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

ISBN-10: 1840760680

ISBN-13: 9781840760682

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Extra info for A Colour Handbook of Gastroenterology

Example text

Reflux of gastric contents is a normal occurrence postprandially, and is only considered abnormal if it gives rise to symptoms – referred to as gastrooesophageal reflux disease (GORD). Oesophagitis refers to the subsequent oesophageal mucosal injury that occurs in a minority of patients (32). Epidemiology and aetiology Up to one-third of the population have symptoms of reflux, but oesophagitis occurs in only a minority of these. Apart from during pregnancy, when it is a common complaint, symptoms are more severe in those aged over 50 years – possibly reflecting an age-related decline in oesophageal motor function.

The pouch appears as a ‘teapot spout’. Cine-radiology is helpful in early cases. Endoscopy should be performed cautiously, as the cricopharyngeal area is often a ‘blind’ region during intubation and this can be dangerous. Prognosis Complicating squamous carcinoma has been reported rarely. Management The standard approach is surgical. Options include cricopharyngeal myotomy, with or without excision of the pouch. Endoscopic stapling (Dohlman’s procedure) is less invasive and patients – who are frequently elderly – may recover more quickly.

The value of these measures is questionable and largely untested. Patients should be advised that smoking reduces the lower oesophageal tone and is a mucosal irritant, and therefore liable to worsen symptoms. Increasingly severe symptoms should be managed with alginates, antacids, and acid suppression as for gastro-oesophageal reflux disease (GORD). The incidence and severity of complications in paraoesophageal hiatus hernia means that all patients should be considered for surgical repair. However, because of the greater age, frailty, and comorbidity of these patients, this is often impractical.

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

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