Helicobacter Pylori and gastric disease Flashcards
What does dyspepsia mean?
A group of symptoms, literally meaning bad digestion
What are some of the symptoms associated with dyspepsia?
retrosternal pain nausea heartburn early satiety pain or discomfort in the upper abdomen vomiting bloating
What is the difference between organic and functional diseases?
organic - specific underlying pathology
functional - no structural difference just not functioning properly
What are some upper GI causes of dyspepsia?
peptic ulcer
gastritis
non ulcer dyspepsia
gastric cancer
What are some lower GI causes of dyspepsia?
colon cancer
IBS
What are some other causes of dyspepsia?
metabolic or cardiac causes
gallstones, coeliac disease, drugs and psychological
What are ALARM symptoms used to decide?
Whether to send for an endoscopy
What are the ALARMS symptoms?
Anorexia Loss of weight Anaemia Recent onset >55 years or persistent despite treatment Maleana/haematemesis or Mass Swallowing problems -dysphagia
What is maleana?
sticky, dark faeces containing partly digested blood
What is haematemesis?
vomiting up blood
Is upper GI endoscopy therapeutic or diagnostic?
can be both
Explain the prepping done before an UGIE
fasted before and consented
throat spray for local anaesthetic or sedation
What are the risks of an UGIE?
perforation, bleeding or drug reaction
What is a perforation of the GI tract?
Hole in the stomach lining
What are the 3 main things to do if a patient presents with dyspepsia?
bloods
drug history
lifestyle
What bloods would you do in a patient presenting with dyspepsia?
FBC, LFT, U+Es, Ca2+, glucose, coeliac screening, serology, IgA
What drugs can be associated with dyspepsia?
NSAIDS, steroids
What are important lifestyle factors to consider with dyspepsia?
smoking, alcohol, exercise, diet, weight
If there are no ALARM symptoms what would you do?
under 55 - screen for H pylori and if positive eradicate with antibiotics and antacid,
over 55 - UGIE
Describe H pylori
spiral shaped gram negative bacteria
flagellated and microaerophilic
What percentage of the population does H pylori affect and when is it acquired?
50% - childhood
Where does H pylori colonise and what is the effect of this?
colonise the mucosa and initiate an immune response
What are the 3 outcomes of H pylori infection?
asymptomatic or chronic gastritis
ulcer/metaplasia
cancer
What is the outcome of H pylori infection dependent on?
site of colonisation
bacteria character
host factors - genetic and environmental
Infection of what part of the stomach by H pylori is more likely to result in cancer? Why?
Nearer the top as decreases acid production and leads to atrophy
What are the non invasive ways to diagnose H pylori infection?
serology
13C/14C urea breath test
stool antigen - ELISA
What must happen 2 weeks before a stool antigen test for H pylori?
taken off PPI
What are the invasive diagnostic procedures for H pylori infections?
endoscopy and biopsy
rapid slide urease test
What is gastritis?
The inflammation in the gastric mucosa and clinical features can be seen at endoscopy
What are the 3 types of gastritis and what is the cause of each?
autoimmune - proteins against parietal cells
bacterial - H pylori
chemical - bile/NSAIDS
Who is most likely to have a peptic ulcer?
men - elderly
What are some causes of peptic ulcers?
previous H pylori infection, smoking and NSAIDS
What are the symptoms of peptic ulcers?
epigastric pain
nausea, vomit, weight loss
Nocturnal/hunger/back pain
haematemesis, melaena
What are the treatment methods for peptic ulcers?
treat H pylori infection
stop NSAIDS
surgery if complicated
PPI or H2R antagonist
What is the treatment plan for H pylori?
triple therapy for 7 days
2 antibiotics - clarithromycin & amoxicillin/tetracycline
PPI - omeprazole
What are some complications of H pylori infection?
bleeding, perforation, fibrosis, gastric outlet obstruction
What is the vomit like in GOO?
lack bile and fermented
What happens to the electrolytes in GOO?
dehydrated and loss of Na/K/Cl in vomit
What is the investigation and treatments for GOO?
endoscopy and aspiration of contents
balloon dilation/surgery
What are some symptoms of gastric cancer?
nausea, vomit, anorexia, weight loss, GI bleed, dyspepsia, iron deficiency anaemia, GOO
What is the aetiology of gastric cancer?
smoking, diet, genes, H pylori previous infection
What are the 3 categories of gastric cancer?
sporadic
familial
heritable (<1%)
How is gastric cancer histologically diagnosed?
endoscopy and biopsy
How is gastric cancer staged?
CT
How is gastric cancer managed after staging?
MDT discussion
chemotherapy/surgery
What structures comprise the upper GI tract?
The oesophagus and stomach
What structures comprise the lower GI tract?
small intestine
Large intestine
List some functions of the stomach
Food storage
Initial digestion
Acidic environment
Intrinsic factor
Does H pylori penetrate the epithelial layer?
No
What does chronic H.pylori in the antrum lead to?
increase in acid production
Low risk of gastric cancer
Increased risk of ulcers
Are duodenal or gastric ulcers more common?
duodenal
Rarer causes of peptic ulcers
Zollinger-Ellison syndrome
hyperparathyroidism
Crohn’s disease
Why may eradication of H.pylori infection fail?
resistance to antibiotics
Poor concordance
