Helicobacter Pylori and Gastric Disease Flashcards
What are some symptoms which can be included in dyspepsia?
Epigastric pain, burning, fullness, bloating, satiety, nausea, sickness, heartburn, reflux and discomfort
What does dyspepsia mean?
Bad digestion
What does dyspepsia describe?
A group of symptoms which cause pain or discomfort in upper abdomen
How long for symptoms to have dypepsia?
4 weeks
Is dyspepsia common?
Yes, very common
80% of people but most no serious underlying disease
What upper GI problems can cause dyspepsia?
GORD, peptic ulcer, gastritis, non ulcer dyspepsia and gastric cancer
What are some causes for dyspepsia?
Drugs
Gallstones
Pancreatic disease
Coeliac Disease
Psychological
What are some drugs to be aware of in dyspepsia?
NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophylline
What bloods should be done for a patient with dyspepsia?
FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA
When should you refer a patient for an endoscopy?
Anorexia
Loss of weight
Anaemia
Recent onset if over 55 or persistence
Melaena/haematemesis
Swallowing
What is an upper GI endoscopy?
Diagnostic and therapeutic upper GI endoscopy
Under local anaesthetic or sedation
Day case and fasted
What are the risks of an endoscopy?
Perforation
Bleeding
Reaction to drugs given
What are the diagnostic pathways of dyspepsia?
Only red flags sent to endoscopy
Lifestyle advice if not and medications like Gaviscon, anti-acid meds
Think of testing for H. pylori
What is Helicobacter Pylori?
Gram negative bacteria
Spiral shaped, microaerophilic and flagellated
Where can H.pylori colonise?
Only gastric type mucosa
Where does H. pylori reside?
In the surface of mucous layer and does not penetrate the epithelial layer
Can survive in acidic environment of stomach
What does H. pylori evoke?
Immune response in underlying mucosa causing inflammation - dependant on host genetic factor
What enzyme does H. pylori produce?
Urease
Describe the pathogenesis of H. pylori?
Enters host and survival
Motility and chemotaxis
Adhesion receptor interacted and establishes colonisation
Toxins release and damage to host
What are the clinical outcomes of Helicobacter pylori infections?
Mostly asymptomatic or chronic gastritis
Some get chronic atrophic gastritis, intestinal metaplasia or gastric/duodenal ulcer
Least common is gastric cancer or MALT lymphoma
What is the outcome of H. pylori dependant on?
Site of colonisation
Characteristics of bacteria
Host factors - susceptibility and environmental factors
What does chronic H. pylori infection cause to antral predominant gastritis?
Increased acid
Low risk of gastric cancer
DU disease
What does chronic H. pylori infection cause to corpus predominant gastritis?
Decreased acid
Gastric atrophy
Risk of gastric cancer
What are the non-invasive ways of diagnosing 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 ways of diagnosing H. pylori infection?
Requires endoscopy for biopsy
Histology can be stained for bacteria
Culture
Rapid slide urease test (CLO)
Describe a CLO test
Campylobacter like organism
Urease acts on gel which has ammonia to turn pink - positive
Biopsy from stomach
What is gastritis?
Inflammation of the gastric mucosa
How is gastritis diagnosed?
Histological
Clinical features seen at endoscopy
What are the 3 types of gastritis?
Autoimmune - parietal cells
Bacterial - H. pylori
Chemical - bile/NSAIDs
What do peptic ulcers include?
Gastric and Duodenal ulcer
What are the majority of peptic ulcers caused by?
Helicobacter Pylori
What are some other causes of peptic ulcers?
NSAIDs and smoking
Rarely - Zollinger-Ellison syndrome, hyperparathyroidism and Crohn’s disease
What is the main symptom of peptic ulcers?
Epigastric pain/ tenderness
What are other symptoms of peptic ulcers?
Hunger pain, back pain, nausea, vomiting, weight loss, if ulcer bleeds then haemoptysis
How are peptic ulcers treated when caused by H. pylori?
Eradication therapy to get rid of bacteria
How are peptic ulcers treated?
Antacid meds - PPI (omeprazole) or H2 receptor antagonist
If NSAIDs involved then stop
When is surgery needed in peptic ulcers?
Only in complicated PUD
Describe the eradication of H. pylori infection
Triple therapy for 7-10 days
Effective in 90% of cases
Describe triple therapy for eradication of H. pylori infection
Clarithromycin
Amoxycillin (tetracycline if penicillin allergy)
PPI - omeprazole
What are some complications of a peptic ulcer?
Acute bleeding
Chronic bleeding
Perforation
Fibrotic structure
Gastric outlet obstruction
What are the symptoms of gastric outlet obstruction?
Vomiting as lacks bile and fermented foodstuffs
Early satiety, weight loss, abdominal distention and gastric splash
Dehydration
What would bloods show in gastric outlet obstruction?
Low Cl, low Na, low K and renal impairment
How gastric outlet obstruction diagnosed?
Endoscopy
How is gastric outlet obstruction treated?
Balloon dilation
Surgery
How are most gastric cancers caused?
Majority are sporadic with no demonstrable inherited component
Some familial clustering but no definite germline mutation
Not many have heritable syndromes
