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Acute small bowel ischaemia may be caused by occlusive arterial disease (60%), non-occlusive ischaemia in critically ill patients (30%) and mesenteric venous thrombosis (10%). Early diagnosis is essential. The common causes of acute abdominal pain must be ruled out, and early laparoscopy or laparotomy performed. Serum markers and CT scanning are currently not sensitive or specific enough to be fully...
Anaemia is a common reason for referral to any gastroenterological service. Iron-deficiency anaemia is the most frequent, making up to 13% of referrals. The type of anaemia and any clinical symptoms often delineate the most appropriate investigations. However, iron-deficiency anaemia (IDA) can be the sole reason for referral and, depending upon patient’s age, necessitates endoscopic investigation...
Acute lower gastrointestinal bleeding often presents a challenging clinical situation. Bleeding may be severe and associated with significant haemodynamic compromise, and yet usually stops spontaneously. The causes are various, and the bleeding source may be difficult to identify, even with sophisticated diagnostic methods. Colonoscopy, CT angiography, mesenteric angiography and radionuclide scintigraphy...
A century ago, Lord Moynihan suggested that the underlying cause of dyspepsia could be discerned by symptoms alone. Subsequent studies have suggested that, unfortunately, this is not the case since the symptoms associated with upper gastrointestinal (GI) disease lack both sensitivity and specificity. ‘Classic’ symptoms of reflux disease (such as heartburn and regurgitation), peptic ulcer disease (such...
Acute gastrointestinal bleeding is an important medical emergency. Outcome and treatment are dependent upon the presence or absence of liver disease. The most important non-variceal cause is peptic ulcer. Prognosis is dependent upon the severity of bleeding, endoscopic findings and the presence of medical comorbidity. Endoscopy is undertaken only after resuscitation is optimized and is done to achieve...
Symptoms of lower gastrointestinal disease are common and are frequent triggers for consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation can represent a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding frequently represents serious pathology and requires rational...
Oesophageal emergencies are relatively rare but their management leaves little room for error. This article explains the aetiology, diagnosis and management of oesophageal bleeding, obstruction, perforation and caustic injury. The essential role of early flexible endoscopy and specialist multi-disciplinary care is emphasized.
Acute pancreatitis is an inflammatory condition with a variable clinical course. Diagnosis is based upon clinical presentation, laboratory indices and imaging studies, whilst illness severity can be assessed by clinical scoring systems, such as the Ranson, Glasgow or APACHE II criteria, or by radiological assessments such as the CT severity index. Most patients develop self-limiting disease. However,...
Intestinal failure is usefully defined from a reduction of intestinal function such that ordinary fluids and nutrients given by mouth are insufficient, and that artificial support by the enteral or parenteral route is needed to maintain health. Intestinal failure usually follows major resection (e.g. in short bowel syndrome [SBS]), but also occurs when the intact intestine is unable to function owing...
Nearly all peptic ulcers are caused by either Helicobacter pylori infection or non-steroidal inflammatory drug (NSAID) use, including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, particularly ulcers complicated by bleeding. Only about 15% of H. pylori-infected people develop an ulcer in their lifetime;...
Adverse drug effects on the gastrointestinal (GI) tract can occur as a predictable result of a drug’s mode of action, by direct injury, through compromising GI defences, or as a consequence of changes in colonic bacterial flora. Non-steroidal anti-inflammatory drugs (NSAIDs) are the commonest cause of gastroduodenal injury, owing to inhibition of prostaglandin synthesis, and increase the risk of serious...
Coeliac disease is a common condition that affects as many as 1 in 100 Caucasians and may present at any age after weaning with a spectrum of symptoms ranging from none to all, through mild irritable bowel type complaints, to weight loss and diarrhoea. Patients with coeliac disease are at increased risk of autoimmunity. The majority of patients express either HLA DQ2 or DQ8 haplotypes, but it is likely...
Eosinophilic oesophagitis (EoE) is an allergic condition of the oesophagus. It is a clinicopathological diagnosis, in which intermittent dysphagia and/or food impaction in adults occur in the presence of severe eosinophilic infiltration of the oesophagus. In children, symptoms can be less well defined, with feeding refusal, vomiting and failure to thrive. Symptoms of reflux, often described by both...
Gastro-oesophageal reflux disease (GORD) has an estimated prevalence in Western society of 10–20%. It is characterized by intermittent incompetence of the gastro-oesophageal junction leading to reflux of gastric contents into the oesophagus. Hiatus hernia with an associated ‘acid pocket’ frequently co-exists and facilitates this process, resulting in more severe GORD. The clinical presentation of...
Gastric tumours are either epithelial or stromal in origin. Benign tumours are rare, whereas the majority are malignant and mostly adenocarcinomas. Gastric lymphomas, gastrointestinal stromal tumours (GISTs) and gastric carcinoid tumours are less common and have variable cancer biology. Benign gastric adenomas and GISTs may be asymptomatic and found incidentally, although they may be complicated by...
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