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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.
The majority of anal diseases may be diagnosed by a careful history and examination. Management of haemorrhoids involves exclusion of more serious pathology, adequate explanation of the disorder, dietary and defecatory advice. Moderate haemorrhoids may be treated with out-patient procedures such as injection sclerotherapy or rubber-band ligation. Surgical haemorrhoidectomy is usually indicated in...
Acute pancreatitis is an inflammatory disease with a varied clinical course. The diagnosis is based upon the clinical presentation, laboratory indices and imaging studies, whilst the severity of the illness can be assessed by bedside scoring systems such as the Ranson, Glasgow or APACHE-II criteria, or by the CT severity index. Most patients develop self-limited disease, but a minority progress to...
In 2007, attention deficit hyperactivity disorder (ADHD) has become more widely accepted as a relatively common disorder. It can result in wide-ranging impairments, and there are clear benefits associated with treatment. However, there are still many unknowns, and understanding of aetiology, diagnosis and management continues to develop. Debate and controversy also continue, with some still doubting...
Anaemia is a common reason for referral to a gastroenterologist. Iron deficiency anaemia is characterized by a microcytic hypochromic blood picture with a low serum ferritin concentration. All patients with iron deficiency, irrespective of age, should be screened for coeliac disease by appropriate serology. Men, post-menopausal women, women over 50 years of age and younger women with gastrointestinal...
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, mesenteric angiography and radionuclide scintigraphy offer a...
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...
Toxic megacolon is a potentially fatal condition that represents the end of a spectrum of severe colitis. Typically, a complication of ulcerative colitis, it is increasingly a consequence of infective colitis. Diagnosis of toxic megacolon requires radiographic evidence of a dilated colon and tachycardia or fever in a patient with severe colitis of any cause. Unprepared flexible sigmoidoscopy should...
Disorders of the mouth, whether as a consequence of primary disease, systemic disease, or as a consequence of treatment may be encountered across most medical specialties. Whilst recurrent aphthous ulceration represents the most common primary oral disease, oral lesions may indicate active systemic disease at less accessible sites. Moreover, when oral disease is present, it may have a detrimental...
Malabsorption – failure of normal absorption of nutrients – has many potential causes. The defect may be in the gut lumen (e.g. inadequate pancreatic enzyme supply, bacterial overgrowth), or the gut mucosa (e.g. coeliac disease, Crohn’s disease) or outside the mucosa (lymphatic obstruction). Malabsorption may be generalized, affecting fat, protein and carbohydrate, or specific (e.g. lactase deficiency...
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 due to inhibition of prostaglandin synthesis, and increase the risk of serious...
Intestinal failure is best defined as the reduction of intestine function so that fluids and nutrients given by the enteral route are needed to maintain health. It usually follows major resection (e.g. in short bowel syndrome [SBS] ), but also occurs when intact intestine is unable to function due to inflammation or disorders of motility. In many patients, both causes coexist. Intestinal failure...
Coeliac disease is a common condition that may present at any age after weaning with a spectrum of symptoms ranging from none at all, through mild irritable bowel type complaints, to weight loss and diarrhoea. Patients with coeliac disease have an increased risk of autoimmunity. The majority of patients express either HLA DQ2 or 8 haplotypes, but other genetic factors required for disease expression...
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;...
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