A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey

By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson

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Differential diagnosis Gastrointestinal bleeding in patients who have oesophageal varices is not always variceal; peptic ulcers are more common in the cirrhotic population and these are said to be more difficult to heal. The gastric mucosa is also more sensitive to injury than normal. Prognosis Although only 30% of patients bleed from their oesophageal varices, the overall mortality rate for first bleed is around 50%. There are no reliable means of predicting which patients will bleed, but endoscopic signs are of some value.

Endoscopic dilatation should be considered for smallcalibre oesophagus, but is associated with a higher rate of oesophageal perforation than peptic disease. Bolus obstruction can be managed endoscopically. There is no routine medical therapy, but topical steroids (fluticasone) and the leukotriene receptor antagonist montelukast have been used. 37 Eosinophilic oesophagitis – note vertical furrows. 38 38 Barium swallow showing smallcalibre oesophagus in a patient with long-standing eosinophilic oesophagitis.

The oesophagogastric junction may be mobile (hiatus hernia). The anatomical borders are the lesser and greater curves, but the body of the stomach is mobile and can be distorted. The stomach may be divided into the cardia, fundus, body, and antrum. The acid-producing mucosa is located predominantly in the body. Histology As in all other parts of the intestine, layers of gut wall consist of: • Mucosa. • Muscularis mucosae (thin layer of organized muscle). • Submucosa (connective tissue). • Circular muscle fibres.

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