Clinical Investigations in Gastroenterology Third Edition Clinical Investigations in Gastroenterology Malcolm C

Malcolm C. Bateson Ian A.D. Bouchier Clinical Investigations in Gastroenterology Third Edition Clinical Investigations in Gastroenterology Malcolm C. Bateson • Ian A.D. Bouchier Clinical Investigations in Gastroenterology Third Edition Malcolm C. Bateson Ian A.D. Bouchier Bishop Auckland Edinburgh, Midlothian United Kingdom United Kingdom ISBN 978-3-319-53785-6 ISBN 978-3-319-53786-3 (eBook) DOI 10.1007/978-3-319-53786-3 Library of Congress Control Number: 2017939629 © Springer International Publishing AG 1988, 1997, 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface When Ian Bouchier had the idea of producing a practical guide to tests in the developing speciality of gastroenterology in 1969, it clearly hit on a useful topic. Clinical Investigation of Gastrointestinal Function went into a second edition with co-worker Malcolm Bateson in 1981. This became Clinical Investigations in Gastroenterology in 1988 (2nd Edition 1997), taking into account new struc- tural, isotope and kinetic tests used in actual practice in Scotland and North East England. Times have moved on. There is now an emphasis on low-risk non-invasive tests, though many patients will always require endoscopy, intubation and biopsy for adequate assessment. 1. The widespread use of anti-Helicobacter pylori therapy in dyspepsia has dra- matically changed the prevalence and significance of this organism in peptic ulcers. 2. Multichannel intraluminal impedance (MII) with high resolution manometry (HRM) to locate accurately the lower oesophageal sphincter has joined pH monitoring in the assessment of gastro-oesophageal reflux. 3. Frequent self-diagnosis by patients of gluten and wheat intolerance, and conse- quent adoption of partial “gluten-free” diets prior to evaluation, is now com- mon and may lead to equivocal results of tests. 4. Conversely, the increasing ethnic minority populations have an appreciable prevalence of alactasia and are often aware of milk intolerance, which is easy to verify if required. 5. Magnetic resonance cholangiopancreatography (MRCP) is now the optimal system for imaging the bile ducts and pancreatic ducts. 6. ERCP is no longer a first-line diagnostic test, but has ceded place to the much safer MRCP and endoscopic endosonography (EUS). ERCP is now generally reserved for patients where therapeutic procedures are planned. 7. Calprotectin assay screening of stool may save some irritable bowel patients unnecessary investigation for inflammatory bowel disease (IBD). Calprotectin measurement is useful to assess activity in asymptomatic Crohn’s disease and in predicting response of IBD to treatment and its risk of relapse. 8. Video colonoscopy and virtual computed tomography (CT) colonoscopy have become frequently used techniques in screening programs in apparently healthy v vi Preface populations and in surveillance and management of polyps, ulcerative colitis and large bowel cancer. 9. Liver imaging now includes transient elastography, as well as MRI, CT, isotope scanning, ultrasonography (US) and laparoscopy. 10. Non-alcoholic steatohepatitis (NASH) as a cause of liver dysfunction and cir- rhosis in the very obese is now well recognised and is an extra incentive to stay slim. 11. Ideas on antibiotic prophylaxis are now quite different and often the reverse of what was previously believed. The focus is again on those tests which have been useful in modern patient care, with special emphasis on those of which the authors have personal experience. Reference is also made to newer tests used elsewhere and to traditional procedures which have historical significance and may still be needed in less well-equipped regions. Information is provided about some investigations which help under- stand disease patterns, without necessarily being required for individual patient management. Special thanks are due to the continuing strong support of the staff of the Gastroenterology Unit at Bishop Auckland General Hospital and the Northern Medical Physics and Engineering Department at the University Hospital of North Durham, especially Clinical Director Alison Mackie and Adrian Davidson. Special Advisors Dr. Manohar Ahluwalia, Consultant Gastroenterologist, Airedale General Hospital, and Professor Matt Rutter, Consultant Gastroenterologist, University Hospital of North Tees, gave invaluable help on current clinical practice. Bishop Auckland, UK Malcolm C. Bateson Contents 1 Helicobacter pylori �� 1 1.1 Introduction �� 1 1.2 Epidemiology �� 1 1.3 Diagnostic Tests �� 2 1.3.1 Presence of Active Duodenal Ulcer �� 2 1.3.2 Direct Urease Test �� 2 1.3.3 Histology �� 3 1.3.4 Microscopy �� 3 1.3.5 Culture �� 3 1.3.6 Serology �� 4 1.3.7 Urea Breath Testing �� 5 1.4 Practical Use �� 5 Bibliography �� 5 2 Upper Digestive Endoscopy �� 7 2.1 Instruments �� 7 2.2 Procedures �� 7 2.2.1 Oesophagus �� 9 2.2.2 Stomach �� 10 2.2.3 Duodenum �� 11 2.3 Endosonography (EUS) �� 12 2.4 Endoscopic Retrograde Cholangiopancreatography (ERCP) �� 13 2.4.1 Instruments �� 13 2.4.2 Procedure �� 13 2.4.3 Indications �� 14 2.4.4 Relative Contraindications �� 14 2.4.5 Complications �� 14 2.5 Disinfection of Endoscopes �� 14 2.6 Prophylaxis of Infections with Antibiotics �� 15 2.7 Anticoagulant Therapy �� 16 Bibliography �� 16 3 Intubation �� 17 3.1 Method �� 17 3.2 Tubes �� 18 vii viii Contents 3.2.1 Oesophagus �� 19 3.2.2 Stomach �� 19 3.2.3 Duodenum �� 19 3.2.4 Intestine �� 21 3.3 Complications ��

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