H. Pylori + Gastric Disease Flashcards
What are the functions of the stomach?
Storage Start digestion Acid secretion Secretion of intrinsic factor Secretion of enzymes (e.g. pepsin)
What is dyspepsia?
General term to describe a group of symptoms causing pain/discomfort in upper abdomen
Describe the 9 symptoms than can be included in dyspepsia
- pain/discomfort in upper abdomen
- retrosternal pain
- anorexia
- nausea
- vomiting
- bloating
- fullness
- early satiety
- heartburn
What percentage of people have dyspepsia?
80%; majority with no underlying disease
What medical professionals generally treats dyspepsia symptoms?
GP; community pharmacist
What are 4 upper GI causes of dyspepsia?
Peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer
Name 3 other organ related cause of dyspepsia?
Hepatic causes
Gallstones
Pancreatic disease
Name 2 lower GI causes of dyspepsia?
IBS, colonic cancer
Name 3 other causes of dyspepsia
Coeliac, psychological, drugs
What types of systemic disease cause dyspepsia?
Metabolic (high Ca; diabetes)
Cardiac (retrosternal heaviness - IHD)
What is the acronym for red flag symptoms for when to refer for endoscopy?
Anorexia
Loss of weight
Anaemia - iron deficiency (could be lesion bleeding in upper GI)
Recent onset > 55 years or persistent despite treatment (could be cancer)
Melaena/haematemesis
Swallowing problems/dysphagia
What are the conditions of an upper GI endoscopy?
local anaesthetic/sedation, day case, fasted, consent
What are the risks of an upper GI endoscopy?
1:2000 perforation, bleeding, reaction to drugs given
What are the 4 elements of investigations into someone with dyspepsia?
History + examination
Bloods
Drug history
Lifestyle
What bloods might you request for someone with dyspepsia?
FBC, ferritin, LFTs, U+Es, calcium, glucose, coeliac serology/serum IgA
What drugs should be asked about in drug history of someone with dyspepsia?
NSAID (brufen, nurofen, ibruprofen, naproxen)
Steroids
Bisphosphonates (osteoporosis - large tablet)
Ca antagonists
Nitrates
Theophyllines
remember OTC
What aspect of lifestyle should be explored?
Alcohol, diet, smoking, exercise, weight reduction
What type of bacteria is H. pylori?
gram neg, microaerophillic, flagellated
Where can H. pylori only colonise?
Gastric type mucosa (stomach) - surface mucous layer not epithelial layer; burrows in to get away from gastric acid
What is H. pylori categorised as?
Type I carcinogen
What is H. pylori effect on epithelial cells?
Cannot go through them but has an effect on those which sit close to it
What is H. pylori mechanism?
It is urease positive - breaks down surrounding substrates and creates a halo of alkilinity
What are 4 clinical outcomes of H. pylori infections?
Asymptomatic/chronic gastritis (>80%) Chronic atrophic gastritis; intestinal metaplasia Gastric/duodenal ulcer (15-20%) Gastric cancer/MALT lymphoma (<1%)
What is the outcome of H. pylori infection dependent on?
Site of colonisation
Characteristics of bacteria (some more virulent)
Host factors e.g. host susceptibility and other environmental factors e.g. smoking
What is the outcome of antral predominant gastritis from chronic H. pylori infection?
Increased acid, low risk of gastric carcinoma - results in DU disease (ulcer etc)
What is the outcome of mild mixed gastritis from chronic H. pylori infection?
Normal acid - no significant disease
What is the outcome of corpus predominant gastritis from chronic H. pylori infection?
Decreased acid, gastric atrophy - gastric carcinoma (or gastric ulcer)
What are 3 non-invasive 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 3 invasive tests for H. pylori infection?
Histology: gastric biopsies stained for bacteria
Culture of gastric biopsies
RAPID SLIDE UREASE TEST (CLO) - ammonia - urease present = H. pylori present = pink
What is gastritis?
Inflammation in gastric mucosa
What are the three types and their associated causes?
Autoimmune - parietal cells
Bacterial - H. pylori
Chemical - bile/NSAIDs
What are the majority of peptic ulcers caused by?
H. pylori
What are 2 other possible causes of peptic ulcers?
NSAIDs
Smoking
Name 3 other conditions which peptic ulcers are rarely caused by?
Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s
Name 5 symptoms associated with peptic ulcers? (E, N, B, N, W)
Epigastric pain (main feature - may be only symptom)
Nocturnal/hunger pain (more DU)
Back pain (suggests penetration of posterior DU)
Nausea/occasionally vomiting
Weight loss + anorexia
What may patients present with if a peptic ulcer bleeds?
Haematemesis and/or melaena (acute)
Anaemia (chronic)
Investigation for peptic ulcer?
endoscopy
Why are ulcers biopsied?
to establish they are benign
How are peptic ulcers treated?
H. pylori eradication
Antacid meds (PPI or H2 receptor agonist (ranitidine))
Stop NSAID if involved
Surgery only in complicated PUD
How to eradicate H. pylori?
TRIPLE THERAPY FOR 7 DAYS
Clarithromycin, amoxycillin (tetracycline in pen allergy), PPI (omeprazole)
Why are PPI involved in H pylori triple therapy?
To protect stomach from excess acid production
What is the success rate for H. pylori infection?
90% of cases
5 potential complications of peptic ulcers?
Acute bleeding Chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction
How does gastric outlet obstruction arise in peptic ulcers?
if pyloric sphincter is affected
Symptoms of gastric outlet obstruction?
Vomiting (main symptom - lacks bile + foodstuff)
Early satiety, distension, weight loss, gastric splash
Metabolic alkalosis
What would the bloods result be in someone with gastric outlet obstruction?
low Cl, low Na, low K, renal impairment
How is gastric outlet obstruction officially diagnosed?
UGIE (identify cause - structure, ulcer, cancer)
How is gastric outlet obstruction treated?
Endoscopic balloon dilatation, surgery
What is the prognosis for gastric cancer?
5-year survival <20%
Gastric cancer presents late in western countries, why?
asymptomatic initially
What histological type are most gastric cancers?
Adenocarcinoma (epithelial cells)
How does a person with gastric cancer generally present?
Dyspepsia Early satiety Nausea + vomit Weight loss GI bleeding Anaemic GOO
Investigations for gastric cancer?
Endoscopy w biopsy
CT chest + abdo to stage
Treatment for gastric cancer?
surgery
chemo
What are aetiologies for gastric cancer?
H. pylori infection Familial Previous gastric resection Biliary reflux Premalignant gastric pathology Smoking Some food groups e.g. high salt, high nitrate
