By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Dysphagia is unusual if the lumen is more than 20 mm. However, sudden complete dysphagia can occur due to obstruction of a bolus of food – the socalled ‘steak-house syndrome’. Management Symptomatic rings or webs can be dilated and antireflux measures instituted. 44 44 Oesophageal ring at endoscopy. 45 Schatzki’s ring – the faint indentation in the distal oesophagus seen on barium swallow. 45 42 CHAPTER 3 Oesophagus Oesophageal diverticula and pouches Definition Oesophageal diverticula are outpouchings of one or more layers of the oesophageal wall.
Diarrhoea is reported in up to one-third of patients – probably reflecting pH-dependent inhibition of pancreatic lipases. acid secretion is raised, but there is overlap into the reference range. Hypergastrinaemia is found and, unlike normal subjects, intravenous infusion of the hormone secretin augments serum gastrin levels. As with other neuroendocrine tumours, serum chromogranin A is frequently raised. Treatment Acid hypersecretion is controlled medically by high-dose proton pump inhibitor treatment and, if possible, the primary tumour is excised surgically.
Chronic oesophageal mucosal inflammation and desquamation of the squamous epithelium occurs in the distal oesophagus. This is replaced by columnar epithelium as an adaptive response, and thus the squamocolumnar junction migrates up 51A 51 Two images of uncomplicated Barrett’s oesophagus. Physical examination There are no physical signs. Laboratory and special examinations The diagnosis is suspected at endoscopy. Normally, the demarcation between pink–grey squamous epithelium and salmon-red columnar epithelium forms an irregular ring at the cardia.