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ABC of the Upper Gastrointestinal Tract
  1. M Lancaster-Smith

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Our comprehension of upper gastrointestinal disease has been extended in the past three decades by the introduction of endoscopy, ultrasonography, computed tomography scanning, pH monitoring, and manometry. This burgeoning of investigational modalities coincided with the development of acid suppressing drugs that for the first time enabled the control of peptic ulcer and gastro-oesophageal reflux disease. However, by the 1990s, long term acid suppression for the majority of patients with peptic ulcer was rendered obsolete by the discovery that Helicobacter pylori eradication resulted in permanent cure. This strategy has been so successful that non-steroidal anti-inflammatory drugs are now the commonest cause of ulcer disease in the developed world.

Despite the decline in ulcer disease there has been no reduction in dyspeptic patients presenting to general practitioners, and the flow of referrals to endoscopy and gastroenterology clinics is undiminished. Patients with functional dyspepsia now greatly outnumber those with peptic ulcer and although the aetiopathogenesis is being unravelled, its management remains problematic. The Hippocratic maxim “I am more interested in the man who has the disease than the disease the man has” always needs to be borne in mind when managing such patients.

Non-gastroenterologists must have struggled to keep abreast of these advances and evolving concepts. I presume therefore a wide range of non-specialists, including general surgeons, family practitioners, house officers, and nurses, will welcome this compilation of articles, which first appeared in the British Medical Journal under its ABC services banner, as a means of regaining lost ground. The specialist readers of this journal will find the excellent coloured figures and photographs invaluable for illustrating lectures and seminars. If, like your reviewer, you failed to retain the original articles or have lost them in your “filing system”, this is a second chance to obtain a valuable resource in a highly convenient format.

The authority of the texts is not questioned, written as they are by acknowledged experts, but the absence of references and in many cases even the omission of suggestions for further reading are deficiencies, which in the era of evidenced based practice, need to be addressed when planning subsequent series.

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