Helicobacter Pylori

Question 1

Definition

Answer 1

Gram negative bacilli
Catalase positive
Oxidase positive
Urease positive

Question 2

Risk factors

Answer 2

Low socioeconomic status
Increasing housing density
Lack of running water
Genetic susceptibility
Swimming in pools, rivers, streams

Question 3

Aetiology

Answer 3

Peptic ulcer disease
Gastritis
Gastric carcinomas

Question 4

Pathophysiology

Answer 4

Highly adapted to the stomach environment + exclusively colonised gastric epithelium + inhabits mucous layer
1. Decreased somatostatin = increased acid release
2. Increased luminal gastric acid
3. Release urease = ammonia generation = toxic to gastric mucosa
4. Decreased HCO3- secretion
Overall major destruction to the mucin layer which protects the mucosa

Question 5

Signs and symptoms

Answer 5

Recurrent burning + epigastric pain
Nausea
Anorexia + weight loss = esp gastric ulcers

Question 6

Diagnosis

Answer 6

If less than 55 = test + treat
- FIRST LINE = stool antigen test
- C-urea breath test
Px must be PPI free 2 weeks and antibiotic free 4 weeks
GOLD STANDARD = Upper GI endoscopy
If above 55 or red flag symptoms = FL

Question 7

Treatment

Answer 7

Amoxicillin (or METRONIDAZOLE if CI)
Clarithromycin
Lansoprazole

Question 8

Complications

Answer 8

Renal stones from hyperuricaemia