H.Pylori and gastric disease Flashcards
name some gastric disorders
dyspepsia
peptic ulcer disease
gastric outlet obstruction
gastric cancer
what is dyspepsia
translate from greek = “bad digestion”
describes a group of symptoms:
- pain or discomfort in the upper abdomen
- retrosternal pain
- anorexia
- vomiting
- bloating
- fullness
- early satiety
- heartburn
what can cause the symptom of dyspepsia
upper GI
- peptic ulcer
- gastritis
- non-ulcer dyspepsia
- gastric cancer
hepatic
gallstones
pancreatic disease
lower GI
- IBS
- colonic cancer
coeliac disease
psychological
drugs
other systemic causes
- metabolic
- cardiac
what are red flag signs to refer of endoscopy (think ALARMS)
Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or Mass
Swallowing problems - dysphagia
what initial investigations should be done if a patient is dyspepsic
Bloods – FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA
what should be asked in a history for a patient with dyspepsia
Drug history – NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophyllines, remember OTT
Lifestyle – alcohol, diet, smoking, exercise, weight reduction
what are the protocols for dealing with a patient with dyspepsia
- ALARMS FEATURES:
yes - upper GI endoscopy
no - see 2 - AGE
>55 years - UGIE
<55 years - test for h pylori - H PYLORI RESULT
+ve - eradication therapy and symptomatic treatment (PPIs, lifestyle factors) - If symptoms persist - refer to GI
what is helicobactor pylori
Gram negative
spiral-shaped, microaerophilic
flagellated bacteria
how does a H pylori infection happen
h pylori can colonise gastric mucosa
resides in the surface layer of the mucosa but does not penetrate epithelial layer
instead invokes an immune response in underlying mucosa
what are the 4 different outcomes of h pylori infections
- asymptomatic or chronic gastritis
- chronic atrophic gastritis, intestinal metaplasia
- gastric or duodenal ulcer
- gastric cancer, MALT lymphoma
what are the outcomes of h pylori infection dependant on
site of colonization,
characteristics of bacteria and host factors e.g. genetic susceptibility
other environmental factors e.g. smoking
what does antral predominant gastritis lead to in terms of disease
increased acid production
low risk of gastric cancer
= DU disease
what does corpus predominant gastritis lead to in terms of disease
decreased acid production
gastric atrophy
= gastric cancer
how can h pylori infection be diagnosed
non-invasively
- serology - IgG against H pylori
- stool antigen test - ELISA
invasively
- histology - gastric biopsies stained for the bacteria
- Culture of gastric biopsies
- Rapid slide urease test (CLO)
define gastritis
Inflammation in the gastric mucosa
Histological diagnosis
Clinical features seen at endoscopy
what are the three types of gastritis (ABC)
Autoimmune (parietal cells)
Bacterial (H. pylori)
Chemical (bile/NSAIDs)
what can cause peptic ulcers
majority - h pylori infection
other - NSAIDS, smoking
rare - crohns, hyperparathyroidism
what symptoms are associated with peptic ulcers
Epigastric pain is the main feature
Nocturnal/hunger pain
Back pain
Nausea and occasionally vomiting
Weight loss and anorexia
Only sign may be epigastric tenderness
If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia
how do you treat a peptic ulcer
caused by h pylori - eradication therapy
antacid medication - PPI (omeprazole) or H2 receptor antagonists (ranitidine)
stop NSAIDS
treat complications as they arise
surgery only indicated in complicated PUD
what is the eradication therapy for H pylori
triple therapy for 7 days:
- clarithromycn
- amoxycillin (or metronizadole - tetracycline if penicillin allergy)
- PPI - omeprazole
what are the complications of peptic ulcers
Acute bleeding – melaena and haematemesis
Chronic bleeding – iron deficiency anaemia
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction – oedema or stricture
how does gastric outlet obstruction present
Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
what will blood results show in gastric outlet obstruction
Metabolic alkalosis
Bloods – low Cl, low Na, low K, renal impairment
how can gastric outlet obstruction be diagnosed
UGIE (prolonged fast/aspiration of gastric contents)
identify cause – stricture, ulcer, cancer
how can gastric outlet obstruction be treated
endoscopic balloon dilatation
surgery
what is the second most common malignancy in the world
gastric cancer
what are the majority of gastric cancers
adenocarcinomas (epithelial cells)
how do patients with gastric cancer present
Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction
what are some risk factors for gastric cancer
smoking diet H pylori infection genetic - family history previous gastric resection biliary reflux premalignant gastric pathology
what are the majority of gastric cancers in terms of genes
majority sporadic with no inherited component
<15% familial clustering
1-3% inheritable gastric cancer syndromes - HDGC, AD, CDH-1 gene
what enable a histological diagnosis
endoscopy and biopsy
what staging investigations are carried out for gastric cancer
CT chest/abdomen - lymph nodes and liver/lung/peritoneum/bone marrow
how is gastric cancer treated
MDT discussion of imaging/histology/patient fitness
- Who is present? gastroenterologist, pathologist, radiologist, upper GI surgeons, oncologists, specialist nurses
surgery
chemotherapy
