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OBJECTIVE: Non-erosive reflux disease (NERD) constitutes the majority of patients with gastroesophageal reflux disease (GERD). Esophageal pH monitoring is useful in distinguishing patients with NERD from functional heartburn. The gastroenterologist often faces the dilemma of choosing the most appropriate investigative modality. The wireless Bravo® capsule allows prolonged 48 hour monitoring with improved patient tolerance, but concerns regarding its reduced sensitivity compared to conventional pH catheter have been raised. We compared the prevalence of high esophageal acid exposure and positive symptom correlation profiles (using the symptom index [SI] and symptom association probability [SAP]) in patients who underwent Bravo® compared to patients who underwent conventional pH catheter, and evaluated the efficacy of Bravo® monitoring in a multiracial Asian cohort. METHODS: Retrospective analysis of all pH studies performed between January 2004 and February 2009 for patients with persistent reflux symptoms and a normal gastroscopy. RESULTS: 66 (27 Male, 42.4 ± 13.4 years) and 55 (24 Male, 47.1 ± 13.3 years) patients underwent wireless and pH catheter evaluation respectively. “True NERD” (abnormal acid exposure) was diagnosed in 26 (39.4%) and 20 (36.4%) patients (pNS) while “acid-sensitive esophagus” (SI ≥ 50% and/or SAP ≥ 95%) occurred in 14 (21.2%) and 12 (21.8%) patients (pNS) using the wireless and pH catheter respectively. Extended recording time with Bravo® led to an incremental diagnostic yield of 30%. CONCLUSION: The wireless capsule was well tolerated. The diagnostic yield was similar using both modalities. With the increasing availability of impedance-pH technology, it is uncertain if devices that detect only acid-reflux events will be surpassed. [ABSTRACT FROM AUTHOR]

OBJECTIVE:  To evaluate the role of endoscopic drainage and endoscopic necrosectomy in the management of symptomatic pancreatic fluid collection. METHODS:  The clinical data of patients with symptomatic pancreatic fluid collection referred for endoscopic drainage were captured prospectively and analyzed. Pancreatic duct disruption was treated with stenting. Endosonography-guided transmural drainage and endoscopic necrosectomy were performed when indicated. RESULTS:  Fifteen consecutive patients (mean age 53.7 years; range 23–82 years) underwent endoscopic management of pancreatic fluid collections (pseudocysts: six; abscesses: six; infected walled-off necrosis: three). Pancreatic duct fistulas were present in 13 patients. The drainage techniques used were: (i) transpapillary drainage; five; (ii) transmural drainage; two (these two patients had no pancreatic duct fistulas); and (iii) combined transpapillary and transmural drainage; eight. An additional transgastric endoscopic necrosectomy was performed in five patients. The endoscopic treatment was successful in all cases. The only complication was asymptomatic pneumo-peritoneum that occurred in one patient. Combined transpapillary and transmural drainage led to the faster resolution of the fluid collection compared to transpapillary drainage (75.6 vs 147 days, P = 0.03). No recurrence occurred over a mean follow up of 486 days. CONCLUSION:  Endoscopic drainage and endoscopic necrosectomy are safe and effective techniques for the treatment of symptomatic pancreatic fluid collection. [ABSTRACT FROM AUTHOR]

The article presents a case study of a Chinese male who was referred for dysphagia and regurgitation. Using Barium swallows and gastroscopy, a presumptive diagnosis of achalasia was made. After serial esophageal dilatations, he experienced intermittent episodes of abdominal bloating, weight loss and reduced bowel movements which clinical investigations diagnosed to be small-bowel intestinal obstruction (IO) without a mechanical cause called chronic intestinal pseudo-obstruction (CIPO).

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced procedure with significant complication rate of 5 to 10%. Scant data is available on quality indicators for trainee-involved ERCP. In our study, we evaluated the outcome of trainee-involved ERCPs in which a protocol-based strategy to minimize complications during selective biliary cannulation was adopted. Patients and methods: Hands-on training was excluded if patients had ASA grade > 3. The trainee's attempts at selective biliary cannulation were stopped and the procedure taken over by the supervising expert endoscopist if the following factors were encountered: (1) failed cannulation after 5 attempts; (2) unsuccessful cannulation after 10 minutes; (3) edematous papilla; (4) pancreatic duct cannulation ≥ 2 times. After successful ductal cannulation, the trainee was allowed to continue additional hands on training in other aspects such as stone extraction and stenting. Results: During the study period, 331 patients underwent ERCP. Trainee group (TG) consisted of 85 patients; mean age 70 (range 27-99). Expert group (EG) consisted of 246 patients; mean age 65 (range 19-98). The overall technical success rate was 97.9% and there was no significant difference between TG (98.8%) and EG (97.6%). The overall complication rate was 3.9% and there was no difference between TG (3.5%) and EG (4%). In TG, although inadvertent pancreatic duct cannulation occurred in 12/85 (14.1%), acute pancreatitis developed only in 3/85 (3.5%). Conclusion: The high success and low complication rates in trainee-involved and expert-only ERCP procedures were similar. While using a protocol-based strategy, good clinical outcome during the provision of hands-on training for ERCP was observed. [ABSTRACT FROM AUTHOR]

Aim: : This study aimed to determine hepatitis B (HBV) carriers' understanding of the etiology, pathology, monitoring and therapy of their chronic disease. Methods: A qualitative study using focus group discussion (FGD) and a semi-structured guideline to explore HBV carriers' understanding of their disease. Result: Thirty-nine asymptomatic HBV carriers of both genders, three races (Chinese, Malays and Indians) and aged 22-75 years were recruited in eight FGDs. Most carriers were aware of the viral origin, its effect on the liver and the main modes of transmission. Confusion of HBV with hepatitis A and transmission with shellfish was common. All had and were aware that the blood and liver ultrasound investigations were to detect liver complications but failed to recognize the need for regular monitoring in view of previous 'normal' results. They were also unaware of the current strategy in the use of anti-viral therapy and relied mostly on their doctors for HBV-related information. Conclusions: HBV carriers had fragmented understanding of their disease. They were less aware of the significance and need for regular disease surveillance or the availability of anti-viral therapy for definitive treatment, and were dependent mostly upon their doctors for health education. [ABSTRACT FROM AUTHOR]

Background: In Singapore, the highest incidence of gastric cancer occurs in the Chinese (C), with lower rates among Malay (M) and Indian (I) subjects. The purpose of the present paper was to examine whether racial differences in the prevalence of Helicobacter pylori and serum pepsinogen (PG) could account for this difference. Methods: A randomized community health survey involving 7000 asymptomatic healthy individuals was conducted. Among the Chinese, Malay and Indian respondents, subjects were matched for age, gender and race and a total of 595 sera were obtained. The H. pylori seropositivity and serum PG levels were determined by ELISA. The dependency of the cumulative gastric incidence rate on H. pylori seroprevalence was evaluated by linear regression. The racial difference in the seroprevalence of H. pylori and low serum PG was determined. Results: The H. pylori seroprevalence was similar between Chinese and Indian subjects, but significantly lower among Malay subjects (C, 46.3%; M, 27.9%; I, 48.1%). The gastric cancer incidence rates correlated with H. pylori seropositivity for the Chinese and Malay subjects, but not for the Indian subjects. The prevalence of low PG was highest in Indian subjects (PG I low: C, 2.1%; M, 5.4%; I, 14.2%; P < 0.0001; PG I:II ratio low: C, 5.3%; M, 5.9%; I, 12.6%; P = 0.012), even when adjusted for gender and the presence of H. pylori. Conclusions: The difference in gastric cancer incidence correlated with H. pylori seroprevalence for Chinese and Malay subjects. The lower incidence of gastric cancer among Indian subjects cannot be explained by differences in H. pylori or serum PG. Other modifying factors such as host and environmental factors may be important. © 2005 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]