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Ménétrier’s disease This is an unusual condition characterised by gross hypertro - phy of the gastric mucosal folds, mucus production and hypo - chlorhydria. The condition is premalignant and may present with hypoproteinaemia and anaemia. There is no treatmen...

Neoadjuvant chemotherapy Most operable patients should have neoadjuvant chemother - apy as there is level 1 evidence of improved survival. Since the early 2000s a platinum-based triplet regime containing epirubicin (e.g. epirubicin, cisplatin and 5-fluorouraci...

Nerves The stomach and duodenum possess both intrinsic and extrinsic nerve supplies. The intrinsic nerves exist principally in two plexuses, the myenteric plexus of Auerbach and the submucosal plexus of Meissner. Compared with the rest of the gut, the submuc...

Neuroendocrine tumours A number of neuroendocrine neoplasms occur in the duode - num. It is a common site for primary gastrinoma (Zollinger– Ellison syndrome). Non-functioning neuroendocrine tumours (usually called carcinoid tumours) also occur but uncommonl...

OTHER GASTRIC CONDITIONS Acute gastric dilatation This condition usually occurs in association with pyloroduo denal disorders or following abdominal surgery . The stomach dilates enormously . The patient may be dehydrated and have electrolyte disturbances. Fai...

Operations for duodenal ulceration Procedures for the treatment of duodenal ulcers have the common aim of excluding acid from the duodenum. This is ing the secretory potential of the stomach or both. All proce - dures achieve this aim to some extent, but wi...

Operations for gastric ulcer In contrast to surgery for duodenal ulcer, where the princi pal objective is to reduce duodenal exposure to gastric acid, in gastric ulcer surgery the ulcer is usually excised so that malignancy can then be confidently excluded. The...

Other forms of gastritis Eosinophilic gastritis appears to have an allergic basis and is treated with steroids and cromoglycate. Granulomatous gastri - tis is seen rarely in Crohn’s disease and also may be associated with tuberculosis. Acquired immunodeficiency...

Other peptic ulcers A prepyloric gastric ulcer was in the past di ffi cult to treat, a problem overcome with the introduction of PPIs. Pyloric chan nel ulcers are similar to duodenal ulcers. Both prepyloric and pyloric ulcers may be malignant and biopsy is esse...

Other treatment modalities Because of the failure of radical surgery to cure advanced gastric cancer, there has been an interest in the use of radio therapy and chemotherapy . Palliative radiotherapy The routine use of radiotherapy is controversial as the ...

Outlook after surgical treatment The outlook after surgical treatment varies considerably between the West and Japan. In Japan, approximately 75% of patients will have a curative resection and, of these, the overall 5-year survival rate is 50–70%. In contrast...

PHYSIOLOGY OF THE STOMACH AND DUODENUM The stomach mechanically breaks down ingested food and, together with the actions of acid and pepsin, forms chyme that passes into the duodenum. In contrast with the acidic environ ment of the stomach, the environment o...

Palliative surgery In patients with significant symptoms of either obstruction or bleeding, palliative resection is appropriate. A palliative gastrectomy need not be radical as it is su ffi cient to remove the tumour and reconstruct the gastrointestinal tract. S...

Parietal cells These are found in the body (acid-secreting portion) of the stomach and line the gastric crypts, being more abundant Leopold Auerbach , 1828–1897, Professor of Neuropathology , Breslau, Germany (now Wroc ł aw , Poland). George Meissner , 1829–...

Pathology Gastric ulcers have similar features to duodenal ulcers but tend to be larger. Fibrosis may result in an ‘hourglass’ deformity of the stomach. Chronic ulcers may erode posteriorly into the pancreas, major vessels such as the splenic artery or rarely ...

Pattern of relapse following surgical treatment The most common site of relapse following radical gastrec tomy is the gastric bed, representing inadequate extirpation of the primary tumour. Widespread nodal intraperitoneal metastases, distant nodal metastase...

Peptides and neuropeptides in the stomach and duodenum As with most of the gastrointestinal tract, the endocrine cells of the stomach produce peptide hormones and neurotrans mitters. Previously , nerves and endocrine cells were considered distinct in terms o...

Portal gastropathy Portal gastropathy refers to changes in the gastric mucosa as a result of portal hypertension. The mucosa is friable and may exude blood, even in the absence of well-developed visible varices. The treatment is as for portal hypertension.