H. Pylori and Gastric Disease

Question 1

What is dyspepsia?

Answer 1

Describes a group of symptoms involving pain or discomfort in the upper abdomen

Question 2

When would you refer someone with dyspepsia to endoscopy?

Answer 2

If they presented with any of the following symptoms:
Anorexia 
Loss of weight 
Anaemia- iron deficient
Recent onset >55yo or persistent despite treatment 
Melaena or Mass
Swallowing problems 
Think: ALARMS

Question 3

What are the risk factors of an upper GI endoscopy?

Answer 3

1:2,000 risk perforation, bleeding or reaction to drugs given

Question 4

What blood tests would you run if a patient presents with dyspepsia?

Answer 4

FBC
Ferritin 
LFTs
U&Es
Calcium 
Glucose
Serum IgA

Question 5

What features of a drug and lifestyle history would be relevant if a patient presented with dyspepsia?

Answer 5

Drug history- NSAIDs, steroids, bisphosphonates, calcium antagonists, nitrates, theophyllines
Lifestyle- alcohol, diet, exercise, weight reduction

Question 6

Describe the H. Pylori bacteria

Answer 6

Gram negative
Spiral shaped
Microaerophilic
Flagellated

Question 7

What layer(s) of the gastric lining does H. Pylori reside in?

Answer 7

The surface mucous layer, not penetrating the epithelial layer

Question 8

What factors influence the outcome of a H. Pylori infection?

Answer 8

Site of colonisation
Characteristics of bacteria
Genetic susceptibility
Smoking

Question 9

How is H. Pylori infection diagnosed?

Answer 9

Non-invasively:
Serology: IgG against H. Pylori
13c/14c urea breath test
Stool antigen test- ELISA

Invasive: requires endoscopy

Question 10

What symptoms are associated with peptic ulcers?

Answer 10

Epigastric pain
Nocturnal/ hunger pains 
Back pain 
Nausea and vomiting 
Weight loss and anorexia
If ulcer bleeds maybe haematemesis, melaena or anaemia

Question 11

How is a H. Pylori infection eradicated?

Answer 11

Through triple therapy for seven days:
Clarithromycin 500mg
Amoxicillin 1g
PPI 20mg

Question 12

What is the success rate of eradicating H.pylori infection and what are the common reasons for failure?

Answer 12

90% success rate, failure caused by resistance to antibiotics and poor compliance