By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Direct endoscopic ablation therapy of the tumour using laser, argon-plasma coagulation, or injection of alcohol into the tumour. • Oesophageal stent. As an alternative to endoscopic ablation, self-expanding metal oesophageal stents can be placed either endoscopically or using fluoroscopic 24A 24B 24C 24D guidance (24), to maintain oesophageal patency. The stents are made from memory metal and are delivered in a compact form. Once in the appropriate position, they are deployed and expand. Although simpler to place than the older rigid stents previously used, and well tolerated by patients, they are still subject to the potential complications of bleeding, stent migration, and oesophageal perforation.
Eradication regimes are under constant review. Currently, antibiotic combinations (or combinations of antibiotics with acid suppression), over different time scales, give high rates of eradication – defined as absent H. pylori 4 weeks after treatment has finished. With ‘triple therapy’ (high-dose proton pump inhibition with two antibiotics), eradication rates reach 80–90%, providing that the patient is compliant with the multi-tablet regime. Dual therapy (using a proton pump inhibitor with a single antibiotic) is associated with poorer eradication rates compared to triple therapy.
The rate of loss can be quantified. In this example, the t1/2 (time to halfemptying of the stomach) is 30 mins. Zollinger–Ellison syndrome 53 Zollinger–Ellison syndrome This is a rare condition caused by a gastrinsecreting tumour (generally in the pancreas or duodenum, 61). g. prolactinoma) and hyperparathyroidism. Patients present with multiple peptic ulcers extending into the distal duodenum and jejunum, as a consequence of gastrin-driven acid secretion. Diarrhoea is reported in up to one-third of patients – probably reflecting pH-dependent inhibition of pancreatic lipases.
A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson