By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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The most severe gastritis is seen in young to middle-aged adults, whereas atrophic changes develop later in the disease process in older people. As gastric glands atrophy, the number of H. pylori organisms falls as, paradoxically, this mucosa supports the organism less well. Finally, intestinal metaplasia develops with the appearance of villiform structures and intestinal architecture. Advanced intestinal metaplasia is a factor in the development of gastric cancer. Diagnosis Invasive/endoscopic methods The importance of H.
Laboratory and special examinations The diagnosis is suspected at endoscopy. Normally, the demarcation between pink–grey squamous epithelium and salmon-red columnar epithelium forms an irregular ring at the cardia. This is called the ora serrata or ‘Z’ line. In columnar-lined oesophagus, this migrates proximally as a cylinder, with islands of pink squamous mucosa or long irregular tongues of columnar mucosa rising into the oesophagus from the cardia (51). Endoscopic mucosal biopsies must be taken at multiple sites, to confirm the gastric columnar epithelium and detect dysplasia.
Endoscopic surveillance Regular endoscopic surveillance of patients with Barrett’s oesophagus, with the aim of identifying dysplastic mucosa or early diagnosis of cancer, remains controversial. It is only worthwhile if the patient is prepared to accept oesophageal resection if high-grade dysplasia is detected. The economic benefit of surveillance is unclear. Current UK recommendations suggest 2-yearly quadratic biopsies of the Barrett’s mucosa every 2 52A 52 Two images of adenocarcinoma of the oesophagus arising in Barrett’s oesophagus.
A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson