Gastric Adenocarcinoma&

H. PyloriA 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 guidelinesgastric 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 guidelinesh 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