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Chapter 35 (page 179)
The area with the highest prevalence of oesophageal carcinoma in the world is the
Transkei region of South Africa (Sagar l989). The majority of patients first consult
traditional healers, by whom they are treated, presenting at a hospital only when the
disease has reached an advanced stage. At Tygerberg Hospital it is not unusual to see 3
or 4 new cases of advanced oesophageal carcinoma per week.
Common factors in the 11 cases mentioned here, are: (1) In all the malignant lesion
involves the gastro-oesophageal junction and/or the region immediately above the
junction, i.e. the intrahiatal part of the oesophagus. This is well seen in Case 35.4. (2) In
all cases partial contraction (i.e. spasm) of the pyloric sphincteric cylinder was evident.
Why the cylinder should show motility disturbances in these cases is not known. One
possibility is that the malignant process may involve the vagus nerves in the oesophageal
hiatus of the diaphragm. Keet and Heydenrych (l97l) showed that experimental
stimulation of the vagi at this site caused contraction of the pyloric sphincteric cylinder
Permanent contraction or spasm of the pyloric sphincteric cylinder will impair trituration
and gastric emptying of solids (Chap. 18). As the swallowing of solids becomes
impossible in advanced oesophageal carcinoma, this should have theoretical implications
only. Gastric emptying of fluids is not delayed by moderate contraction of the
sphincteric cylinder (Chap. 13, 18), and fluids reaching the stomach through the
oesophageal lesion should empty without undue delay. Moderate contraction of the
cylinder "fixes" the pyloric aperture in the patent position (Chap. 20), so that increased
duodenogastric reflux may be expected (Chap. 27).
- Keet AD, Heydenrych JJ. Hiatus hernia, pyloric muscle hypertrophy and
contracted pyloric segment in adults. Amer J Roentg Rad Ther Nucl
Med l97l, 113, 217-228.
- Sagar PM. Aetiology of cancer of the oesophagus : geographical studies in the
footsteps of Marco Polo and beyond. Gut l989, 30, 561-564.
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