Non-Pharmacological approach for the management of gastroesophageal reflux disease.

Treatment of Gastro-Esophageal Reflux Disease (GERD) is becoming a challenge. Proton pump inhibitors (PPIs) are commonly prescribed but have many risks, particularly in long-term use. In an earlier pilot study, we have reported benefits of short-term practice of a new life-style, two meals a day with only liquids in between, for management of GERD. Present case report demonstrates benefits of long-term practice of this dietary regimen. A 61 year old patient complaining of night refluxes was diagnosed to have severe GERD with ulcerations at gastroesophageal junction and was advised to take two meals a day with only water, fruit juice, tea, or milk in intervening period. His reflux symptoms improved within fortnight and he remained well for long-time. Endoscopy done after seven years revealed competent and clear gastroesophageal junction. It is concluded that suggested life-style, "Akram's life-style", for GERD is a useful alternate to risky medical and surgical interventions.

Primary hypertrophic osteoarthropathy.

We describe two cases of familial primary hypertrophic osteoarthropathy. In this family, brother and a sister were affected with history of similar features in father.

Efficacy and safety of cinitapride in functional dyspepsia.

OBJECTIVE: To study the efficacy and safety of cinitapride in the treatment of functional dyspepsia, and to evaluate the improvement of patients' quality of life. METHODS: The prospective cross-sectional multi-centre phase IV study was conducted at Jinnah Hospital, Lahore, Ziauddin Medical University, Karachi and Pakistan Railways General Hospital, Rawalpindi, from July 2009 to June 2010 and comprised 121 patients of functional dyspepsia who were given cinitapride 1mg thrice daily 15 minutes before meals and were followed up for four weeks. Primary clinical response was assessed by using the Global Index Score. Secondary response was seen by percentage change of the total score as well as of each dyspepsia symptom compared with baseline and the overall subjective assessment of patients by using the 7-point Likert's scale. Reduction in Nepean Dyspepsia Index-Short Farm was used to evaluate the improvement in quality of life of patients at week 2 and 4. SPSS 15 used for statistical analysis. RESULTS: After 4 weeks of treatment, the Global Index Score showed statistically significant reduction in 58 (48.92%) patients (p<0.01). Similar reduction (p<0.01) was seen in individual dyspepsia symptoms; early satiety, post-prandial fullness, and abdominal distension. The 7 point Likert's scale also showed similar improvement in subjective response (p<0.01).The quality of life also improved significantly at week 2 and 4 (p<0.01). No abnormal results were seen in vital signs, physical and laboratory examination except an unexplained rise in globulin level. Only one adverse event (sore throat) was reported during the study. CONCLUSION: The drug was effective in minimising dyspepsia symptoms, and improving the quality of life of patients. It was well tolerated and was almost free of side effects.

Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM) of stomach and spleen: a case report.

BACKGROUND: In this paper we are reporting one case of exsanguinating upper gastrointestinal tract (GIT) bleed requiring massive blood transfusion and immediate life saving surgery. CASE PRESENTATION: A 30 years old female, 12 weeks pregnant was referred to our hospital from the earth-quake affected area of Kashmir with history of upper abdominal pain, haematemesis and melaena for one week. After stabilizing the patient, upper gastro-intestinal endoscopy was performed. It revealed gastric ulcer just distal to the gastro-esophageal junction on the lesser curvature. Biopsy from the ulcer edge led to profuse spurting of the blood and patient went into state of shock. Immediate resuscitation led to rebleeding and recurrence of post haemorrahagic shock. CONCLUSION: The patient was immediately explored and total gastrectectomy with splenectomy concluded as life saving procedure. A review of literature was conducted to make this report possible.

Gastric carcinoma: 5 years survival after gastric surgery.

OBJECTIVE: To study the five years survival rate after resection for gastric carcinoma. METHODS: Fifty six patients with gastric carcinoma in different stages were followed up for 5 years after gastric surgery to see recurrence, complications and survival rate. RESULTS: Of the 56 patients, 6 underwent total gastrectomy, 50 partial gastrectomy, 7 Billroth I and 43 modified DI resection with Billroth II reconstruction. Six patients were alive at the end of 5th year, 3 with early gastric carcinoma and 3 with locally advanced carcinoma. Mortality was 17 patients in the first year, 10 in second year, 8 in third year, 3 in fourth year and 1 in the fifth year. CONCLUSION: Gastric carcinoma carries a bad prognosis. The 5-year survival rate in our series was 13.3% [corrected] Efforts should be made to diagnose and treat these patients at an early stage.