H Pylori and Gastric Disease

Question 1

Dyspepsia

Answer 1

indigestion

pain or discomfort in the abdomen

Question 2

various symptoms of dyspepsia

Answer 2

upper abdominal discomfort

retrosternal pain

anorexia

nausea

vomitting

bloating

fullness

early satiety and heartburn

Question 3

what upper GI problems can cause dyspepsia?

Answer 3

upper GI issues: peptic ulcer, gastritis, non ulcer dyspepsia, gastric cancer

hepatic causes

gallstones

pancreatic disease

coeliac disease

Question 4

when to refer for endoscopy

ALARMS

Answer 4

anorexia

loss of weight

anaemia (iron deficiency)

Recent onset (over 55 or persistence)

melaena/ haematemesis

swallowing problems (dysphagia)

Question 5

Blood tests for dyspepsia

Answer 5

FBC

Ferritin

LFTs

U and Es

calcium

glucose

coeliac serology

Question 6

drug history of patients with dyspepsia

Answer 6

NSAIDs

steriods

biphosphates

calcium antagonists

nitrates

Question 7

lifestyle of patients with dyspepsia

Answer 7

alcohol

diet

smoking

exercise

weight reduction

Question 8

dyspepsia requires a test for

Answer 8

H pylori

Question 9

H pylori can only colonise in the

Answer 9

gastric type mucosa

Question 10

H pylori evokes what in underlying mucosa?

dependent on host genetic factors

Answer 10

immune response

Question 11

the outcome of H pylori infections depends on

Answer 11

the site of colonisation

characteristics of bacteria and host factors

genetic and environmental factors (eg smoking)

Question 12

clinical outcomes chronic H pylori infections

4

Answer 12

asymptomatic or chronic gastritis

gastritis - intestinal metaplasia

gastric or duodenal ulcer

gastric cancer

Question 13

Diagnosis of H pylori non-invasive tests

Answer 13

serology -IgG against H pylori

13/14 Urea breath test

stool antigen test (ELISA)

Question 14

diagnosis of h pylori invasive tests

Answer 14

endoscopy

histology (gastric biopsies stained for the bacteria)

culture of gastric biopsies

Question 15

gastritis is

Answer 15

inflammation in the gastric mucosa

Question 16

peptic ulcers are also caused by

Answer 16

NSAIDs

smoking

(occasionally hyperparathyroidism, Crohn’s)

Question 17

symptoms associated with peptic ulcer

Answer 17

epigastric pain

nocturnal/hunger pain

back pain

nausea + vomiting

if the ulcer bleeds patient may have melaena or anaemia

Question 18

how to treat peptic ulcers

Answer 18

antacid medication

if on NSAIDs they must be stopped

surgery if complicated

Question 19

eradication of H pylori infection

Answer 19

triple therapy for 7 days (clarithromycin, amoxycillin, PPI - proton pump inhibitor)

Question 20

reasons why eradication of H pylori might fail

Answer 20

resistance to antibiotics

Question 21

complications of a peptic ulcer

Answer 21

acute bleeding (melaena and haematemesis)

chronic bleeding (iron deficiency)

perforation

fibrotic stricture

gastric outlet obstruction

Question 22

how do patients with gastric cancer present?

Answer 22

dyspepsia

early satiety

nausea and vomiting

weight loss

GI bleeding

iron deficiency anaemia

gastric outlet obstruction

Question 23

aetiology of gastric cancer

Answer 23

diet

genetics

smoking

h pylori infection

polyps

Question 24

investigations for gastric cancer

Answer 24

endoscopy and biopsies

CT chest (metastasis)

Question 25

treatment for gastric cancer

Answer 25

surgical and chemotherapy