By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Extra info for A Colour Handbook of Gastroenterology
RADIOLOGY The barium meal examination is excellent for detecting anatomical variations, such as large hiatus hernias or chronic gastric volvulus, which can be bewildering to the endoscopist. Doublecontrast studies can delineate mucosal lesions such as polyps, erosions, and ulcers. Although benign and malignant ulcers can be separated using radiological criteria, this is not sufficiently sensitive, and all gastric ulcers must be assessed histologically by multiple repeated biopsies at endoscopy.
Other forms Hypertensive lower oesophageal sphincter syndrome Patients have elevated resting lower oesophageal sphincter tone, occurring alone or in association with nutcracker oesophagus (31) – which describes abnormally high distal oesophageal contractions, presenting with angina-like chest pain. 29 Maonmetric trace of diffuse oesophageal spasm (DOS). 30 Irritable oesophagus Patients have symptoms of noncardiac chest pain, caused at different times by either acid reflux or dysmotility. Irritable oesophagus can be identified by 24-hr intraoesophageal pH and pressure measurements.
Endoscopic surveillance Regular endoscopic surveillance of patients with Barrett’s oesophagus, with the aim of identifying dysplastic mucosa or early diagnosis of cancer, remains controversial. It is only worthwhile if the patient is prepared to accept oesophageal resection if high-grade dysplasia is detected. The economic benefit of surveillance is unclear. Current UK recommendations suggest 2-yearly quadratic biopsies of the Barrett’s mucosa every 2 52A 52 Two images of adenocarcinoma of the oesophagus arising in Barrett’s oesophagus.