H. Pylori and Gastric Disease Flashcards
What is dyspepsia?
Indigestion
What are the symptoms of dyspepsia?
Pain/discomfort in upper abdomen Retrosternal pain Anorexia Nausea Vomiting Bloating Fullness Early satiety Heartburn
What can cause the symptoms of dyspepsia?
Upper GI (GORD, peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer) Hepatic causes gallstones Pancreatic disease Lower GI (IBS, Colonic cancer) Coeliac disease Psychological Drugs Other systemic diseases - metabolic, cardiac
What blood investigations are done in patients with dyspepsia?
FBC Ferritin LFTs U&Es Calcium Glucose Coeliac serology/serum IgA
What medications do you check in patients with dyspepsia?
NSAIDS Steroids Bisphosphonates Ca antagonists Nitrates Theophyllines
What are symptoms that suggest endoscopy is required?
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 helicobacter pylori?
Gram negative bacteria
Spiral-shaped
Microaerophilic
Flagellated
Where does H.pylori infection occur?
In the surface mucous layer and does not penetrate the epithelial layer
Can ONLY colonise gastric type mucosa
What are the clinical outcomes of helicobacter pylori infections?
Asymptomatic or chronic gastritis (>80%) Chronic atrophic gastritis Intestinal metaplasia Gastric or duodenal ulcer (15-20%) Gastric cancer MALT lymphoma <1%
What is the outcome of helicobacter pylori dependent on?
Site of colonisation
Characteristics of bacteria
Host factors e.g. genetic susceptibility and other environmental factors
What are the non-invasive diagnostic tests for H.pylori infection?
Serology- IgG against H. pylori
13c/14c urea breath test
Stool antigen test - ELISA - need to be off PPI for 2 weeks
What are the invasive diagnostic tests
Endoscopy
Histology - gastric biopsies stained for the bacteria
Culture of gastric biopsies
Rapid slide urease test (CLO)
What does an IgG positive test for H.pylori infection mean?
Patient could have been previously exposed and still has antibodies for it
Not necessarily an active infection
What type of gastritis is caused by H. pylori?
Bacterial
What are peptic ulcers caused by?
Majority caused by H. pylori
Can be caused by other conditions such as Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease
What symptoms are associated with peptic ulcers?
Epigastric pain Nocturnal/hunger pain Back pain Nausea and occasional vomiting Weight loss/anorexia If ulcer bleeds, potential haematemesis and/or melaena, or anaemia
How are peptic ulcers treated?
Ulcers caused by H. pylori treated by eradication therapy
Antacid meds - proton pump inhibitors or H2 receptor antagonists
If NSAIDS involved, must be stopped
Surgery only in complicated PUD
How is eradication of H. pylori infection done?
Triple therapy for 7 days of: - clarithromycin - amoxycillin - PPI May differ dependent on local antibiotic resistance profiles
What are the main reasons for eradication of H. pylori not to work?
Resistance to antibiotics
Poor compliance
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 are the clinical signs of gastric outlet obstruction?
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 is gastric outlet obstruction diagnosed?
Upper GI endoscopy (prolonged fast/aspiration of gastric contents) to identify cause (stricture, ulcer, cancer)
How is gastric outlet obstruction treated?
Endoscopic balloon dilatation
Surgery
What are the signs of gastric cancer?
Dyspepsia Early satiety Nausea + vomiting Weight loss GI bleeding Iron deficiency anaemia Gastric outlet obstruction
What are the staging investigations for gastric cancer?
CT chest/abdomen
MDT discussion - imaging/histology/patient fitness
What is the treatment for gastric cancer?
Surgery
Chemotherapy/radiotherapy
