Helicobacter pylori

Helicobacter pylori

Q. 1

A 54-year-old man presents with gnawing epigastric pain that occurs at regular intervals daily. The pain is partially relieved by antacids and food. Upper endoscopic studies reveal a duodenal lesion. Furthermore, a biopsy confirms the benign nature of the lesion and demonstrates numerous Helicobacter pylori bacilli. Which of the following would be the most effective pharmacotherapy?

 A

Aluminum or magnesium-containing antacid

 B

H2-receptor blocking agent

 C

Prostaglandin analog

 D

Proton pump inhibitor plus antibiotic

Q. 1

A 54-year-old man presents with gnawing epigastric pain that occurs at regular intervals daily. The pain is partially relieved by antacids and food. Upper endoscopic studies reveal a duodenal lesion. Furthermore, a biopsy confirms the benign nature of the lesion and demonstrates numerous Helicobacter pylori bacilli. Which of the following would be the most effective pharmacotherapy?

 A

Aluminum or magnesium-containing antacid

 B

H2-receptor blocking agent

 C

Prostaglandin analog

 D

Proton pump inhibitor plus antibiotic

Ans. D

Explanation:

The gross specimen shows a typical peptic ulcer of the first portion of the duodenum. The great majority of these ulcers are associated with chronic H. pylori infection, which plays a pathogenetic role.

Eradication of H. pylori is necessary not only for rapid healing of active ulcers, but also to prevent future recurrence. Therefore, drugs that eradicate this gram-negative bacillus are used for treatment of active peptic ulcer disease. Proton pump inhibitors (omeprazole or lansoprazole) also have activity against H. pylori, but alone are not sufficient to achieve eradication.

This treatment must be combined with at least one of the antibiotics (usually two) that are effective against H. pylori. Clarithromycin is usually used in combination with either metronidazole or amoxicillin.

Aluminum or magnesium-containing antacids  are probably the most common over-the-counter medications used by patients with peptic ulcers and gastroesophageal reflux for prompt relief of epigastric pain and discomfort. These drugs are no longer recommended as first-line agents for treatment of peptic disease nor do they have anti-H. pylori activity.
 
H2-receptor blocking agents, including cimetidine, famotidine, and ranitidine are not effective in eradicating H. pylori infection. However, they provide rapid symptomatic relief and promote ulcer healing.
 
Prostaglandin analogs (e.g. misoprostol)  are used exclusively as prophylactic agents to prevent NSAIDs-induced ulcers, not as a standard treatment of peptic ulcers. These drugs act by stimulating mucus and bicarbonate production.

Q. 2

All are tests used to assess the treatment response in helicobacter pylori infection, EXCEPT:

 A

Urea breath test, the

 B

Stool antigen test

 C

Biopsy-based tests

 D

Serology

Q. 2

All are tests used to assess the treatment response in helicobacter pylori infection, EXCEPT:

 A

Urea breath test, the

 B

Stool antigen test

 C

Biopsy-based tests

 D

Serology

Ans. D

Explanation:

The urea breath test, the stool antigen test, and biopsy-based tests can all be used to assess the success of treatment

 
Ref:Harrisons Principles of Internal Medicine, 18th Edition, Page 1221

 


Q. 3

True about helicobacter pylori are all except ‑

 A

Urea breath test is diagnostic

 B

Gram negative, flagellate bacilli

 C

Risk factor for development of adenocarcinoma of stomach

 D

It provides life long immunity

Q. 3

True about helicobacter pylori are all except ‑

 A

Urea breath test is diagnostic

 B

Gram negative, flagellate bacilli

 C

Risk factor for development of adenocarcinoma of stomach

 D

It provides life long immunity

Ans. D

Explanation:

Ans. is ‘d’ i.e., It provides life long immunity 

. There is no effective immunity against H. pylori infection. The immune response to H. pylon includes both the production of antibody (local and systemic) and a cell-mediated response but is ineffective in clearing the bacterium.

H. Pylori has a protective role against gastroesophageal reflux disease (GERD) and adenocarcinoma of the esophagus and gastric cardia.

.  Antral predominant gastritis is most closely linked with duodenal ulceration, whereas pangastritis is linked with gastric ulceration and adenocarcinoma.

Antral gastritis       —> duodenal ulcer

Pangastritis           —> Gastric ulcer

Gastric adenocarcinoma

.  IL – 1 fi is the major proinflammatory cytokine in peptic ulcer disease.

About other options

.   Urea breath test is the most consistently accurate test.

.   H. pylori is a gram negative, flagellate bacillus which is motile by lophotrichous flagella.

Quiz In Between


Q. 4

All of the following are true about Helicobacter pylori except –

 A

About 50% of world population affected

 B

85% of population is affected in some developing contries

 C

All childrens in developing countries have immunity by five years of age

 D

Infection is common in low socioeconomic status

Q. 4

All of the following are true about Helicobacter pylori except –

 A

About 50% of world population affected

 B

85% of population is affected in some developing contries

 C

All childrens in developing countries have immunity by five years of age

 D

Infection is common in low socioeconomic status

Ans. C

Explanation:

Ans. is ‘c’ i.e., All children in developing counteries have immunity by five years of age

.   “Today, helicobacters colonise the stomach of half the human population of the world”.

Developed countries                                 30%

Developing countries                               > 80%

.   H. pylori is usually acquired in childhood but immunity does not develop.

.  Low socioeconomic status is a risk factor for H. pylori positivity.


Q. 5

True about Helicobacter pylori is –

 A

Culture and gram staining of biopsy is the gold standard investigation

 B

Controlled urea breath is negative with massive infection.

 C

Anti urease antibody are produced only by invasive strains

 D

Urease activity provides protective environment to the bacilli.

Q. 5

True about Helicobacter pylori is –

 A

Culture and gram staining of biopsy is the gold standard investigation

 B

Controlled urea breath is negative with massive infection.

 C

Anti urease antibody are produced only by invasive strains

 D

Urease activity provides protective environment to the bacilli.

Ans. D

Explanation:

Ans. is ‘d’ i.e., Urease activity provides protective environment to the bacilli

.  H. pylori produces an exceptionally powerful urease, almost 100 times more active than that of proteus vulgaris, which is vital to its survival in the stomach.

.  Urease acts on urea to generate ammonia, which neutralizes acid around bacteria.

Remember

.  H pylori is easily cultured from vomitus and gastroesophageal refluxate and is less easily cultured from stool.

About other options

Option A

–       Microbial culture is most specific but may be insensitive because of difficulty with H. pylori isolation. (How can an insensitive procedure be gold standard investigation).

Option B

–   Urea breath test is the most consistently accurate test. It will be positive with massive infection.

Option C

– Antiurease antibodies are not produced. The only antibody produced by the infection of H. pylori is anti `CagA’

antibody.


Q. 6

Eradication of helicobacter pylori has been proved to be beneficial in which of the following disorders of the stomach –

 A

Low grade malt lymphoma

 B

Erosive gastritis

 C

Carcinoma stomach

 D

Gastroesophageal disease

Q. 6

Eradication of helicobacter pylori has been proved to be beneficial in which of the following disorders of the stomach –

 A

Low grade malt lymphoma

 B

Erosive gastritis

 C

Carcinoma stomach

 D

Gastroesophageal disease

Ans. A

Explanation:

Ans. is ‘a’ i.e., Low grade malt lymphoma 

Quiz In Between


Q. 7

Helicobacter pylori is not associated with :

 A

Gastrointestinal lymphoma

 B

Gastric cancer

 C

Gastric leiomyoma

 D

Peptic ulcer

Q. 7

Helicobacter pylori is not associated with :

 A

Gastrointestinal lymphoma

 B

Gastric cancer

 C

Gastric leiomyoma

 D

Peptic ulcer

Ans. C

Explanation:

Answer is C (Gastric leiomyoma)

Gastric leiomyomas are not associated with H. pylori infections


 

Q. 8

A patient with H. Pylori infection is treated with drugs. The best method to detect presence of residual H.Pylori infection in this person is :

 A

Rapid unrease test

 B

Urea breath test

 C

Endoscopy and biopsy

 D

Serum anti H.Pylori titre

Q. 8

A patient with H. Pylori infection is treated with drugs. The best method to detect presence of residual H.Pylori infection in this person is :

 A

Rapid unrease test

 B

Urea breath test

 C

Endoscopy and biopsy

 D

Serum anti H.Pylori titre

Ans. B

Explanation:

Answer is B (Urea breath test) :

The test of choice for documenting eradication is urea breath test.

Assessing success of Treatment / Eradicatiion of H. Pyrlori  :

  • Assessment should be done atleast 4 weeks after completin of anti H. Pylori therapy.
  • In the assessment of treatment success non invasive tests are normally preferred.

Assessment of success of treatment

Non invasive tests are preferred                      

Inasive tests are not preferred

 

 

Urea breath test  :

Test of choice for documenting eradication.

Stool antigen test :If UBT is not available a stool antigen test should be considered for documenting eradication

Biopsy based tests

(Biopsy Urease test, Histology / Culture) are invasive tests based on Endoscopic biopsy.

Serological testing :Is not useful for purpose of documentation of eradication as antibody titres fall slowly and often do not become undetectable

These may be used to document eradication but are not preferred for this purpose.

 


Q. 9

All are true regarding Helicobacter pylori except

 A

Less prevalent in developing countries

 B

Toxicogenic strains usually causes ulcers

 C

Urea breath test is positive

 D

Gram negative organism

Q. 9

All are true regarding Helicobacter pylori except

 A

Less prevalent in developing countries

 B

Toxicogenic strains usually causes ulcers

 C

Urea breath test is positive

 D

Gram negative organism

Ans. A

Explanation:

Answer is A (Less prevalent in developing countries)

H. pylori infection are inane prevalent in developing countries.

  • The prevalence of H. pylori is approx. 30% in U.S. and other developed countries as against > 80% in most developing countries – Harrison
  • H. Pylori is a gram negative, spiral, flagellated bacillus – Harrison
  • Strains producing toxins (strains possessing cag pathogenicity DNA island) are more likely to give rise to severe gastritis, peptic ulceration and gastric cancer than strains without it.
  • DNA island or cag pathogenicity island is a large region of DNA which has genes that control production of toxins.
  • Urea breath test is a simple, inexpensive and consistently accurate test for H.pylori detection.

Quiz In Between


Q. 10

Which of the following statements about peptic ulcer disease is true :

 A

Helicobacter pylori eradication increases the likelihood of occurrence of complications

 B

The incidence of complications has remained unchanged

 C

The incidence of Helicobacter pylori reinfection in India is very low.

 D

Helicobacter pylori eradication does not alter the recurrence ratio.

Q. 10

Which of the following statements about peptic ulcer disease is true :

 A

Helicobacter pylori eradication increases the likelihood of occurrence of complications

 B

The incidence of complications has remained unchanged

 C

The incidence of Helicobacter pylori reinfection in India is very low.

 D

Helicobacter pylori eradication does not alter the recurrence ratio.

Ans. B

Explanation:

Answer is B (The incidence of complications has remained unchanged)

  • H. pylori eradication decreases the likelihood of occurrence of complications.
  • The incidence of H.pylori is > 80% in most developing countries, and so the chances of reinfection are also high.
  • H. pylori eradication reduced the chances of recurrence
  • ‘After successful eradication of H.pylori with antibiotics, ulcer recurrence rates are reduced dramatically to 5-20% at 1 year – CMDT 2003/571
  • Option ‘b’ ‘The incidence of complications has remained unchanged’ is thus the answer of exclusion !!

Q. 11

Duodenal ulcer is most commonly caused by:

March 2013 (c, d, e)

 A

GERD

 B

NSAID therapy

 C

Stress ulcer

 D

H. pylori

Q. 11

Duodenal ulcer is most commonly caused by:

March 2013 (c, d, e)

 A

GERD

 B

NSAID therapy

 C

Stress ulcer

 D

H. pylori

Ans. D

Explanation:

Ans. D i.e. H. pylori

Peptic ulcer/Peptic ulcer disease

  • It is defined as mucosal erosions equal to or greater than 0.5 cm.
  • As many as 70-90% of such ulcers are associated with Helicobacter pylori, a helical-shaped bacterium that lives in the acidic environment of the stomach.
  • Four times as many peptic ulcers arise in the duodenum—the first part of the small intestine, just after the stomach—as in the stomach itself.
  • About 4% of gastric ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer.
  • Duodenal ulcers are generally benign.

Q. 12

Which of the following drug is not a component of triple drug therapy for helicobacter pylori:

March 2008

 A

Lansoprazole

 B

Clarithromycin

 C

Metronidazole

 D

Cimetidine

Q. 12

Which of the following drug is not a component of triple drug therapy for helicobacter pylori:

March 2008

 A

Lansoprazole

 B

Clarithromycin

 C

Metronidazole

 D

Cimetidine

Ans. D

Explanation:

Ans. D: Cimetidine

Triple therapy is considered to be the standard treatment for children.

A proton pump inhibitor combined with two antibiotics has been shown to be very effective in clearing H pylori from the stomach.

The current recommendation is treatment with amoxicillin, clarithromycin, and a proton pump inhibitor (lansoprazole) for 2 weeks.

Quiz In Between


Q. 13

Anti-Helicobacter pylori drugs are all of the following except:     

March 2010

 A

Clarithromycin

 B

Amoxicillin

 C

Metronidazole

 D

Tetracycline

Q. 13

Anti-Helicobacter pylori drugs are all of the following except:     

March 2010

 A

Clarithromycin

 B

Amoxicillin

 C

Metronidazole

 D

Tetracycline

Ans. D

Explanation:

Ans. D: Tetracycline


Q. 14

Commonest cause of peptic ulcer disease:

September 2006, March 2013(a)

 A

NSAID ingestion

 B

Smoking

 C

H. pylori

 D

Genetic factors

Q. 14

Commonest cause of peptic ulcer disease:

September 2006, March 2013(a)

 A

NSAID ingestion

 B

Smoking

 C

H. pylori

 D

Genetic factors

Ans. C

Explanation:

Ans. C. H.pylori

It is now widely accepted that infection with H. pylori is the most important factor in the development of peptic ulceration followed by NSAID ingestion.

Helicobacter pylori is a Gram-negative, microaerophilic bacterium that can inhabit various areas of the stomach and duodenum.

It causes a chronic low-level inflammation of the stomach lining and is strongly linked to the development of duodenal and gastric ulcers and stomach cancer.

Over 80% of individuals infected with the bacterium are asymptomatic.

The most reliable method for detecting H. pylori infection is a biopsy check during endoscopy with a rapid urease test, histological examination, and microbial culture.

The standard first-line therapy is a one week “triple therapy”


Q. 15

Which of the following is microaerophilic‑

 A

E coli

 B

Bacteroides

 C

Clostridium

 D

Helicobacter pylori

Q. 15

Which of the following is microaerophilic‑

 A

E coli

 B

Bacteroides

 C

Clostridium

 D

Helicobacter pylori

Ans. D

Explanation:

Ans. is `d’ i.e., Helicobacter pylori

Microaerophiles are those groups of bacteria that can grow under reduced oxygen (5% to 10%) and increased carbon dioxide (8% to 10%).

Higher oxygen tensions may be inhibitory to them. This environment can be obtained in specially designed jars or bags.

Examples of Microaerophiles are: Campylobacter jejuniHelicobacter pylori etc.


Q. 16

The characteristic flagella as marked by a red arrow in the picture below is seen in ? 

 A

V cholera.

 B

H pylori.

 C

Ps aeroginosa.

 D

Spirochetes.

Q. 16

The characteristic flagella as marked by a red arrow in the picture below is seen in ? 

 A

V cholera.

 B

H pylori.

 C

Ps aeroginosa.

 D

Spirochetes.

Ans. B

Explanation:

H. pylori has five to seven sheathed polar flagella as shown in the photograph above.

Vibrio cholerae and Pseudomonas aeruginosa have single polar flagellum. Occasional strains of pseudomonas may contain 2 or 3 flagella.

Spirochetes (Treponema) is motile by endoflagella.

Quiz In Between



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