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 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

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 guidelines h 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