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

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Doublecontrast studies can delineate mucosal lesions such as polyps, erosions, and ulcers. Although benign and malignant ulcers can be separated using radiological criteria, this is not sufficiently sensitive, and all gastric ulcers must be assessed histologically by multiple repeated biopsies at endoscopy. Postoperative stomach Radiological assessment is useful to investigate the early complications in the postoperative stomach. Examples include anastomotic leakage or postoperative obstruction, which are best investigated with water-soluble contrast radiology.

The mucosal damage is usually confined to the distal 5 cm of the oesophagus, and is best assessed at endoscopy. 33 Extensive reflux oesophageal stricture seen on barium study. 33 Oesophagitis can be graded, lesions brushed and biopsied, and the presence of columnar-lined oesophagus determined. Oesophageal pH monitoring (34) is reserved for the patient with atypical symptoms or obscure chest pains, and for the investigation of reflux in relationship to respiratory symptoms. Differential diagnosis The diagnosis is usually straightforward.

Immunohistochemical staining or an ‘owl’s eye’ nuclear inclusion is diagnostic on histopathological examination. 50 Differential diagnosis Diagnosis can be confirmed from biopsies or brushings. g. nystatin or amphotericin, given orally. 50 Oesophageal candidiasis: endoscopic appearance – fluffy white plaques of Candida. 44 CHAPTER 3 Oesophagus Columnar-lined oesophagus (synonym Barrett’s oesophagus) the oesophagus. Gastro-oesophageal reflux is common in Barrett’s patients, which supports this view.

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