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By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson

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The aetiology may be failure of relaxation during swallowing, due to primary cricopharyngeal dysfunction, sometimes referred to as cricopharyngeal achalasia. There is an association with hiatus hernia. 46 46 Chest X-ray showing outline of pharyngeal pouch in right upper mediastinum. Clinical history Patients present variably with cough, dysphagia, regurgitation, and weight loss. There is a risk of aspiration. Physical examination Large pouches can sometimes be palpated in the neck after food has been eaten.

Small erosions require sensitive double-contrast techniques. Barium studies have a very limited role, due to the superiority of endoscopic diagnosis and endoscopic therapy. Motility Barium meal examination is, however, better than endoscopy at detecting loss of antral peristalsis and antral narrowing. This occurs in diffuse infiltrative processes, such as linitis plastica from 59 Normal endoscopic appearances of the stomach. (A) Antrum, (B) body, and (C) fundus (the endoscope is in the retroverted or ‘J’ position).

Laboratory and special examinations Serological findings Parietal cell autoantibodies are present in the serum of 90% of patients with autoimmune chronic gastritis; intrinsic factor antibodies occur in the minority (<20%) of patients, who are likely to progress to pernicious anaemia. In established pernicious anaemia, serum vitamin B12 levels are low. Following ingestion of labelled vitamin B12, <10% is excreted in the urine within 24 hr, but this is corrected when ingestion of B12 is repeated with intrinsic factor (this is the basis of the Schilling test).

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