H.pylori & gastric disease Flashcards
What is dyspepsia?
Pain / discomfort in the upper abdomen (indigestion)
Also includes symptoms such as bloating, anorexia etc
For 4 weeks
How common is dyspepsia?
Very common
80% of people get it at some point
What tends to cause dyspepsia?
Upper GI problems
Hepatic causes & gallstones
Pancreatic disease
Coeliac disease
Psychological
Drugs
Systemic/other illness
Lower GI rarely
What investigations can be done for a patient presenting with dyspepsia?
FBC
Ferritin
LFTs
U&Es
Calcium
Glucose
Coeliac serology/serum IgA
What aspects of a history are particularly important for patients with dyspepsia?
Drug history
Lifestyle
What drugs are linked to causing dyspepsia?
NSAIDs
Steroids
Bisphosphonates
Ca antagonists
Nitrates
Theophyllines
Remember OTT?
What symptoms are ALARMS?
A - Anorexia
L - Loss of weight
A - Anaemia
R - Recent onset >55
M - Melaena/haematemesis*
S - Swallowing problems (dysphagia)
*Persistent vommiting is also serious
What would be done for a patient with ALARMS signs/symptoms?
Refer for endoscopy
(urgent investigation for cancer)
For a patient without ALARMS symptoms, what is the next course of action?
Lifestyle advice
Offer antacid medication such as Gaviscon
Offer H2 receptor antagonist: Ranitidine
H.Pylori SA test
What type of bacteria is Helicobacter pylori?
Gram negative, spiral-shaped, microaerophilic, flagellated Gram –ve bacteria
How common is infection by H.pylori?
Infects 50% of the world population
Where can H.pylori colonise in the GI tract?
H.pylori can only colonise gastric type mucosa
It resides in the mucous layer, and does not penetrate the mucosal epithelium
What determines whether or not someone with H.pylori in their stomach will actually get sick?
Host genetic factors determine whether or not an immune response happens
Site of colonisation, characteristics of the bacteria
Environmental factors as well - eg smoking
What are the possible outcomes of infection by H.pylori
>80% - Asymptomatic or chronic gastritis
15-20% - Chronic atrophic gastritis, intestinal metaplasia or Gastric/duodenal ulceration
<1% - Gastric cancer, MALT lymphoma
What happens when there is chronic H. pylori infection in the Antrum of the stomach?
Antral predominent gastritis can lead to increased Acid production by parietal cells
Increased acidity causes duodenal ulceration, but has lower risk for cancer
(antral infection = ulcers)
What happens when there is chronic H.pylori infection which exists more in the corpus area of the stomach?
Corpus predominent gastritis leads to decreased acid production and gastric atrophy
This causes an increased risk of cancer
How is H.pylori infection investigated/diagnosed?
Stool antigen (ELISA) test
Serology: IgG antibody against H.pylori
13C/14C urea breath test
Endoscopy:
- Biopsy for staining
- Biopsy for Culture
- Rapid slide Urease test (CLO)
How does a rapid slide urease test work?
Detects urease, an enzyme which is secreted by H.pylori
Red = positive
Yellow = negative
(Urease is also what makes the urea breath test work)
What is gastritis and how is it diagnosed?
Inflammation of the gastric mucosa
Diagnosed histologically (needs biopsy)
What are the causes of gastritis?
Think ABC
A - Autoimmune (parietal cells)
B - Bacterial (H.pylori)
C - Chemical (bile/NSAIDs)
What type of peptic ulcer is most common?
Duodenal ulcers are more common than gastric ulcers
What causes the majority of Peptic ulcers?
H.pylori infection
What other conditions/things can cause Peptic ulcers?
Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s disease
(NSAIDs & Smoking are risk but i cba asking that by itself)
How do age and gender affect your likelihood of getting peptic ulcers?
Men > women
Old > young
How are Gastric and duodenal ulcers diagnosed?
Through endoscopy (through mouth)
Peptic ulcer symptoms?
Epigastric pain
Nocturnal hunger/pain
Nausea / vomitting
Anorexia / weight loss
GI bleeding symptoms
Peptic ulcer clinical signs?
Epigastric tenderness
(GI bleeding may cause anaemia)
How do you treat peptic ulcers?
H.pylori eradication therapy
Antacid (Omeprazole, Ranitidine)
Stop NSAIDs (or protect against them)
Treat complications
Surgery only if complicated/serious enough
What type of drug is Omeprazole?
Proton pump inhibitor
Type of antacid
What type of drug is Ranitidine?
H2 receptor antagonist
Type of antacid
Describe the process of H.pylori eradication
7 days Triple therapy
- Clarithromycin 500mg bd
- Amoxycillin 1g bd*
- PPI eg Omeprazole 20mg bd
*or Metronidazole 400mg bd OR Tetracycline if allegic to penicillin
What are the complications of peptic ulcers?
Acute bleeding - Melaena/haematemesis
Chronic bleeding - Iron deficiency anaemia
Perforation
Fibrotic stricturing
Gastric outlet obstruction - oedema or strictures
What are the symptoms of gastric outlet obstruction?
Vomitting
Early satiety (feel full quickly)
Weight loss
Abdo distension
What signs on examination indicate gastric outlet obstruction?
Dehydration
Gastric splash
Metabollic alkalosis
What investigations should be done for gastric outlet obstruction and why?
Bloods - these would show Low Cl-, low K+, low Na+, renal impairment
Upper GI endoscopy - will identify any ulcer/stricture/cancer causing the problem
What are the different types of Gastric tumours?
Adenocarcinoma (epithelial cells) - most common
MALT lymphoma (mucosa-associated lymphoid tissue)
GIST (gastrointestinal stroma tumour) - type of sarcoma
What is the prognosis for gastric cancer?
5 year survival < 20%
What are the symptoms/signs of gastric cancer?
Dyspepsia
Early satiety (fullness when eating)
Nausea & vommiting
Weight loss
GI bleeding
ID anaemia
Gastric outlet obstruction
What are the risk factors for gastric cancer?
Diet
Smoking
Genetics
History of H.pylori infection
Others: family history, previous gastric resection, biliary reflux, premalignant gastric pathology
What is the Correa hypothesis?
The histological pathway from H.pylori infection to various subtypes of gastric cancer
