A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey

By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson

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H. pylori eradication is rarely symptomatically helpful (unless gastric or duodenal ulceration is present). Whether H. pylori should be eradicated in an attempt to prevent subsequent development of gastric cancer is controversial and unproven. AUTOIMMUNE CHRONIC GASTRITIS Epidemiology Autoimmune chronic gastritis is more common in women than in men (3:1), and is associated with northern European ancestry and the genetic haplotype HLA-B8 and DR3. Pathophysiology Autoimmune chronic gastritis causes an antralsparing atrophic gastritis with hypergastrinaemia.

Pathophysiology Normally, all the blood delivered to the liver by the portal venous system returns through the liver 39 to the systemic circulation via the hepatic veins. With cirrhosis, and when the portal venous system is obstructed, this does not occur. Portal venous pressure rises and portovenous shunts open to enable venous blood to return to the systemic circulation via alternative routes. Clinical history The patient may have a prior history of bleeding oesophageal varices, and of underlying liver disease.

Differential diagnosis The diagnosis is usually straightforward. Other causes of distal oesophageal ulceration include CMV, herpes, and Candida in the immunocompromised. Strictures associated with oesophagitis need to be differentiated from malignant strictures. Prognosis For most patients, GORD is a chronic condition with intermittent exacerbations of symptoms. Patients with severe circumferential oesophagitis are at risk of peptic stricture and columnar-lined oesophagus. Management The aim of treatment is symptomatic relief and the prevention of complications.

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