H. Pylori and Gastric Disease

Question 1

Dyspepsia

Answer 1

Pain or discomfort in the upper abdomen

Question 2

Causes of dyspepsia

Answer 2

Peptic ulcer
Gastritis
Non ulcer dyspepsia
Gastric cancer
Hepatic causes
Gallstones
Pancreatic disease
IBS
Colonic cancer
Coeliac disease
Psychological
Drugs
Other systemic disease – metabolic, cardiac

Question 3

When to refer for endoscopy

Answer 3

Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

Question 4

Helicobacter pylori

Answer 4

Gram negative, spiral-shaped, microaerophilic, flagellated bacteria

Question 5

H. pylori colonises

Answer 5

Gastric type mucosa only

Question 6

Why does H. pylori only colonise mucous layer

Answer 6

To avoid gastric contents

Question 7

Non invasive diagnosis of H. pylori

Answer 7

Serology - IgG against H. pylori
Urea Breath Test
Stool antigen test

Question 8

Invasive diagnosis of H. pylori

Answer 8

Requires endoscopy for culture or histology

Rapid slide urease test

Question 9

Urease for diagnosis

Answer 9

H. pylori produce urease and so can be utilised in slide or breath tests

Question 10

What is gastritis

Answer 10

Inflammation in the gastric mucosa

Question 11

Types of gastritis

Answer 11

Autoimmune
Bacterial
Chemical

Question 12

Autoimmune gastritis from

Answer 12

Parietal cells

Question 13

Bacterial gastritis from

Answer 13

H. pylori

Question 14

Chemical gastritis from

Answer 14

Bile/NSAIDs

Question 15

Majority of peptic ulcers caused by

Answer 15

H. pylori infection, NSAIDs and smoking

Question 16

GU

Answer 16

Gastric ulcer

Question 17

DU

Answer 17

Duodenal ulcer

Question 18

Symptoms of peptic ulcers

Answer 18

Epigastric pain 
Nocturnal/hunger pain 
Back pain 
Nausea and occasionally vomiting 
Weight loss and anorexia
Haematemesis and/or melaena, or anaemia

Question 19

Treatment of peptic ulcers

Answer 19

Eradication therapy to get rid of H. pylori
Antacid medication – proton pump inhibitors (omeprazole)or H2 receptor antagonists (ranitidine)
Cessation of NSAIDs if these are a factor

Question 20

Eradication of H. pylori

Answer 20

Triple therapy for 7 days =>
Clarithromycin
Amoxycillin
PPI

Question 21

Main complications of a peptic ulcer

Answer 21

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

Question 22

Gastric outlet obstruction symptoms

Answer 22

Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
Metabolic alkalosis

Question 23

Cause of gastric outlet obstruction

Answer 23

Cancer
Ulcer
Stricture

Question 24

Treatment of gastric outlet obstruction

Answer 24

Endoscopic balloon dilatation

Surgery

Question 25

Gastric cancer type

Answer 25

Adenocarcinoma - glandular epithelial cells

Question 26

Presentation of gastric cancer

Answer 26

Dyspepsia
Early satiety
Nausea & vomiting
Weight loss
GI bleeding
Iron deficiency anaemia
Gastric outlet obstruction

Question 27

Diagnosis of gastric cancer

Answer 27

Endoscopy and biopsies for a histological diagnosis

Question 28

Treatment of gastric cancer

Answer 28

Surgery and chemotherapy