Helicobacter Pylori and Gastric Disease

Question 1

What are some symptoms which can be included in dyspepsia?

Answer 1

Epigastric pain, burning, fullness, bloating, satiety, nausea, sickness, heartburn, reflux and discomfort

Question 2

What does dyspepsia mean?

Answer 2

Bad digestion

Question 3

What does dyspepsia describe?

Answer 3

A group of symptoms which cause pain or discomfort in upper abdomen

Question 4

How long for symptoms to have dypepsia?

Answer 4

4 weeks

Question 5

Is dyspepsia common?

Answer 5

Yes, very common
80% of people but most no serious underlying disease

Question 6

What upper GI problems can cause dyspepsia?

Answer 6

GORD, peptic ulcer, gastritis, non ulcer dyspepsia and gastric cancer

Question 7

What are some causes for dyspepsia?

Answer 7

Drugs
Gallstones
Pancreatic disease
Coeliac Disease
Psychological

Question 8

What are some drugs to be aware of in dyspepsia?

Answer 8

NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophylline

Question 9

What bloods should be done for a patient with dyspepsia?

Answer 9

FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA

Question 10

When should you refer a patient for an endoscopy?

Answer 10

Anorexia
Loss of weight
Anaemia
Recent onset if over 55 or persistence
Melaena/haematemesis
Swallowing

Question 11

What is an upper GI endoscopy?

Answer 11

Diagnostic and therapeutic upper GI endoscopy
Under local anaesthetic or sedation
Day case and fasted

Question 12

What are the risks of an endoscopy?

Answer 12

Perforation
Bleeding
Reaction to drugs given

Question 13

What are the diagnostic pathways of dyspepsia?

Answer 13

Only red flags sent to endoscopy
Lifestyle advice if not and medications like Gaviscon, anti-acid meds
Think of testing for H. pylori

Question 14

What is Helicobacter Pylori?

Answer 14

Gram negative bacteria
Spiral shaped, microaerophilic and flagellated

Question 15

Where can H.pylori colonise?

Answer 15

Only gastric type mucosa

Question 16

Where does H. pylori reside?

Answer 16

In the surface of mucous layer and does not penetrate the epithelial layer
Can survive in acidic environment of stomach

Question 17

What does H. pylori evoke?

Answer 17

Immune response in underlying mucosa causing inflammation - dependant on host genetic factor

Question 18

What enzyme does H. pylori produce?

Answer 18

Urease

Question 19

Describe the pathogenesis of H. pylori?

Answer 19

Enters host and survival
Motility and chemotaxis
Adhesion receptor interacted and establishes colonisation
Toxins release and damage to host

Question 20

What are the clinical outcomes of Helicobacter pylori infections?

Answer 20

Mostly asymptomatic or chronic gastritis
Some get chronic atrophic gastritis, intestinal metaplasia or gastric/duodenal ulcer
Least common is gastric cancer or MALT lymphoma

Question 21

What is the outcome of H. pylori dependant on?

Answer 21

Site of colonisation
Characteristics of bacteria
Host factors - susceptibility and environmental factors

Question 22

What does chronic H. pylori infection cause to antral predominant gastritis?

Answer 22

Increased acid
Low risk of gastric cancer
DU disease

Question 23

What does chronic H. pylori infection cause to corpus predominant gastritis?

Answer 23

Decreased acid
Gastric atrophy
Risk of gastric cancer

Question 24

What are the non-invasive ways of diagnosing H. pylori infection?

Answer 24

Serology - IgG against H. pylori
13c/14c Urea breath test
Stool antigen test - ELISA (need to be off PPI for 2 weeks)

Question 25

What are the invasive ways of diagnosing H. pylori infection?

Answer 25

Requires endoscopy for biopsy Histology can be stained for bacteria Culture Rapid slide urease test (CLO)

Question 26

Describe a CLO test

Answer 26

Campylobacter like organism Urease acts on gel which has ammonia to turn pink - positive Biopsy from stomach

Question 27

What is gastritis?

Answer 27

Inflammation of the gastric mucosa

Question 28

How is gastritis diagnosed?

Answer 28

Histological Clinical features seen at endoscopy

Question 29

What are the 3 types of gastritis?

Answer 29

Autoimmune - parietal cells Bacterial - H. pylori Chemical - bile/NSAIDs

Question 30

What do peptic ulcers include?

Answer 30

Gastric and Duodenal ulcer

Question 31

What are the majority of peptic ulcers caused by?

Answer 31

Helicobacter Pylori

Question 32

What are some other causes of peptic ulcers?

Answer 32

NSAIDs and smoking Rarely - Zollinger-Ellison syndrome, hyperparathyroidism and Crohn's disease

Question 33

What is the main symptom of peptic ulcers?

Answer 33

Epigastric pain/ tenderness

Question 34

What are other symptoms of peptic ulcers?

Answer 34

Hunger pain, back pain, nausea, vomiting, weight loss, if ulcer bleeds then haemoptysis

Question 35

How are peptic ulcers treated when caused by H. pylori?

Answer 35

Eradication therapy to get rid of bacteria

Question 36

How are peptic ulcers treated?

Answer 36

Antacid meds - PPI (omeprazole) or H2 receptor antagonist If NSAIDs involved then stop

Question 37

When is surgery needed in peptic ulcers?

Answer 37

Only in complicated PUD

Question 38

Describe the eradication of H. pylori infection

Answer 38

Triple therapy for 7-10 days Effective in 90% of cases

Question 39

Describe triple therapy for eradication of H. pylori infection

Answer 39

Clarithromycin Amoxycillin (tetracycline if penicillin allergy) PPI - omeprazole

Question 40

What are some complications of a peptic ulcer?

Answer 40

Acute bleeding Chronic bleeding Perforation Fibrotic structure Gastric outlet obstruction

Question 41

What are the symptoms of gastric outlet obstruction?

Answer 41

Vomiting as lacks bile and fermented foodstuffs Early satiety, weight loss, abdominal distention and gastric splash Dehydration

Question 42

What would bloods show in gastric outlet obstruction?

Answer 42

Low Cl, low Na, low K and renal impairment

Question 43

How gastric outlet obstruction diagnosed?

Answer 43

Endoscopy

Question 44

How is gastric outlet obstruction treated?

Answer 44

Balloon dilation Surgery

Question 45

How are most gastric cancers caused?

Answer 45

Majority are sporadic with no demonstrable inherited component Some familial clustering but no definite germline mutation Not many have heritable syndromes