Doctor Medical

BPH

Q) A 72-year-old man presented with a 3-week history of dysphagia and was found to have a large oesophageal adenocarcinoma at 37 cm.
Which of the following is the most significant predisposing factor in the pathogenesis of oesophageal adenocarcinoma?

A. Alcohol excess
B. Helicobacter pylori infection
C. Obesity
D. Smoking
E. Social deprivation

H. PYLORI-INDUCED PUD

Helicobacter pylori: gram-negative, spiral-shaped (comma shaped), catalase-positive, urease-positive, oxidase-positive rod with motile flagella

**Mode of Transmission**
* oral-oral
* fecal-oral
* Gastro-oral

**Risk factors: smoking, nonsteroidal anti-inflammatory drug (NSAID) use

**Associated disease: Gastritis, Gastric and duodenal ulcer, CA stomach, MALT

**Pathogenesis**
1. the bacteria produces urease, which produces ammonia and results in an alkaline environment —> the ammonia allows the bacteria to survive in the acidic gastric environment
2. the bacteria colonize the antrum of the stomach
3. inflammatory cytokines inhibit parietal cell acid secretion causing gastric ulcers (mucosal inflammation leads to atrophy)
4. at the pyloric antrum, somatostatin production is reduced and gastric production is increased (hypochloridia causes ↑ gastrin), ↑ gastrin from G cells in the stomach and duodenum leading to metaplasia of the duodenal cells and causing duodenal ulcers

**Clinical features**
* dyspepsia
* belching
* postprandial bloating
* heartburn
* epigastric pain
* may cause nighttime awakening
* relief with food or antacids
* others features include: fullness, vomiting, weight lose, poor appetite, bloating, shortness of breath, hematemesis, melena and depression symptoms

**Diagnostic**
Serology test
Stool/Fecal antigen test
Blood titers
Urease breath test
UGD

Standard Eradication Rx as CAP
Adult
C - Clarithromycin 500mg x BD
A - Amoxicillin 1g x BD
P - PPIs (Omeprazole) 40mg x OD or 20mg x BD

Children
Syp Clarithromycin 125mg/250mg x 1-2 TSP x BD
Syp Amoxicillin 125mg/250mg x 1-2 TSP x BD
Syp Famotidine 10mg x 1-2 TSP x BD

Compiled by Dr.Asif ali