Stomach Flashcards
In H. pylori infection, what mutation is associated with increased risk of malignancy?
CagA
What are the first line treatment options for H. pylori infection?
- Bismuth quad therapy (PPI, bismuth, tetracycline, metronidazole)
- clarithromycin triple therapy (if known low resistence to claritho)- PPI, clarithro and either amox or metronidazole
- concomitant therapy with PPI, amoxicilin, metronidazole, clarithromycin
What are second line therapies for H. pylori infection?
- give bismuth quad therapy if not given initially
No PCN allergy
-PPI, amoxicilin, levaquin or rifabutin
PCN allergy
-PPI, bismuth, levaquin, tetracycline or metronidazole -PPI, bismuth, tetracycline, clarithromycin
When do you test for eradication of H. pylori?
4 weeks after treatment, 2 weeks off PPI
What are to two most common types of atrophic gastritis?
- H.pylori (antrum)
- autoimmune (body)
What are the features of autoimmune gastritis?
parietal cell ab
intrinsic factor ab
hypochloridia
hypergastrinemia
low acid secretion
b12 deficiency (pernicious anemia)
IDA
type 1 gastric NET
Someone is diagnosed with pernicious anemia- what should you do next?
EGD w/in 6 months, often precedes cancer
Who qualifies for surveillance for GIM (not associated with atrophic gastritis)?
- incomplete GIM (colon +small intestine type)
- extensive (body + antrum)
- FDR with gastric cancer
- immigrant from high risk area
- racial/ethnic minorities
If GIM is detected on rouine EGD, should short term repeat EGD be performed to complete staging?
No
Yes only if considered high risk - incomplete GIM, extensive, FDR with gastric cancer, immigrant
What is the differential for hypertrophic gastric folds?
-Menetrier’s disease- foveolar hyperplasia associated with bleeding, malnutrition and pain
- gastric lymphoma
- gastric adenoCa
-amyloidosis,
- zollinger-ellison
What is the best NSAID for high risk CV patients?
What is the best NSAID for patients w/ history of bleeding PUD?
high risk CV patients- naproxen
high risk PUD- use COX2 selective
What are the diagnostic and clinical features of Zollinger-Ellison Syndrome?
Diagnostic
-high gastrin
-high acid section
-Basal acid output >15
Clinical
- diarrhea, PUD, acid reflux
-assoc with MEN1 - pancreatic, pituitary, parathyroid
**surgery is only curative in non-MEN ZE.
Pathological and EUS features of GIST. How do you manage it?
+ cKIT
4th layer (dark)- muscularis propria
homogenous
well demarcated smooth borders
remove if >2cm
annual surveillance if <2cm
TKI if metastati
What are the 3 types of GI neuroendocrine tumors?
Type 1 - ECL cells
high gastrin, low acid secretion
associated with atrophic gastritis
Type 2- ECL cells
high gastrin, high acid secretion
associated with ZE
Type 3- Enterochromaffin cells
normal gastrin
normal acid secretion
sporadic
**highest risk of malignancy
How do you manage a new presentation of dyspepsia?
