H. Pylori & Gastric Disease Flashcards
What is Heliobacter Pylori?
A gram -ve, spiral shaped, microaerophilic, flagellated bacterium carried by around 50% of the worlds population
Where does Heliobacter Pylori colonise?
Gastric mucosa
How does Heliobacter Pylori cause a problem?
Ammonia and other chemicals
Damages epithelial lining
What does a Heliobacter Pylori cause?
Chronic gastritis leading to:
- In most people no significant disease
- If predominant in the body -> Loss of acid, gastric atrophy and finally gastric cancer
- If predominantly in the antrum -> Rise in acid -> Duodenal ulcers
What determines the outcome of a Heliobacter Pylori infection?
- Site
- Environmental factors e.g. smoking
- Genetic susceptibility
- Bug characteristics (virulence factors)
Define virulence factors?
Molecules produced by certain strains of a micro organism which give it an advantage at colonising or harming the host.
In what ways can we diagnose Heliobacter Pylori infection?
Non-Invasive:
- Stool Antigen Test (ELISA)
- Urea Breath Test
- Serology (IgG test)
Invasive (by Upper GI endoscopy):
- Staining of gastric biopsy
- Culture of biopsy
- Rapid slide urease test
Explain the rapid slide urease test?
Biopsy of mucosa isplaced in a medium with urea and a pH indicator
> Urease converts urea to ammonia and CO2
pH rises
Indicator changes colour
Urease is an enzyme produced by Heliobacter Pylori
Explain the Urea breath test?
- Urea tagged with an unusual isotope of carbon is breathed in
- Bacteria converts to ammonia + CO2
- Unusual isotope of carbon detected in breathed out CO2
What is the best invasive vs non-invasive way of detecting Heliobacter Pylori?
Stool Antigen Test (ELISA)
Rapid slide Urease Test
How do we eradicate a Heliobacter Pylori infection?
7 days of triple therapy:
- Clarithromycin
- Amoxicillin (tetracycline if penicillin allergic)
- A Proton Pump Inhibitor (PPI) e.g. Omeprazole
Further 2nd line protocols should this fail
Define Dyspepsia?
Also known as indigestion.
A condition of impaired digestion causing symptoms such as: - Upper abdominal pain/discomfort - Anorexia - Bloating - Nausea / Vomiting - Fullness and early satiety - Heartburn Retrosternal pain
How common is dyspepsia?
Around 80% of people get it occasionally with no serious underlying disease
Define a functional disorder?
One which impairs normal function of the gut without any detectable pathology.
Define an organic disorder:
Any disease in which there is detectable pathology. Either micro or macroscopic
Give some examples o dyspepsia causing conditions and whether they are functional or organic?
Functional:
- Psychological (psychological factors are very important in many functional disorders)
- Non-ulcer Dyspepsia
- IBS
- Drugs
Organic:
- Peptic Ulcer
- Gastritis
- Gastric Cancer
- Coeliac Disease
- Colonic Cancer
When would an upper GI endoscopy be indicated for dyspepsia?
If it came with any of the ALARMS symptoms:
- Anorexia
- Loss of Weight
- Anaemia
- Recent Onset >55 yrs or Persistant despite Treatment
- Melaena/Haematemesis or Mass
- Swallowing problems (Dysphagia/Odynophagia)
Define Haematemesis?
Vomiting blood
Define Odynophagia?
PAin when swallowing
NAme a few drugs that can cause dyspepsia
NSAIDs & Steroids
Ca Antagonists
Theophyllines
Nitrates
What is the flow chart approach to dyspepsia?
Dyspepsia:
- Alarms features?
- > Yes = Upper GI endoscopy
- No = Age?
- > Over 55 = UGIE
- Under 55 = Heliobacter Pylori test
- > If +ve do eradication therapy and or symptom treatent with antacids (PPIs or H2R antagonists) and change lifestyle factors
What are H2R antagonists?
Histamine H2 receptor antagonists
What lifestyle factors affect dyspepsia?
Smoking
Drinking
Diet
Lack of exercise
Loss of weight is an indicator
Define Gastritis
Inflammation in the gastric mucosa