By J. M. Naish

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A. Squamous-celled carcinoma of the oesophagus. b. Adenocarcinoma of columnar cells in the oesophagus. c. Adenocarcinoma of gastric cardia invading the oesophagus. 3. Rolling Hiatus Hernia. 4. — a. Achalasia. b. Tonic oesophagus. c. Corkscrew oesophagus. d. After high vagotomy. 5. — Scleroderma or systemic sclerosis. FURTHER READING The Oesophageal Closure Mechanisms A T K I N S O N , M . (1962), 'Mechanisms protecting against Gastro-oesophageal Reflux: a R e v i e w ' , Gut, 3 , 1. Achalasia of Cardia ADAMS, C .

CLINICAL P I C T U R E T h e concept of a classic duodenal ulcer history is hallowed by tradition, by constant textbook repetition, and is associated in Great Britain with the name of that pioneer of gastric surgery, Lord Moynihan. Unfortunately, ulcer patients rarely complain of such textbook symptoms, and duodenal ulcer may occur without any at all. A certain pattern is, however, usually discernible, and the features which are both frequently noted with, and most typical of, duodenal ulcer are listed in order of their estimated importance :— ι.

PATHOLOGY Acute erosive gastritis may be diffuse or localized to the antrum. T h e mucosa is red and oedematous, and there are many small erosions 1-5 mm. in diameter, the floors of which are covered with fibrinous exudate. Polymorphs, plasma cells, eosinophils, and lymphocytes infiltrate the stroma beneath the epithelium. Gland cells, particularly the chief cells, are necrotic. T h e epithelial cells of the surface become cuboidal and are separated by vacuoles containing polymorphs. If an erosion extends through the muscularis mucosa it is regarded as an acute gastric ulcer.

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