H.Pylori Infection

Overview

Peptic ulcer disease is the disruption of the mucosal integrity of the stomach caused by local inflammation/decrease mucosal resistance/hyperacidity which leads to ulcers. Gastric ulcers are due to the decreased gastric mucosa and duodenal ulcers are due to hyperacidity.

Signs and Symptoms

Nausea, Vomiting, Abdominal bloating, Central abdominal pain, Pain that radiates to the back (duodenal), Pain that relieves by food and is cyclical (duodenal), Pain that occurs early hours in the morning (duodenal), Pain precipitated by food (gastric), Painless cyclical (gastric), Weight loss

Common Causes

Helicobacter pylori infection (inflammation probably initiated by H. pylori infection and sustained by the combined effect of gastric acid and pepsin secretion upon the mucosa of upper GIT), Drugs such as NSAIDs, clopidogrel and glucocorticoids, Smoking, Alcohol misuse, Excessive caffeine intake, Poor diet, Spicy food, Psychological stress, Anxiety, Chemotherapy, Hormonal, Oral contraceptive pills

Risk Factors

Increasing age, Female, Chronic use of NSAIDS, Pregnancy

Investigation Techniques

Oesophagogastroduodenoscopy (OGDS), CLO test (biopsy urease test), Barium meal, Urease breath test, CO2 breath test, Stool antigen testing, Serology, Fasting serum gastrin levels, CT Angio, Erect plain chest X-ray, Serum amylase levels (rule out pancreatitis)

Treatment and Prevention

Control of predisposing factors using triple therapy. Triple therapy consist of 1-2 weeks of 2 antibiotics (amoxicillin 1g BD and clarithromycin 500mg BD) with proton pump inhibitor, Diminish irritant effects of acid-pepsin using antacid or alginate preparation, Mucosal protective agents using sucralfate, Reduction of acid secretion using proton pump inhibitor or H2 blocking drugs