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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.

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Gastric Adenocarcinoma & H. Pylori

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  1. Gastric Adenocarcinoma& H. Pylori • A review • britni Hebert • 8.11.09

  2. Introduction • Gastric Adenocarcinoma • types and oncogenesis • H. pylori • relationship • practice recommendations

  3. gastric adenocarcinoma • two distinct types: • Intestinal Type • Diffuse Type

  4. Intestinal type • progresses through defined precancerous stages • nonatrophic gastritis • atrophic gastritis • metaplasia • dysplasia • invasive adenocarcinoma

  5. intestinal type • pathology • differentiated • glands/tubules • Oncogenes: • +: K-ras, C-met • -: TP53, tp73 , APC, TFF, DCC, FHIT • advancing edge

  6. DIffuse Type • more aggressive, poorer prognosis • no known precancerous stage

  7. diffuse type • pathology • invasive • signet ring • linitis plastica • e-cadherin loss • genetic factors

  8. Helicobacter Pylori • spiral shaped gram negative bacteria • most common chronic bacterial infection • worldwide ~ 50% infected • USA ~ 50% greater than 60 yo

  9. Overlap • strong correlation b/t seroposivity and cancer • contributes to both intestinal and diffuse types, as well as MAltoma

  10. pathogenesis • Incompletely understood • inducible Nitric Oxide synthase (iNOS) • oncogene correlation • Caga and vaca s1 and m1 strains • Response to treatment

  11. 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

  12. high risk populations? • Japan • Venezuela • Chile

  13. 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

  14. 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

  15. practice guidelinesh pylori treatment • triple therapy x 10-14 days • PPI • Amoxicillin • clarithromycin • test of cure at 4 weeks

  16. 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

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