H.pylori and gastric disease Flashcards
What is dyspepsia
Pain or discomfort in the upper abdomen
When to refer for endoscopy
ALARMS
Anorexia
Loss of weight
Anaemia - iron defficiency
Recent onset
Maelena/haematemesis
Swallowing problems (dysphagia)
Describe the structure of H pylori
Gram negative spiral shaped flagella
What kind of mucosa can H pylori colonise
Gastric mucosa only - does not penetrate the epithelial layer either
What can h pylori lead to
most common :
Asymptomatic
Chronic gastritis
Common: Chronic atrophic gastritis
Gatric or duodenal ulcer
Least common - Gastric cancer
How is H pylori diagnosed
Serology - IgG against H pylori
Urea breath test
Stool antigen test - ELISA - needs to be off PPI 2 weeks
What is gastritis
Inflammation of the gastric mucosa
Describe peptic ulcers
Common
Men>women
Mainly caused by H pylori
Can be caused by NSAIDs and smoking
Duodenal ulcer more common than gastric ulcer
What is the difference between gastric and duodenal ulcer in symptoms
Gastric is made worse when eating due to acid release while duodenal ulcers are relieved while eating due to the neutralisation of the acid
What are the symptoms of a peptic ulcer
Epigastric pain which is relieved by antacids
Hunger - mainly duodenal ulcer
Back pain
nausea
vomiting
weight loss
anorexia
haematemesis or malena if there is bleeding
What is the treatment of a peptic ulcer
If caused by H pylori - eradicate infection
Antacid medication :
PPI - omeprazol
H2 receptor antagonists - ranitidine
Stop NSAIDs
What is the treatment for H pylori
Triple therapy for 7 days:
C - clarithromycin - 500mg twice a day
A - amoxycillin -1g twice a day - tetracycline if penicillin allergy
P- PPI - 40mg omeprazole twice a day
Presentation of gastric cancer
Dyspepsia
Early satiety
Nausea and vomiting
Weight loss
GI bleeding
Iron deficiency anaemia
gastric outlet deficiency
Virchow’s node at left supraclavicular region
