Week 2.6 - H.pylori and Gastric Disease

Question 1

What is the most common cause of gastritis?

Answer 1

H.pylori bacteria

Question 2

How does h.pylori colonise?

Answer 2

only resides on surface mucosa layer. produces urease enzyme which allows it to migrater through mucus layer and attach to stomach epithelium.

Question 3

What is the clinical outcome of h.pylori colonisation?

Answer 3

• 80% asymptomatic or chronic gastritis
• 15-20% chronic atrophic gastritis with intestinal metaplasia, or ulceration
• 1% gastric cancer

Question 4

What are 3 locations h.pylori may affect and its outcomes?

Answer 4

antral predominant gastritis is in antrum - leads to more acid thus causing duodenal ulcer disease

corpus predominant gastritis leads to less acid production reducing gastrin secretion, leading to atrophy of cells and towards cancer

may lead to normal acid with no disease

Question 5

What are some non-invasive tests for h.pylori? (3)

Answer 5

• Serology of IgG against h.pylori
• c13 and c14 urea breath test
• stool antigen test

Question 6

What are some invasive tests for h.pylori?

Answer 6

histology of biopsy, culture of biopsy, rapid slide urease test (look for urease in gastric mucosa)

Question 7

What is the most common cause of peptic ulcers?

Answer 7

h.pylori

Question 8

What are some chemical causes of peptic ulcers?

Answer 8

NSAID’s and smoking

Question 9

What are symptoms of peptic ulcer?

Answer 9

epigastric pain common.
may have back pain, nausea, vomiting,

Question 10

How do you treat peptic ulcers of different causes?

Answer 10

• use antibiotics (clarithromycin and amoxycillin) and PPI/H2RA (omeprazole and ranitidine) if bacterial cause.
• stop NSAID’s if chemical cause.

Question 11

What are complications of peptic ulcers?

Answer 11

• acute bleeding (melena and haematemesis)
• chronic bleeding (iron deficiency anaemia),
• perforation
• fibrotic stricture
• gastric outlet obstruction

Question 12

What is gastric outlet obstruction? What are signs/symptoms?

Answer 12

• blocked outflow.
• vomiting,
• early satiety,
• weight loss,
• abdominal distension,
• dehydration,
• loss of H+ and Cl- in vomit,
• low electrolytes

Question 13

How do you diagnose and treat gastric outlet obstruction?

Answer 13

find cause - stricture, ulcer or cancer.

treat with endoscopic baloon therapy or surgery

Question 14

What is the prognosis of gastric cancer?

Answer 14

poor as diagnosis usually late.<20% 5ysr.

Question 15

Symptoms of gastric cancer?

Answer 15

• dyspepsia
• early satiety
• nausea and vomiting
• weight loss
• GI bleeding
• iron deficiency anaemia
• gastric outlet obstruction

Question 16

Causes of gastric cancer?

Answer 16

Mainly H.pylori. also smoking, diet, alcohol, genetics

Question 17

management of gastric cancer?

Answer 17

first diagnose and stage. consider chemo and surgery.