Your next patient is a 68 year old female. She has a 3 month history of epigastric pain which has not improved with a one month course of PPI. She lost weight and has also started to vomit occasionally after meals. There is no dysphagia. You refer her as a 2 week wait referral for an OGD. Her oesophagus is normal. Below are images of her stomach:

What is the diagnosis?

Biopsies taken at the time of the patient’s endoscopy confirm the presence of a MALT lymphoma, with concomitant H.Pylori infection. 

 How would you treat this patient?

Your first patient is 42-year female with long history of heartburn, regurgitation and odynophagia. She tells you that she first developed heartburn over 10 years ago when she was pregnant. Her symptoms improved after the birth but never resolved. She’s managed her symptoms with Gaviscon until last year when she was started on omeprazole. She took this for a month and her symptoms improved considerably. She isn’t keen on taking regular medication, so stopped the omeprazole. Since then, her symptoms have worsened, and she now has heartburn every night and frequently during the day. Hot drinks and alcohol hurt in her chest when she swallows and occasionally food seems to stick in her chest. You arrange an endoscopy. Below is an image of her lower oesophagus:

Image credit: https://www.endoscopy-campus.com/en/classifications/reflux-esophagitis-los-angeles-classification/

What is the diagnosis?

What drug treatment would you offer this patient?

Your next patient is a 58 year old male with a history of intermittent episodes of a feeling of food sticking in his lower oesophagus. This usually occurs when swallowing meat, especially steak. If he has a drink and waits, the blockage has always cleared but the last time it took several hours. He hasn’t lost any weight and doesn’t have any heartburn. You refer him for an endoscopy and this is an image of his lower oesophagus:

Image credit: https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/

What does the image show?

They are seen in roughly what percentage of patients undergoing barium swallow?

What are the treatment options?