helicobacter pylori

Question 1

who is colonised with H pylori

Answer 1

present in 30% of australians
higher prevelance in older, migrants, low socio economic or institutionalised
related to living conditions in childhood

Question 2

what does H pylori do

Answer 2

causes active chronic gastritis through most people re asymptomatic
confers a lifetime risk of H pylori associated peptic ulcer disease of 15-20% and gastric cancer of up to 2%

Question 3

usual first line test for H pylori

Answer 3

urea breath test

Question 4

alternative tests for H pylori

Answer 4

faecal antigen testing
serology
invasive tests based on edoscopic biopsy (rapid urease test or histology)

Question 5

what do you have to do to minimise the chance of false negative results in H pylori testing

Answer 5

anntbiotics should not be taken for 4 weeks and PPI should be withheld for 1-2 weeks before use breath test or faecal antigen test to minimise the chance of false negative results

Question 6

how does the urea breath test work

Answer 6

ingestion of urea in the presence of isotope C13 or C14 causes CO2 production which is detected on expired breath
higher than 95% sensitivity and specificity
can also be used to test for eraication

Question 7

H pylori serology

Answer 7

lower sensitivity and specificity than breath or faecal
stays positive for years after eraaddication

Question 8

indicatons for H pylori testing

Answer 8

PUD
dyspepsia
atrophic gastritis and intestinal metaplasia
first degree relatives of patients with gastric cancer
MALT lymphoma
at patient request
gastric cancer prevention in communities at high risk
selected users of NSAIDs
patients requiring long term acid suppression

Question 9

H pylori causing peptic ulcer disease

Answer 9

H pylori is a common cause of PUD
successful eradication is curative

Question 10

H pylori is people who use NSAIDs

Answer 10

the use of NSAIDs in people with H pylori infection increases the risk of ulcer disease

Question 11

H pylori gastritis symptoms

Answer 11

all people infected with H pylori develop chronic gastritis
there is inconstant reltionship between the presence of H pylori gastritis and symptoms
functional dyspepsia symptoms may not always be cured by H pylor eradication, but this is usully offered as it is more likley to improve symptoms than empiricl acid suppression therapy