H Pylori and Gastric Disease Flashcards
what contents are in the upper GI tract
oesophagus
stomach
what contents are in the lower GI tract?
small intestin and large
functions of stomach
Food storage, initial digestive processes, acidic environment –defence , secretion – gastric acid, gut hormones, intrinsic factor, pepsin
what is dyspepsia?
Pain or discomfort in the upper abdomen
upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn
what can cause the symptom of dyspepsia in the upper GI?
GORD Peptic ulcer Gastritis Non ulcer dyspepsia Gastric cance
what can cause symptoms in the lower GI?
IBS
Colonic cancer
what can cause symptoms of dyspepsia
drugs
psychological
coeliac disease
what do you do if a patient has dyspepsia?
Bloods – FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA
Drug history – NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophyllines, remember OTT
Lifestyle – alcohol, diet, smoking, exercise, weight reduction
when to refer to endoscopy
Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia
what is an upper GI endoscopy?
Diagnostic and therapeutic upper GI endoscopy
Local anaesthetic (throat spray) or sedation
what is helicobacter pylori?
Gram negative, spiral-shaped, microaerophilic, flagellated Gram –ve bacteria
where does the H.pylori infect?
It resides in the surface mucous layer and does not penetrate the epithelial layer
what is the outcome of H.pylori dependent on?
Outcome dependent on site of colonization, characteristics of bacteria and host factors e.g. genetic susceptibility & other environmental factors e.g. smoking
diagnosing H.pylori
Non-invasive
Serology: IgG against H. pylori
13C /14C Urea Breath Test
Stool antigen test – ELISA - need to be off PPI for 2 weeks
Invasive: requires endoscopy
Histology: gastric biopsies stained for the bacteria
Culture of gastric biopsies
Rapid slide urease test (CLO)
what is gastritis?
Inflammation in the gastric mucosa
Histological diagnosis
Clinical features seen at endoscopy
causes of gastritis
Autoimmune (parietal cells)
Bacterial (H. pylori)
Chemical (bile/NSAIDs)
what is the more common ulcer
duodenal or gastric
duodenal
what are the majority of peptic ulcers caused by?
H.pylori
what symptoms are associated with peptic ulcers?
Epigastric pain is the main feature (pointing sign, may be relieved by antacids)
Nocturnal/hunger pain (more common in DU)
Back pain (may suggest penetration of a posterior DU)
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
how do you treat a peptic ulcer?
Ulcers caused by H. pylori are treated by eradication therapy to get rid of the bacteria
Antacid medication – proton pump inhibitors (omeprazole)or H2 receptor antagonists (ranitidine)
If NSAIDs are also involved, these have to be stopped if possible, or should continue to receive other protective agents following eradication therapy
Complications are treated as they arise
Surgery is only indicated in complicated PUD
how do you eradicate H.pylori?
Triple therapy for 7 days
Clarithromycin 500mg bd
Amoxycillin 1g bd (or Metronidazole 400mg bd)
Tetracycline is given if penicillin allergy
PPI: e.g. omeprazole 20mg bd (2 times a day)
what are the complications of a peptic ulcer?
Acute bleeding – melaena and haematemesis
Chronic bleeding – iron deficiency anaemia
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction – oedema or stricture
what does gastric outlet obstruction cause?
Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
Metabolic alkalosis
Bloods – low Cl, low Na, low K, renal impairment
how do you diagnose gastric outlet obstruction
UGIE (prolonged fast/aspiration of gastric contents), identify cause – stricture, ulcer, cancer
treatment of gastric outlet obstruction?
endoscopic balloon dilatation, surgery
what is the second commonset malignancy worldwide?
gastric cancer
presentation of gastric cancer
Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction
aetiology of gastric cancer
smoking genetic smoking ulcers H.pylori diet
management of a patient with gastric cancer
Endoscopy and biopsies to make a histological diagnosis
Staging investigations – has it spread elsewhere?
CT chest/abdo – lymph nodes and liver/lungs/peritoneum/bone marrow
MDT discussion – imaging/histology/patient fitness
MDT discussion – imaging/histology/patient fitness
Who is present? gastroenterologist, pathologist, radiologist, upper GI surgeons, oncologists, specialist nurses
Treatment – surgical and chemotherapy
