SUMMARY This paper reports the incidence and natural history of macroscopic gastritis in a series of 127 consecutive patients with portal hypertension of various aetiologies. Gastritis was observed endoscopically in 65 patients (51%) and was of two main types. Twenty eight patients had severe or persistent gastritis which caused clinically significant bleeding on 80 occasions and accounted for 25% of the bleeds from all sources. The remainder had mild gastritis. The presence of gastritis seemed to be independent of the severity of liver disease or the degree of rise of wedged hepatic venous pressure and there was no difference in age, sex, or drugs prescribed in patients with or without gastritis. The mean follow up period and the mean number of sclerotherapy treatments was significantly greater (p<0.005) in patients with gastritis. Full thickness gastric biopsies in seven surgical patients and 11 autopsy specimens showed dilated and tortuous submucosal veins. Endoscopic biopsies in 14 patients showed vascular ectasia in the mucosal layer which was in excess of the degree of inflammatory infiltrate. Gastritis occurred in patients with portal hypertension of all common aetiologies and the clinical and pathological evidence supports the contention that it reflects a congested gastric mucosa and should be renamed congestive gastropathy. As injection sclerotherapy improves survival from variceal bleeding congestive gastropathy may become more common. The response to conventional ('anti-erosive') therapy is poor and measures aimed at reducing the gastric portal pressure may be the only effective means of treating this condition.

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SUMMARY Serial studies were carried out on six healthy volunteers (19-24 years) to investigate the effect of meal temperature [either 4°C (cold), 37°C (control) or 50°C (warm)] on the rate of gastric emptying of a radiolabelled isosmotic drink of orange juice. The mean maximum intragastric temperature occurred 60 seconds after the onset of ingestion of the warm drink and reached 43 O0C (0.4) mean (SD) while the mean minimum intragastric temperature occurred 45 seconds after the onset of ingestion of the cold drink and reached 21 2°C (1-9). Intragastric temperature then returned to body temperature within 20-30 minutes of ingestion of the warm and cold drinks. Warm and cold drinks appeared to empty from the stomach more slowly than the control drink. The initial rate of gastric emptying of the cold drink was significantly slower than the control drink (p<005) and the difference in emptying rates between cold and control drinks were significantly correlated with the differences in intragastric temperatures (p<0-01). The difference in the initial emptying rates between warm and control drinks were not statistically significant.Several studies have assessed the effect of meal temperature on the rate of gastric emptying with conflicting results. '`The question of thermal effects on gastrointestinal function is pertinent for several reasons, however. First, specific thermosensitive afferent fibres with endings in the gastrointestinal mucosa have been identified in the vagus nerves of cats.' Three types of thermoreceptor have been described all of which are silent at normal core temperature; cold receptors respond at temperatures below 36°C with an optimum at 10-12°C, warm receptors respond optimally at 46-49°C, while mixed receptors respond to both warming and cooling of the mucosal surface.7 Second, activation of vagal thermoreceptors reflexly inhibits gastroduodenal motility and could therefore have a direct effect on gastric emptying.'The physiological significance of these vagal thermoreceptors is difficult to gauge because neural responses occur at temperatures well away from normal core temperatures and because changes in intragastric temperature associated with ingestion of warm or cold meals, are likely to be limited by heat exchange during passage down the oesophagus.

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