CC Sept 2017 Helicobacter pylori

echoecho's version from 2017-12-03 05:12


Question Answer
H. pylori is a gram_____ bacteria that colonizes the gastric mucosa in < ____% of adults in the US?negative; 30
In fection has been associated with _____ ulcers (95% of cases) and _____ ulcers (70% of cases), adenocarcinoma of the distal stomach and gastric mucosa-associated lymphoid tissue (MALT) lymphoma?1) duodenal 2) gastric
What is the therapy that has been shown to aid in the healing of ulcers and decreasing the risk of relapse?combination of antibiotics and a PPI
*** A "test and treat" approach is indicated in patients < age ____ with no warning signs of gastric cancer?55
List the 6 reasons why H. pylori testing is recommended by the American College of Gastroenterology?1) active peptic ulcer disease 2) hx of PUD 3) dyspepsia 4) gastric MALT lymphoma 5) early gastric cancer 6) before initiating chronic NSAID or low-dose ASA (eradicating H. ppylori among these patients reduces the risk of ulceration and bleeding)
List the noninvasive testing for H. pylori?1) urea breath testing 2) serology 3) stool monoclonal antigen test
Explain the urea breath testing?1) patient must fast for 4-6 hours prior to the test and avoid PPI for 2 weeks 2) patient ingests urea tagged with carbon-13 or carbon-14, followed by collection of the patient's breath several minutes later
Can urea breath test be used for initial dx or test of cure?yes, both
Stool monoclonal antigen tests are less expensive than urea breath testing and require less equipment, can they be used to test for active infection or as a test of cure?yes, both
Unlike breath testing, does PPI affect stool testing?no
Serologic tests measuring igG levels are easy to obtain and can be accurate, however, can it be used to test for cure or recurrence? why?1) no 2) because antibody levels persist even after successful therapy
EGD is recommended in patients suspected of PUD and who display what red flag symptoms?1) > 55 years 2) unexplained weight loss 3) hematemesis 4) melena 5) family hx of gastric cancer
What test, when performed on biopsy specimens, is inexpensive and has a high degree of accuracy?rapid urease test
Can the rapid urease test be used if a patient has taken a PPI within 1-2 weeks, bismuth within 4 weeks or an antibiotic within 4 weeks?no
In the above case, what should be performed?histology or culture
*** Is test of cure generally recommended after treatment?no
List the 4 specific conditions when retesting (which should be done 4 weeks after the completion of eradication therapy) include?1) H. pylori-associated ulcer 2) persistent symptoms of dyspepsia 3) H. pylori-associated MALT lymphoma 4) after resection for gastric cancer
List the predictive values for positive and negative for tests of H. pylori infection?1) Urea breath test = (pos predictive value 99%; negative predictive value 1.5%) 2) stool monoclonal antigen test (89% pos predictive value; 3.9% neg predictive value 3) rapid urease test (99% pos pred value; 2.4% neg predictive value) 4) histology (pos predictive value 97%; neg predictive value 3%)
*** SUMMARY = PUD is commonly caused by infections of what?H. pylori
*** SUMMARY = A "test and treat" approach is indicated in patients < ____ y.o., with no warning signs of gastric cancer?55
*** SUMMARY = List tests that are accurate for dx of H. pylori infection?1) stool antigen testing 2) sereology 3) exhaled urea breath tests