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In coeliac disease, the mucosa of the small intestine is abnormal. The condition improves morphologically and symptomatically with a gluten-free diet and relapses when gluten is re-introduced. It was previously called non-tropical sprue, gluten-sensitive enteropathy, idiopathic steatorrhoea or primary malabsorption.
Each year, more than 300 million travellers cross international boundaries–about 30 million from an industrialized country to a location in the developing world; 30-50% experience an attack of travellers' diarrhoea, depending on the country visited. Travellers' diarrhoea leads to inconvenience for holidaymakers and disruption of professional and business travel activities, and has economic implications...
Aphthae are small, well-circumscribed ulcers of the lining mucosa that are self-limiting. They are common, particularly in adolescents and young adults. Treatment options for mild cases include tetracycline/nystatin mouthwashes and topical corticosteroids (Figure 1). Severe cases may justify prednisolone or thalidomide.
The new millennium has already proved to be an exciting time in hepatobiliary disease. In the developed world, the epidemic of obesity leading to metabolic syndrome has aroused academic and commercial interest in non-alcoholic fatty liver disease (NAFLD). This update covers some of the most recent developments in hepatology.
Diarrhoea may be defined as frequent passage of loose stools or, more accurately, passage of an increased volume of stool water. A stool volume of more than 200 ml/m2/day indicates diarrhoea, as does a stool weight of more than 150-200 g watery stool/m2/day. Such precise measurements are difficult to achieve in children, and infants would have to be admitted to a metabolic unit. Therefore, more practical...
Acute upper gastrointestinal haemorrhage is the most important gastrointestinal emergency and is responsible for about 25,000 admissions to hospital each year in the UK. The incidence is 50-150/10,000/year and is highest in areas of social deprivation. It appears that the overall incidence of admissions for upper gastrointestinal bleeding has decreased in the UK. In Hong Kong, the incidence has decreased...
Capsule endoscopy uses a disposable capsule that can image the entire small bowel. This area of the gastrointestinal tract is difficult to examine with conventional endoscopy because of patient discomfort and limits to how far the enteroscope can be advanced into the small bowel. The capsule weighs 3.7 g and is small enough to be swallowed (30 mm × 11 mm). Within the capsule are a camera, an LED light...
Malabsorption is a failure of normal absorption of nutrients in the gut. It differs from malnutrition, which is inadequate food intake. The principal types of malabsorption are generalized and specific.
Gastrointestinal haemorrhage may present as an acute, life-threatening emergency or as anaemia in patients with chronic blood loss. Diagnosis and management require a coordinated approach by physicians, surgeons and radiologists if morbidity and mortality are to be minimized.
Clinical diagnosis of oesophageal disease largely depends on an accurate history; physical examination is generally unrewarding. Symptoms of disordered transit (dysphagia, regurgitation) with pain typify oesophageal disease. Pain or chest discomfort (including retrosternal burning) alone is not specific to oesophageal disease; it may occur in various conditions ranging from angina pectoris to disease...
Gastritis is inflammation of the gastric mucosa. It is diagnosed and classified histologically because endoscopic appearances such as redness are often misleading. Gastritis is seldom if ever symptomatic, but can have important clinical sequelae, principally duodenal and gastric ulceration, gastric adenocarcinoma and primary gastric lymphoma. The three most important causes of gastritis are Helicobacter...
During their lifetime, up to 30% of patients with ulcerative colitis require removal of their colon and rectum. Before the mid-1980s, all such patients received a permanent end ileostomy. The procedure of anastomosing a pouch or reservoir fashioned from the terminal ileum to the anal canal was then introduced, and will eventually more than halve the total number of patients with a permanent ileostomy...
Almost every individual suffers at least one episode of acute diarrhoea each year. Worldwide, diarrhoeal diseases are second only to cardiovascular diseases as a cause of death, and in some parts of the world they account for more years of potential life lost than all other causes combined. In the UK, diarrhoea is the most common illness after the common cold; acute diarrhoeal illnesses account for...
Disorders of the large bowel are common in the West. Colonic cancer is the second most common cause of cancer-related death; about 34,000 new cases are diagnosed each year in the UK. The incidence of inflammatory bowel disease (IBD), particularly Crohn's disease, continues to increase. Effective imaging to diagnose and document the extent of disease is essential. Imaging may be indicated to define...
Ulcerative colitis is an inflammatory disorder of the colonic mucosa characterized by relapses and remissions. The rectal mucosa is always involved, occasionally by microscopic inflammation alone, and the disease extends proximally (Figure 1).
Crohn's disease is a chronic inflammatory disorder of the gastro-intestinal tract of unknown aetiology. It can affect any part of the tract from mouth to anus, but most commonly affects the terminal ileum (35%) or the ileocaecal region (40%). The disease is confined to the colon in about 20% of patients, but even in these the rectum is often not involved.
Survival of patients with bowel cancer has changed little in the last 40 years. However, there have been considerable advances in surgical and medical management of the disease, focusing on improving quality of life and widening the spectrum of therapeutic options. In the last decade, surgical strategies have been adopted that are likely to lead to survival benefits in the future. This contribution...
Colorectal carcinoma is the second most common cause of death from cancer in Westernized countries, accounting for 15% of cancer deaths in the UK in 1999. The incidence of colorectal cancer increases steeply after the age of 40 years; the lifetime risk is about 5% in the UK. Although there are several well-known high-risk groups (Figure 1), 75% of cases are sporadic. In most populations worldwide,...
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