No abstract

Of 1200 patients referred to the esophageal laboratory at Guy's Hospital for investigation of suspected esophageal motility disorders, 61 (5.1%) were diagnosed as diffuse esophageal spasm. Twenty of these patients whose symptoms were severe did not respond to conservative treatment and were treated by balloon dilatation. Results were good in 14 and poor in six patients, which included one esophageal perforation. Diffuse esophageal spasm was diagnosed where more than 30% nonperistaltic activity was demonstrated by manometry. Lower esophageal sphincter pressure and relaxation were normal in all cases except one. Gastroesophageal reflux was present in four of five poor responders who were examined by 24-h ambulatory pH monitoring, and in only one of 10 good responders. Three of the six patients in whom balloon dilatation was successful proceeded to full-length myotomy, with relief of symptoms in two. The indications for, and results of, balloon dilatation in this condition are discussed, and a new radiological sign is described.

We present a case in which a patient with suspected colorectal cancer, referred to the surgical outpatient clinic, was subsequently found to have a chicken wishbone apparently perforating the sigmoid colon. This demonstrates the complexities of diagnosis and management of an unusual presentation of ingested foreign body. This case is a useful learning point in consideration of differential diagnosis in the presentation of an apparently malignant lesion.

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This paper describes the technique of sequential endoscopy and biopsy of the intact rat stomach. It is recommended that this procedure be performed on fasted animals with access to water only, when a mortality of only 4% can be achieved.