

Question 16

What are the complications of a peptic ulcer?

Answer 16

Acute bleeding - melaena & haematemesis
Chronic bleeding - iron deficiency anaemia
Perforation
Fibrotic Stricture (narrowing)
Gastric Outlet Obstruction - oedema or stricture

Question 17

What are the signs and symptoms of gastric outlet obstruction?

Answer 17

Vomiting, early satiety, abdominal distension, weight loss, gastric splash, dehydration, metabolic alkalosis

Question 18

What blood results are associated with gastric outlet obstruction?

Answer 18

Low Cl, low Na, low K and renal impairment

Question 19

What investigation is used to diagnose gastric outlet obstruction?

Answer 19

UGIE

Question 20

What is the treatment for gastric outlet obstruction?

Answer 20

Endoscopic balloon dilatation and surgery

Question 21

What are the symptoms of gastric cancer?

Answer 21

Dyspepsia, early satiety, nausea/vomiting, weight loss, GI bleeding, iron deficiency, anaemia and gastric outlet obstruction

Question 22

What are the causes of gastric cancer?

Answer 22

Diet, genes, smoking, ulcers, FH, previous gastric resection, biliary flux and premalignant gastric pathology

Question 23

What is the management of a patient with gastric cancer?

Answer 23

Staging investgations, MDT discussion and treatment (surgical and chemotherapy)