Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology.

The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.

Behcet's Disease: The Darker side !

Behcet's disease (BD) is a chronic inflammatory disease affecting blood vessels throughout the body mainly veins and clinically characterized by oro-genital aphthae ,ophthalmologic involvement ,cutaneous lesions ,articular, neurological involvement and less commonly by gastrointestinal manifestations which may have dreadful complications. Here we report a case of 58 year male with gastrointestinal complications of BD and a rapidly worsening course.

Type 1 diabetes mellitus and extrahepatic portal vein obstruction: a causal association?

So far, no association has been described between multifactiorial disorders such as insulin- dependent diabetes mellitus and extrahepatic portal vein obstruction (EHPVO), which is the most common cause of extra-hepatic portal hypertension in children. We describe 3 cases of EHPVO who developed type 1 diabetes mellitus.

Management of ingested foreign bodies in upper gastrointestinal tract: report on 170 patients.

BACKGROUND: Ingestion of foreign bodies (FB) is commonly encountered in gastrointestinal practice. METHODS: Retrospective analysis of data on endoscopic removal of FB in 170 patients (124 children) who were managed at a tertiary referral center over a six-year period. OUTCOME: Coins were the most common FB removed (n=134). Dentures (12), food boluses (19), sharp objects such as needles and pins (7), and certain unusual FB (12) made up the remainder. Esophagus was the most common site of FB lodgement (56%). Most patients with esophageal FB complained of FB sensation, dysphagia, odynophagia or chest pain. Gastric and duodenal FB produced no symptoms. FB could be successfully removed endoscopically in 166 patients (97.6%) without morbidity or mortality. Four patients required surgical removal of FB. Certain Innovative methods like loop basket, electrocautery and suction retrieval were used to remove some FB. CONCLUSION: Endoscopic removal of FB in the esophagus and stomach is safe but often requires the use of innovative techniques and accessories.