Transcript Gastric Adenocarcinoma & H. Pylori

Gastric Adenocarcinoma
&
H. Pylori
A review
britni Hebert
8.11.09
Introduction
Gastric Adenocarcinoma
types and oncogenesis
H. pylori
relationship
practice recommendations
gastric adenocarcinoma
two distinct types:
Intestinal Type
Diffuse Type
Intestinal type
progresses through defined precancerous stages
nonatrophic gastritis
atrophic gastritis
metaplasia
dysplasia
invasive adenocarcinoma
intestinal type
pathology
differentiated
glands/tubules
Oncogenes:
+: K-ras, C-met
-: TP53, tp73 , APC,
TFF, DCC, FHIT
advancing edge
DIffuse Type
more aggressive, poorer prognosis
no known precancerous stage
diffuse type
pathology
invasive
signet ring
linitis plastica
e-cadherin loss
genetic factors
Helicobacter Pylori
spiral shaped gram
negative bacteria
most common chronic
bacterial infection
worldwide ~ 50% infected
USA ~ 50% greater than
60 yo
Overlap
strong correlation b/t seroposivity and cancer
contributes to both intestinal and diffuse types, as well as
MAltoma
pathogenesis
Incompletely understood
inducible Nitric Oxide synthase (iNOS)
oncogene correlation
Caga and vaca s1 and m1 strains
Response to treatment
Practice guidelines
gastric cancer
screening of high risk populations
EGD for suspicious symptoms
biopsy Ulcers and uninvolved mucosa
EGD for test of cure at 8-12 weeks
high risk populations?
Japan
Venezuela
Chile
symptoms?
refractory dyspepsia/PUD
weight loss
ida
Board classics
virchow’s node
sister mary joseph node
krukenberg tumor
Blumer’s shelf
leather flask on barium swallow
practice guidelines
h pylori
test and treat :
<55 w dyspepsia
pud
h/o pud
absence of red flags:
bleeding, anemia, early satiety, weight loss, +FH, odyn/dysphagia
practice guidelines
h pylori treatment
triple therapy x 10-14 days
PPI
Amoxicillin
clarithromycin
test of cure at 4 weeks
references
American College of Gastroenterology Issues Guidelines for Treatment of Helicobacter pylori Infection CME/CE; News Author: Laurie
Barclay, MD; CME Author: Désirée Lie, MD, MSEd
Uptodate
pathogenesis of gastric cancer
clinical features, diagnosis and features of gastric cancer
risk factors for gastric cancer
association between helicobacter infection and gastrointestinal malignancy
indications and diagnostic tests for helicobacter pylori infection
treatment regimens for helicobacter pylori