By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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In established pernicious anaemia, serum vitamin B12 levels are low. Following ingestion of labelled vitamin B12, <10% is excreted in the urine within 24 hr, but this is corrected when ingestion of B12 is repeated with intrinsic factor (this is the basis of the Schilling test). Histology Unlike H. pylori-associated gastritis, autoimmune chronic gastritis is inactive (no polymorphonuclear leukocytes). There is an increased risk of epithelial dysplasia and gastric cancer (approximately three-fold).
Management Any GORD should be treated. Endoscopic dilatation should be considered for smallcalibre oesophagus, but is associated with a higher rate of oesophageal perforation than peptic disease. Bolus obstruction can be managed endoscopically. There is no routine medical therapy, but topical steroids (fluticasone) and the leukotriene receptor antagonist montelukast have been used. 37 Eosinophilic oesophagitis – note vertical furrows. 38 38 Barium swallow showing smallcalibre oesophagus in a patient with long-standing eosinophilic oesophagitis.
The acid-producing mucosa is located predominantly in the body. Histology As in all other parts of the intestine, layers of gut wall consist of: • Mucosa. • Muscularis mucosae (thin layer of organized muscle). • Submucosa (connective tissue). • Circular muscle fibres. • Longitudinal muscle fibres. • Outer serosal lining. 58 58 Normal histology of the acidbearing area of the stomach. The gastric mucosa is specialized for acid production, which occurs in pit-like glands lined with acid-producing cells (parietal cells) (58).
A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson