By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Extra resources for A Colour Handbook of Gastroenterology
Laparoscopic and open surgical approaches are both used. 55 Hiatus hernia, showing protrusion of upper portion of stomach through the diaphragm. 55 56 56 Endoscopic view of an axial hiatus hernia looking down from the oesophagus. 57 57 Mixed hiatus hernia. This page intentionally left blank CHAPTER 4 Stomach and duodenum Inflammatory diseases and neoplasia dominate gastric pathology. Neoplasia is very rare in the duodenum Helicobacter pylori can cause acute and chronic gastritis, and predisposes to gastric and duodenal ulceration, gastric atrophy, and gastric cancer Endoscopy is the predominant diagnostic modality 49 50 CHAPTER 4 Stomach and duodenum Stomach: anatomy and histology The stomach extends from the oesophagogastric junction below the diaphragm to the pylorus (gastroduodenal junction), the latter being fixed to the peritoneum.
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. Oesophageal varices 39 Oesophageal varices Definition Oesophageal varices are defined as dilated intramural oesophageal veins. They are portosystemic venous communications, and the direct result of portal hypertension.
Oesophageal webs and rings Definition Mucosal abnormalities are common in the oesophagus. Webs are folds of squamous mucosa that protrude into the lumen and may be found at all levels of the oesophagus. Rings are circumferential, with their upper surface covered by stratified squamous epithelium and columnar epithelium occurring on the lower surface. The most commonly encountered type of mucosal abnormality is Schatzki’s ring (44, 45), which occurs as a thin submucosal scar at the squamocolumnar junction.