Lecture 16 Helicobacter pylori and Gastric Disease Flashcards
What is Dyspepsia
A group of symptoms that include Pain or discomfort in the upper abdomen, upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn that last for 4 weeks
Symptoms of Dyspepsia
- Epigastric pain
- Burning
- Fullness
- Bloating
- Satiety
- Nausea
- Sickness
- Heartburn
- Reflux
- Discomfort
If a patient presents with dyspepsia what are the necessary investigations
History and examination
Bloods
Drug history
Lifestyle
When do you refer someone that has presented with dyspepsia to endoscopy
ALARMS- suspicion of malignancy
What is H.pylori
Gram negative
Spiral shaped
Microaerophilic flagellated
Describe the pathogenesis of H.pylori
Enters host and survival
Motility and chemotaxis
Adhesion-receptor interaction-establish colonisation
Toxins release- damage host
What are the 3 divergent responses to H.pylori infection
Antral predominant gastritis
Mild mixed gastritis
Corpus predominant gastritis
Describe astral predominant gastritis
Increase in acid
Low risk of gastric cancer
Can develop into DU disease
Describe Mild mixed gastritis
Normal acid
No significant disease
Describe Corpus predominant gastritis
Decrease in acid
Gastric atrophy
Increase risk of developing into gastric cancer
How is a H.pylori infection diagnosed
Serology- IgG against H.pylori 13C /14C Urea Breath Test Stool antigen test- ELISA Histology- bx Rapid slide urease test
What is gastritis
Inflammation in the gastric mucosa
What are the 3 types of gastric mucosa
- Autoimmune (parietal cells)
- Bacterial (H. pylori)
- Chemical (bile/NSAIDs)
What are the complications of gastritis
Peptic ulcers
What are the common causes of peptic ulcers
H.pylori infections NSAIDS Smoking Zollinger-Ellison syndrome Hyperthyroidism
What are the symptoms of peptic ulcers
Epigastric pain Nocturnal/hunger pain Back pain Nausea, occasional vomiting Weight loss Anorexia Epigastric tenderness Haematamesis Melaena Anaemia
Treatment of Peptic ulcers
if causes by H.pylori- eradication therapy
Antacid-proton pump inhibitors (omeprazole) or H2 receptor antagonists (ranitidine)
Describe Eradication Therapy
• Triple therapy for 7 days
• Clarithromycin 500mg bd
• Amoxycillin 1g bd (or Metronidazole 400mg bd)
• Tetracycline is given if penicillin allergy
PPI- omeprazole
Why is triple therapy important
To prevent resistance
Complications of peptic ulcers
- Acute bleeding – melaena and haematemesis
- Chronic bleeding – iron deficiency anaemia
- Perforation
- Fibrotic stricture (narrowing)
- Gastric outlet obstruction – oedema or stricture
Presentation of gastric outlet obstruction
Vomiting Early satiety Abdominal distention Weight loss Gastric splash
Signs of gastric outlet obstruction
- Dehydration and loss of H+ and Cl- in vomit
- Metabolic alkalosis
- Bloods – low Cl, low Na, low K, renal impairment
How is gastric outlet obstruction diagnosed
• UGIE (prolonged fast/aspiration of gastric contents), identify cause – stricture, ulcer, cancer
What is the treatment for gastric outlet obstruction
- Endoscopic Balloon dilatation
* Surgery
Whats the most common type of gastric cancer
Adenocarcinoma
What are the presentation of gastric cancer
- Dyspepsia
- Early satiety
- Nausea and vomiting
- Weight loss
- GI bleeding
- Iron deficiency anaemia
- Gastric outlet obstruction
Aetiology of Gastric Cancer
- Diet
- Genetics
- Smoking
- Previous gastric resection
- Biliary reflux
- Premalignant gastric pathology
What genes are associated with gastric cancer
HDGC; AD, CDH-1 gene (E-cadherin)
• 1-3% heritable gastric cancer syndromes
Management of gastric cancer
- Endoscopy and biopsies to make a histological diagnosis
- Staging investigations – has it spread elsewhere?
- CT chest/abdo – lymph nodes and liver/lungs/peritoneum/bone marrow
- MDT discussion – imaging/histology/patient fitness
Treatment of gastric cancer
Surgical and chemotherapy
