H. Pylori and Gastric Disease Flashcards
What is dyspepsia?
Indigestion
Pain or discomfort in the upper abdomen (epigastric) - very wide variety of symptoms (burning, nausea, pain etc.)
What are some upper GI derived causes of dyspepsia?
GORD
Peptic ulcer
Gastritis
Gastric cancer
Non upper GI causes of dyspepsia?
Pancreatic disease
Gallstones
Coeliac disease
Drugs
What are important investigations/history questions for when a patient presents with dyspepsia?
Drug history (NSAIDs/theophyllines/steroids)
Bloods (FBC, ferritin, LFTs, U&E’s)
Lifestyle (diet/alcohol)
When should you refer a patient with dyspepsia for an endoscopy?
When they present with ALARMS symptoms A - anorexia L - loss of weight A - anaemia R - recent onset of progressive symptoms M - Melaena/haematemesis or mass S - swallowing problems/dysphagia
What type of gram stain bacteria is helicobacter pylori?
Gram negative
Where does H. pylori reside in an infected human host?
Can only colonize gastric type mucosa
Resides in the surface mucous layer, doesn’t penetrate epithelium
Causes immune response in the underlying mucosa depending on the host genetics
Possible outcomes of H. pylori infection?
Asymptomatic/chronic gastritis (80%)
Atrophic gastritis/ulcers in stomach or duodenum (15-20%)
Gastric cancer (<1%)
How does antral predominant gastritis differ from corpus (body) predominant gastritis in progression?
Antral gastritis - increase acid in response to infection, lower risk of cancer but higher for other disease
Corpus gastritis - decrease acid, atrophy of gastric cells. Higher cancer risk
Non-invasive methods of diagnosing H. Pylori infection?
Serology (IgG)
Urea breath test
Stool antigen test (ELISA)
Invasive methods for H. Pylori diagnosis?
Histology of biopsies
Culture of biopsies
Rapid slide urease test (CLO)
All require endoscopy for biopsy/tissue sampling
3 Types of gastritis?
A - autoimmune
B - bacterial (H. pylori)
C - Chemical (NSAIDs)
Causes of peptic ulcers?
H. Pylori infection (majority)
NSAIDs
Smoking
Rare: Crohn’s, Zollinger-Ellison syndrome, hyperparathyroidism
Are peptic ulcers more common in the duodenum or gastric region?
Duodenum
Symptoms of peptic ulcers?
- Epigastric pain (may be relieved by antacids)
- Nocturnal hunger/pain
- Haematamesis/malaena/anaemia
- Back pain
- Nausea/vomiting
- Weight Loss
What is malaena?
Blood in faeces
dark sticky complexion
Treatment of peptic ulcers?
Antibiotics to get rid of H. Pylori if bac infection
Antacid medication:
Proton pump inhibitors/H2 receptor agonists
Stop NSAIDs if they’re being used, surgery only in complicated cases
Drug cycle for eradication of H. Pylori infection?
Triple therapy for 7 days:
- PPI (omeprazole)
- Amoxycillin (or metrondiazole)
- Clarithromycin
Effective for 90% of cases
Possible complications of peptic ulcers?
Acute bleeding (haematemesis/malaena) Chronic bleeding (anaemia) Perforation Obstruction (stricture by fibrosis/oedema)
If a mass develops or excessive stricture from fibrosis occurs at the gastric outlet, what can happen? Symptoms?
The gastric outlet can become obstructed Symptoms: - vomiting (lacks bile) - Early satiety, weight loss - Abdominal distension
Investigations for gastric outlet obstruction?
Bloods (metabolic alkalosis, low Cl, Low Na, Low K)
UGIE (upper GI endoscopy)
Treatment of gastric outlet obstruction?
Fast and aspirate gastric contents
Identify what is causing the obstruction
Endoscopic balloon dilatation / surgery
What percentage of the population have experienced H. Pylori infection?
50%
Is gastric cancer usually heritable?
No, mostly not inherited
Mutations in HDGC and CDH-1 genes can cause heritable gastric cancer though (1-3%)
Which genes can act as biomarkers for gastric cancer?
HDGC
CDH-1
