1983-discovered by Warren and Marshall in AustraliaNearly 20 species of Helicobacter are now recognised H. pylori infection occurs worldwide Prevalence varies greatly among countries and population groups 20 – 50% prevalence in middle age adults in industrialised countries >80% prevalence in middle age adults in developing countries

1. ‫الرحيم‬ ‫الرمحو‬ ‫اهلل‬ ‫بسم‬

2. ROLE OF ENDOSCOPY IN
MANAGEMENT OF H-
PYLORI DISORDERS
DR: ESSAM MOHAMED HOWERA
CONSULTANT OF SURGERY,
ESGE, MS, MBBCh

3. 1983-discovered by Warren and
Marshall in Australia
Nearly 20 species of Helicobacter are
now recognised

4. • H. pylori infection occurs worldwide
• Prevalence varies greatly among
countries and population groups
• 20 – 50% prevalence in middle age
adults in industrialised countries
• >80% prevalence in middle age adults
in developing countries

5. Transmission :
Oral ingestion of bacterium
within families (esp children)
person-person contact
faecal-oral transmission

6. The outcome of infection by H. pylori
reflects an interaction between:
Strain virulence
Host genotype
Environmental
factors

7. Course of infection
After several days incubation
period, patients suffer mild attack
of acute gastritis
-abdominal pain
-nausea
-flatulence
-bad breath

8. ‫للجراحة‬ ‫حويرة‬ ‫عصام‬ ‫الدكتور‬ ‫مركس‬
‫والقولوى‬ ‫والشرج‬ ‫اهلضمى‬ ‫اجلهاز‬ ‫ومهاظري‬

9. ‫ومهاظري‬ ‫للجراحة‬ ‫حويرة‬ ‫عصام‬ ‫الدكتور‬ ‫مركس‬
‫والقولوى‬ ‫والشرج‬ ‫اهلضمى‬ ‫اجلهاز‬

10. The development of flexible fibro optic
and video endoscopes in 1970 and
1980s enabled GIT doctors to view the
gut.
Endoscopy is generally superior to
radiology as investigative technique, as
it provides a direct mucosal view,
enables biopsies to be taken for
histological and biochemical analysis
and permits therapeutic maneuvers.

11. CLASSIFICATION OF
ENDOSCOPIES

12. 4)capsule endoscopy : to view all GIT.
3)Endoscopic retrograde cholangiopancreaticography
[ERCP]
b)Colonoscopy ;from anus to the terminal ileum
a)Flexible sigmoidscopy; from anus to splenic flexure.
2)lower GI endoscopy which include:
1)Upper GI endoscopy started from mouth to the third
part of the duodenum.

15. 1-GASTRITIS
CHRONIC SUPERFICIAL GASTRITIS OR CHRONIC ATROPHIC
GASTRITIS
OF NON-EROSIVE TYPE
,MAY BE ASYMTOMATIC
DISCOVERED DURING
UGE
ACUTE GASTRITIS
CHRONIC GASTRITIS 90%

16. 2-ULCERS
DUODENAL GASTRICoccurs in 80 to 95% of
patients with peptic
ulcer disease.
H. pylori infection
impairs the protective
mechanisms of the G.I.
tract against low pH
and digestive enzymes
and leads to ulceration
of the mucosa.

19. 3-MALIGNANT
EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA
(MALT) LYMPHOMA
the bacterium has been categorized as a group I carcinogen by the
International Agency for Research and WHO
ABOUT 90% IS
ASSOCISATED WITH H-
PYLORI INFECTION

20. GASTRIC CANCER
LONG STANDING CHRONIC GASTRITIS LEAD TO
ATROPHY AND METAPLASIA OF GASTRIC MUCOSA AND
LASTLY GASTRIC CANCER MOSTLY ADENOCARCINOMA
,BUT IT LESS THAN 5 % FROM PT INFECTED WITH H-
PYLORI

21. in pt with chronic liver disease
4-LIVER DISEASE
hyperammonemia and the subsequent development of
hepatic encephalopathy (Miyagi et al., 1997).
impair cytochrome P450 (Giannini et al., 2003)
hepatocellular carcinoma
a potential role for H. pylori in HCC (Ponzetto et al., 2003).
gall bladder and intrahepatic biliary stones
a potential role for H. pylori in cholesterol stones (Abayli et al, 2005 )

22. 5- NON ULCER DYSPEPSIA & HYPOCHLOROHYDRIA

23. ROLE OF ENDOSCOPY IN
H-PYLORI MANAGEMENT

24. TREATMENTDIAGNOSIS
FOLLOWUP

25. DIAGNOSIS
According to guideline of American society
of git endoscopy (ASGE)
advise esophagogastroduodenoscopy (EGD) in patients older
than age 50 with new-onset dyspepsia and in patients of any
age with alarm features that suggest significant structural
disease or malignancy.
Alarm features include
a family history of upper GI malignancy, unintended weight
loss, overt GI bleeding, iron deficiency anemia, progressive
dysphagia or odynophagia, persistent vomiting, a palpable
mass, or lymphadenopathy.
UGIT ENDOSCOPY IS ADVISABLE FOR ANY PT WITH
PERSISTANT DYSPEPTIC SYMPTOMS

26. Endoscopic tests for H Pylori include
endoscopic biopsies for :
histologic examination,
culture and sensitivity,
rapid urease testing
real time polymerase chain reactions
(RT-PCR)

27. CULTURE AND SENSITIVITY
Isolation of H pylori by culture of a biopsy specimen is
definitive evidence of active infection and isolates can
subsequently be tested for susceptibility to various
antimicrobial agents

28. Similar to culture, the detection of H pylori in gastric biopsies by
histopathologic evaluation is considered diagnostic for active
infection,also to exclude malt lymphoma and gastric cancer
Histopathology

29. Rapid urease test, also known as the CLO test
(Campylobacter-like organism test)
A biopsy of mucosa is taken from multiple sites of the stomach, and
is placed into a medium containing urea and an indicator such as
phenol red. The urease produced by H. pylori hydrolyzes urea to
ammonia, which raises the pH of the medium, and changes the
color of the specimen from yellow (NEGATIVE) to red
(POSITIVE).

30. ATTENTION:
By Using magnifying technique,
we are able to identify HP-infected
mucosa during the endoscopic
procedure and are also
able to evaluate the efficiency of the
eradication therapy.
DIAGNOSIS

31. ENDOSCOPIC SIGNS OF H-PYLORI
ANTRAL
NODULARITY
PATERN OF
CORPAL RUGAE

32. IRAC(irregular arrangement of collecting venules)
NORMAL H-PYLORI

33. MORE THAN 95 % OF DUODENAL
ULCERS ARE DT H-PYLORI

34. TREATMENT
FORERADICATIONOFH-PYLORI:TOPICALTREATMENT
DRUGS ARE KEPT IN THE STOMACH FOR FEW HOURES BY
THE AID OF EGD USING TUBE INSERTED IN THE DUODENUM,
Then the 100 ml of 7% sodium bicarbonate solution including the drugs
ABM: amoxicillin 4.0 g, bismuth subnitrate 4.0 g and metronidazole 2.0g,
and the other regimen is
CM: clarithromycin 1.6g and metronidazole 2.0g
The cure rate of ABM was 77% , and that of CM was 81% . (Kimura , et al.1995)
Advantage of topical therapy:
-It requires much less time than oral medication
-well tolerated
- Few side effects by antibiotics absorbed from intestine
- Drugs do not reach the stomach by way of the blood stream

35. FOR TREATMENTCOMPLICATIONS OF H-PYLORI
• BLEEDING PEPTIC ULCER
1-INJECTION:
of sclerosant materials, saline,
vasoconstrictors, adhesive tissues
around the ulcers in 4 quadrants
2= MECHANICAL :
applying clips
By endoscopic clipping device
around the ulcers,
sloughed fter 7-10 days

36. 3- THERMAL :
contact thermal probe
to produce coagulation of the
bleeding vessel
non contact argon plasma coagulation(APC)

37. • EARLY GASTRIC CANCER (EGC)
EGC Differentiated adenocarcinoma
Intramucosal cancer
No lymph-vascular involvement
Tumor less than 3cm

38. ESD (ENDOSCOPIC
SUBMUCOSAL DISSECTION
EMR (ENDOSCOPIC
MUCOSAL RESECTION)

39. FOLLOWUP
ENDOSCOPY IS ESSENTIAL FOR FOLLOW UP IN
THE FOLLOWING CASES AFTER ERADICATION
H-PYLORI:
CHRONIC GASTRITIS
PEPTIC ULCER
MALT LYMPHOMA
GASTRIC CANCER

40. VIDEOS

41. ‫مبكرة‬‫مرحلة‬‫فى‬‫باملعدة‬‫ورم‬‫حويرة‬‫عصام‬‫د‬‫مركز‬

42. ‫حويرة‬‫عصام‬‫د‬‫مركز‬,,‫باملعدة‬‫التهابات‬

43. ‫حويرة‬‫عصام‬‫د‬‫مبركز‬,,‫باملنظار‬ ‫عشر‬‫اإلثنى‬‫قرحة‬‫عالج‬

44. ‫حويرة‬‫عصام‬‫د‬‫مركز‬,,‫باملنظار‬ ‫املعدة‬‫قرحة‬‫عالج‬

45. ‫حويرة‬‫عصام‬‫د‬‫مركز‬,,‫باحلـــقن‬‫العــالج‬

46. ‫عليها‬ ‫زائد‬ ‫فأنت‬ ‫فيها‬ ‫تسد‬ ‫مل‬ ‫إى‬ ‫الدنيا‬
(‫صادق‬ ‫مصطفى‬‫الرافعى‬)

47. THANKS