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

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At endoscopy, white plaques of Candida are seen on hyperaemic mucosa (50). CYTOMEGALOVIRUS OESOPHAGITIS Cytomegalovirus (CMV) is another cause of ulceration in the oesophagus and upper gastrointestinal tract of the immunocompromised. 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.

Basal acid and stimulated 61 61 A gastrinoma in the wall of the duodenum, demonstrating that these tumours may be small, but may still be responsible for devastating hyperacidity. 54 CHAPTER 4 Stomach and duodenum Gastritis Gastritis is inflammation of the gastric mucosa. Classification has been contentious, but an international working party has proposed a new scheme. The purpose was to incorporate endoscopic and biopsy findings, and to recognize the bacterium H. pylori as the principal cause of chronic, nonimmune gastritis.

These are rare and, for low-grade lesions, there are reports of tumour regression with H. pylori eradication. H. pylori and dyspepsia Dyspeptic symptoms are prevalent in the general population, as is H. pylori colonization, but the relationship between these events is complex. There is strong evidence that H. pylori colonization confers risk of peptic ulcer disease, and this is attenuated with eradication therapy. However, studies of H. pylori eradication in dyspeptic patients have generally been disappointing.

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