By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Extra info for A Colour Handbook of Gastroenterology
Secondary forms are seen in diabetic or alcoholic neuropathy, pseudo-obstruction, and Chagas’ disease (parasitic infection due to Trypanosoma cruzi). Differential diagnosis Carcinoma of the gastric cardia may both mimic and complicate achalasia. Endoscopy and biopsy are therefore mandatory. Endoscopy is a frequent investigation in patients with dysphagia; although achalasia cannot be diagnosed in this way, it may be suspected when undigested food debris is seen in the oesophagus. DIFFUSE OESOPHAGEAL SPASM Epidemiology and aetiology This is rare, but occurs in patients aged over 50 years, and in both sexes.
Pylori, it was appreciated that gastric cancers often arose in areas of intestinal metaplasia and gastric atrophy. It has been suggested that H. pylori infection might facilitate the progression of changes from gastritis to gastric atrophy to intestinal metaplasia to gastric cancer. This Helicobacter pylori 59 hypothesis is based on the association between H. pylori infection rates shown by seroepidemiology and gastric cancer rates in different populations, and evidence of past H. pylori infection in patients with gastric cancer.
G. gastric fundal varices (42) or portal hypertensive gastropathy. The latter has a range of endoscopic appearances, from a mosaic ‘snakeskin’ pattern, to a ‘watermelon’ stomach. Bleeding from portal hypertensive gastropathy is usually chronic and self-limiting, but patients can become anaemic. The investigation of portal hypertension includes assessment of portal vein patency by Doppler ultrasound, or by CT or magnetic resonance (MR) angiography, and appropriate investigation of the liver. Portal pressures can be assessed indirectly by the difference between the wedged and free hepatic venous pressures, but this approach is not routine and is usually only carried out in specialized centres.
A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson