H pylori and gastric disease

Question 1

what structures make up the upper GI tract

Answer 1

oesophagus

stomach

Question 2

what structures make up the lower GI tract

Answer 2

small intestine

large intestine - colon

Question 3

functions of the stomach (7)

Answer 3

food storage
initial digestive process 
acidic environment for defence 
secretion of gastric acid
gut hormones
intrinsic factor
pepsin

Question 4

what is dyspepsia?

Answer 4

it’s a group of symptoms

pain or discomfort in the upper abdomen

it occurs for 4 weeks
very common but most often no serious cause

Question 5

give examples of some of the symptoms dyspepsia describes (8)

Answer 5

upper abdominal discomfort
retrosternal pain
anorexia 
nausea
vomiting
bloating
reflux
heartburn

Question 6

what 2 main categories can dyspepsia be divided into?

Answer 6

functional

organic

Question 7

Upper GI causes for the symptoms of dyspepsia (5)

Answer 7

GORD
Peptic ulcer
Gastritis
Non ulcer dyspepsia
Gastric cancer

Question 8

Systemic diseases that cause symptoms of dyspepsia (3)

Answer 8

metabolic and cardiac disease
drugs
psychological

Question 9

what bloods, drug and lifestyle changes would need to be done/made if a patient presented with dyspepsia?

Answer 9

FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA

drugs - NSAIDs, steroids, biphosphonates, Ca antagonist, nitrates

lifestyle - alcohol, diet, smoking, exercise, weight reduction

Question 10

What does the term ‘ALARMS’ cover when looking at referral for endoscopy?

Answer 10

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 11

what type of bacteria is helicobacter pylori (H. pylori)

Answer 11

gram negative
spiral shaped
microaerophilic

Question 12

what % of the world population does H. Pylori infect?

Answer 12

50% usually acquired during childhood

Question 13

H.pylori can only colonise in which type of mucosa?

Answer 13

gastric type mucosa

Question 14

where does the H. pylori bacteria reside in the gastric mucosa

Answer 14

in the surface mucous layer - it does not penetrate the epithelial layer

Question 15

what are the clinical outcomes of H. pylori infections? (7)

Answer 15

Most commonly -asymptomatic or chronic gastritis

15-20% chronic atrophic gastritis, intestinal metaplasia or gastric/ duodenal ulcer

<1% gastric cancer or MALT lymphoma

Question 16

what is the clinical outcome of H.pylori infection dependent on? (3)

Answer 16

site of colonisation
characteristics of bacteria 
host factors (e.g genetic susceptibility and other environmental factors like smoking)

Question 17

what are some of H.pylori’s virulence factors

Answer 17

urease - allows it to colonise in acidic environment of the stomach

flagella - enables it to move and colonise elsewhere

adhesive toxins

Question 18

common response to chronic H. pylori infection in the antral part of the stomach (pyloric end near bottom)

Answer 18

increased gastric acid

low risk of gastric cancer

Question 19

common response to chronic H. pylori infection in the corpus part of the stomach (main bit)

Answer 19

decreased gastric acid
gastric atrophy (inflamed mucosal lining for years)

often leads to gastric cancer

Question 20

non invasive techniques to diagnose H. pylori infection (3)

Answer 20

serology - IgG against H. pylori
13/14 degrees urea breath test
stool antigen test - ELISA need to be off proton pump inhibitors for 2 weeks

Question 21

invasive techniques to diagnose H. pylori infection (3)

Answer 21

histology - gastric biopsies stained for the bacteria or culture of the biopsy

rapid slide urease test (CLO) - detects urease enzyme of H. pylori

Question 22

what are the majority of peptic ulcers caused by?

Answer 22

H. pylori

Question 23

symptoms associated with peptic ulcers (7)

Answer 23

Epigastric pain

Nocturnal/hunger pain

Back pain

Nausea and occasionally vomiting

Weight loss and anorexia

Only sign may be epigastric tenderness

If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia

Question 24

treatment for peptic ulcers caused by H. pylori?

Answer 24

eradication therapy to get rid of bacteria

antacid medication - proton pump inhibitors or H2 receptor antagonist

surgery only indicated in complicated peptic ulcer disease

Question 25

how is H. pylori infection eradicated

Answer 25

triple therapy for 7 days

Clarithromycin
Amoxycillin
(Tetracycline is given if penicillin allergy)
PPI eg omeprazole

very effective

Question 26

complications of a peptic ulcer (5)

Answer 26

Acute bleeding – melaena and haematemesis

Chronic bleeding – iron deficiency anaemia

Perforation

Fibrotic stricture (narrowing)

Gastric outlet obstruction – oedema or stricture

Question 27

how is gastric outlet obstruction treated

Answer 27

endoscopic balloon dilatation

surgery

Question 28

symptoms of gastric outlet obstruction

Answer 28

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 29

Types of gastric tumour

Answer 29

MALT

GIST

Question 30

what is the name of the hereditary condition that increases your chance of getting gastric cancer

Answer 30

Hereditary diffuse gastric cancer (HDGC)

Question 31

what is the main tumour sepressor gene involved with gastric cancer

Answer 31

CDH-1 gene