By Robert Logan, Adam Harris, J. J. Misiewicz, J. H. Baron
(BMJ Books) Univ. clinic, Nottingham, united kingdom. offers a concise consultant to issues of the higher gastrointestinal tract. hugely illustrated with charts, diagrams, and colour pictures. displays most recent advances in knowing the pathophysiology and pathogenesis of this sickness. For scientific scholars, nurses, and clinicians. Softcover.
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Limited evidence suggests that these benefits may be shared by other NSAIDs. 3 In 1938 Douthwaite and Lintott provided the first endoscopic evidence that aspirin caused gastric mucosal damage. Images show gastric antrum before (left) and after (right) administration of aspirin (reproduced from Douthwaite AH, Lintott JAM. Lancet 1938;ii:1222-5) Indigestion and non-steroidal anti-inflammatory drugs Who is at particular risk? Risk factors for gastroduodenal ulcer complications are now fairly well defined.
Further antisecretory treatment, repeat endoscopy, or formal assessment of eradication is not necessary, and one can await the clinical outcome. Recurrent symptoms indicate either eradication failure or the presence of some other disease. Subsequent management will not be clear unless the outcome of eradication treatment is known, and this is best assessed by a 13C-urea breath test performed more than four weeks after the antimicrobial treatment. Recurrent symptoms after documented H pylori eradication are often due to gastro-oesophageal reflux disease, the symptoms of which may be misattributed to duodenal ulcer.
Bleeding from gastric erosions, oesophagitis, or vascular malformations usually stops spontaneously and is not usually life threatening. Mallory-Weiss tears are a consequence of retching, and most patients have a history of alcohol misuse, have features of other gastrointestinal disease such as peptic ulcer or gastroenteritis, or have non-gastrointestinal causes of vomiting. Bleeding usually stops spontaneously, although endoscopic haemostatic treatment is sometimes required. Bleeding from upper gastrointestinal malignancy is not usually severe, and the prognosis is dictated by the stage of the disease.