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The two most commonly occurring oesophageal tumours are squamous cell carcinomas and adenocarcinomas. These differ in their aetiology, pathogenesis and response to treatment. The incidence of oesophageal adenocarcinoma is rapidly increasing and, for both tumours, the prognosis remains poor. Here, we discuss the management of these tumours as well as the current recommendations for screening and surveillance.
Gastric tumours are mostly adenocarcinomas, although it is important to diagnose gastrointestinal stromal tumours (GISTs) and gastric lymphoma since novel therapeutic interventions have dramatically changed the survival of patients with these rarer tumours. The major aetiological factor worldwide remains chronic Helicobacter pylori infection which affects up to 80% of the population in the developing...
Gastro-oesophageal reflux 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 frequently (but not invariably) co-exists and, when present, facilitates this process, resulting in more severe gastro-oesophageal reflux disease (GORD). The clinical...
This contribution discusses the epidemiology, aetiology and clinical characteristics of comorbid substance use and psychiatric disorders, and briefly reviews the services that are needed to address the needs of this challenging group.
The oesophagus and stomach are responsible for transporting food to the small intestine in a manner which does not compromise the safety of the airway, is relevant to the composition of the meal, and allows for optimal absorption of nutrients. To achieve this, several intricate control mechanisms interact to ensure that the swallowed bolus traverses the oropharynx into the oesophageal body and on...
Motor abnormalities of the small and large intestine are commonly observed in functional and organic gastrointestinal disorders. However, the presence of some of these patterns of ‘dysmotility’ in healthy controls, the absence of correlation with symptoms, and the poor response to treatments has raised questions as to whether these are epiphenomena rather than pathophysiologically relevant. This is...
2007 is a landmark year for palliative care: 40 years since the first hospice, St Christopher's, opened in the UK, and 20 years since palliative medicine was first recognized as a medical specialty. In that time, palliative care has developed a firm foundation based largely on the care of patients with cancer. More recently, the specialty has broadened to encompass the care of adults and children...
Irritable bowel syndrome (IBS) is characterized by a number of symptoms including diarrhoea, constipation, wind and bloating. Despite many years of research, IBS still has an uncertain aetiology. The Rome criteria have been devised to ensure recruitment consistency in studies. This contribution looks into the possible causes of IBS and now it may be managed.
Tuberculosis (TB) is common in both underdeveloped and developing countries and, as a result of HIV, is increasingly seen in the developed world also. The lungs are the most common site of involvement in TB, but the abdomen is a common site of extrapulmonary involvement. Abdominal TB includes involvement of the gastrointestinal tract, peritoneum and lymph nodes. Most patients have a chronic presentation...
Infectious diarrhoea remains a major cause of morbidity and mortality world wide. Viruses, bacteria and protozoa are responsible for the majority of infections which are transmitted most commonly by the faecal-oral route through water, food and person-to-person transmission. Clinical presentation of infectious diarrhoea conforms to three patterns, namely acute watery diarrhoes, dysentery and persistent...
Ulcerative colitis (UC) and Crohn’s disease (CD) represent the two major forms of inflammatory bowel diseases (IBD). UC is a chronic idiopathic inflammatory condition affecting the colon and rectum. Increasing data provide evidence of a complex interplay between components of the innate immune system and environmental factors, notably the microflora of the intestinal mucosa, in the healthy gut. This...
Comprising the two separate but related conditions of lymphocytic and collagenous colitis, the term microscopic colitis describes a condition of chronic watery diarrhoea in the absence of macroscopic evidence of colonic inflammation but with characteristic microscopic appearances. Disease severity ranges from mild and self-limiting, which may be adequately managed with loperamide, to severe and refractory...
Gastrointestinal diseases associated with impaired immunity are largely infections, although an increased incidence of extranodal lymphoma is also found in the context of HIV infection. The range of such infections is related to the role of CD4-positive T cells in their eradication. Infections tend to occur with organisms of limited virulence, to be recurrent and are associated with disseminated infection...
Understanding the aetiology and pathogenesis of Crohn's disease remains a challenge, but it is clearly an interaction between the environment and a genetically susceptible individual. Multiple genes are being described, each contributing a small degree of susceptibility or protection, but the functional consequences of gene mutations are not known. Diagnostic imaging with capsule endoscopy allows...
Colorectal cancer is a common malignancy affecting 35,000 people a year in the UK. Most cancers are sporadic but a few, occurring at young age, have a clear genetic basis. The majority are in the rectum or rectosigmoid and give rise to symptoms of rectal bleeding often with a looser or more frequent stool. Right-sided cancers typically give rise to anaemia because the blood in the stool is occult...
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