H Pylori and Gastric Disease

Question 1

Describe the aetiology of dyspepsia.

Answer 1

Upper GI;

• GORD
• Peptic ulcer
• Gastritis
• Gastric cancer

Hepatic;
- Gallstones

• Pancreatic disease
• Coeliac disease
• Psychological
• Drugs

Question 2

What is the definition of dyspepsia?

Answer 2

• Pain or discomfort in upper abdomen

- For 4 weeks

Question 3

List the symptoms of dyspepsia.

Answer 3

• Epigastric pain
• Burning
• Satiety
• Bloating
• Nausea
• Heartburn/reflux
• Discomfort

Question 4

Describe the investigation of dyspepsia.

Answer 4

• History and examination (esp. drug history and lifestyle)

Bloods;

• FBCs
• Ferritin
• LFTs
• U&Es
• Calcium
• Glucose
• Coeliac serology/serum IgA

Question 5

When should you refer for endoscopy (ALARMS)?

Answer 5

Anorexia
Loss of weight
Anaemia
Recent onset <55 years OR persistent despite treatment
Melaena/haematemesis or Mass
Swallowing problems (dysphagia)

Question 6

Describe the diagnosis techniques of an H. pylori infection.

Answer 6

Non-invasive;

• Serology: IgG against H. pylori
• Urea breath test
• *Stool antigen test

Invasive (requires endoscopy);

• Histology: gastric biopsies stained for H. pylori
• Culture of biopsies
• *Rapid slide urease test

Question 7

Describe the epidemiology of peptic ulcers.

Answer 7

• Common
• Decreasing incidence in developed countries
• DU>GU
• M>F
• More common in elderly

Question 8

List several causes of peptic ulcers.

Answer 8

• H. pylori infection
• Drugs e.g. NSAIDs
• Smoking
• Conditions e.g. hyperparathyroidism, Crohn’s

Question 9

List the symptoms of peptic ulcers.

Answer 9

• Epigastric pain (tenderness is a sign)
• Nocturnal/hunger pain (DU)
• Back pain (penetration of post. DU)
• Nausea and vomiting
• Weight loss and anorexia
• Ulcer bleeds –> haematemesis, melaena, anaemia

Question 10

Describe the treatment of peptic ulcers.

Answer 10

• If caused by H. pylori, treat infection
• If caused by drug, stop drug
• Give antacids e.g. PPIs (omeprazole), H2 receptor antagonists (ranitidine)
• Surgery only necessary if complications arise

Question 11

Describe the treatment given to eradicate H. pylori infection.

Answer 11

Triple therapy for 7 days;
- Clarithromycin
- Amoxycillin (tetracycline if allergic to penicillin)
- PPI e.g. omeprazole
Effective in 90% of cases.

Question 12

Describe the presentation of gastric outlet obstruction.

Answer 12

• Vomiting: lack of bile, fermented foodstuffs
• Early satiety
• Abdominal distension
• Weight loss
• Gastric splash
• Loss of water/electrolytes through vomiting –> dehydration and metabolic alkalosis

Question 13

Describe the investigation of gastric outlet obstruction.

Answer 13

Bloods;

• Low Cl-, Na+, K+
• Renal impairment
• UGIE to identify cause

Question 14

Describe the treatment of gastric outlet obstruction.

Answer 14

• Endoscopic balloon dilation

- Surgery

Question 15

Describe the presentation of gastric cancer.

Answer 15

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

Question 16

Describe the management of gastric cancer.

Answer 16

Diagnosis: endoscopy and biopsy.

Staging: CT chest and abdo.

Treatment: surgery and chemotherapy.