Oesophagus ulcer

Peptic ulceration occurs as an acute or chronic non-traumatic epithelial breach typically in the gastric or duodenal mucosa, but also in the oesophagus (see above) and occasionally in the small intestine with the Zollinger-Ellison syndrome of gastrin overproduction or with an acid-secreting Meckel s diverticulum. Symptoms overlap with those of non-ulcer dyspepsia and cancer and the diagnostic cornerstone is endoscopy. Biopsy may be necessary to distinguish ulcer from cancer. 

Side effects Side effects such as erosions, superficial ulceration or mucosal necrosis can be expected in > 80% of cases. Sucralfate, cimetidine, ranitidine and omeprazole (116) as well as fibrin adhesive have been used both for prevention and to promote healing. From a morphological viewpoint, these inflammatory tissue reactions are to a certain extent necessary to induce thrombosis and vessel wall fibrosis. Fever, leucocytosis, chest pain and tension occur as frequent yet usually insignificant concomitant reactions. Dysphagia or dysfunction of the oesophagus are of no clinical significance. The develop-... 

PEM prescription event monitoring see epidemiology, poptic ulcer A disease state characterized by ulceration, initially of the mucosa of the alimentary tract, caused by the action of pepsin and hydrochloric acid. It may be in the body of the stomach (gastric ulcer), the duodenum (duodenal ulcer), jejunum (jejunal ulcer especially in Zollinger-Ellison syndrome) or of the oesophagus (oesophageal ulcer ... 

Untreated CD is associated with significant morbidity and increased mortality, largely related to the development of enteropathy-associated T-cell lymphomas (EATL). Other less common complications include refractory sprue, carcinomas of the oropharynx, oesophagus and small bowel, and ulcerative jejuno-ileitis and its collagenous variant (Logan et al. 1989 Holmes et al. 1976 Catassi et al. 2005). 

The oesophagus has only a transport function for active substances. It is important, however, that corroding and irritating active substances, like doxycycline and bisphosphonates, do not stick in the oesophagus as they can damage the tissue and cause ulcerations. Ample water should be taken when swallowing such medicinal products. 

Barrett NR. Chronic peptic ulcer of the oesophagus and oesophagitis. BrJ Surg 1950 38 175-182. 

The easy scalability of enantioselective HPLC can be demonstrated for the separation of omeprazole [29], one of the blockbuster drugs for the treatment of ulcers (see Fig. 17). The (S)-enantiomer, esomeprazole with the trade name Nexium, is used as an improved active pharmaceutical ingredient against inflammation and ulcers of the oesophagus (reflux oesophagitis), heartburn/ pyrosis (gastrooesophagal reflux), and ulcers of the duodenum after infection with helicobacter pylori. 

Endoscopy is normal in up to 20% of patients with a typical medical history. Some endoscopists emphasise that erythema and increased vulnerability of the distal oesophagus are signs of early reflux disease, as is blurring of the Z-line, but others deny this. All agree that the presence of erosions, however tiny, shallow various-shaped ulcers demarcated by shiny red rims, and scar formations are lesions caused by reflux (Figs. 3.11,3.12). See table below. 

In typical cases of Barrett s when there is no concomitant oesophagitis, the normal pale squamous cell membrane of the oesophagus is sharply delineated from the pinkish metaplastic mucosa, where no vessels are seen. When oesophagitis is present the typical features of erosions, ulcers, exudation, and bleedings are seen. 

Benign tumours of the oesophagus are incidental and rare findings of which leiomyomas are the most common. These submucosal lesions are usually situated in the proximal part of the oesophagus. In contrast to gastric leiomyomas, oesophageal ones rarely ulcerate. 

In 1975, Bokey and Hugh reported a case of localized oesophageal ulceration associated with the dissolution in the oesophagus of a doxycycline capsule that did not go right down (79 ). More recently, Crowson et al. have reported on 3 patients with oesophageal ulceration associated with the ingestion of tetracycline or doxycycline (82C). 

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