The internationally accepted definition of dyspepsia is "chronic or recurrent pain or discomfort centered on the upper abdomen."Gastro-esophageal reflux disease on the other hand is defined as the presence of risks of physical complications of gastroesophageal reflux, or the experience of clinically significant impairment of health-related well being (quality of life) due to reflux related symptoms. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and H. pylori infection. There seems to be a significant overlap of pathophysiological disorders between dyspepsia and GERD. The diagnosis of dyspepsia is challenging. The use of self administered questionnaires in routine clinical care has been questioned by other authors as studies showed that the rate of recognition of heartburn differed between questionnaires. Endoscopy is the preferred procedure to detect lesions in the upper gastrointestinal tract. However, experts suggest empiric treatment over prompt endoscopy because of cost and limited availability of endoscope facilities. After a diagnosis of dyspepsia or GERD, the primary care physician can choose between the following strategies: symptom-guided empirical treatment, direct referral for endoscopy, non-invasive testing for H pylori and subjecting the H pylori positive patients to endoscopy ("test-and-scope"), and. non-invasive testing for H pylori and treatment of the infection in H pylori positive patients ("test-and-treat"). While the role of H pylori in peptic ulcer has been clearly established, its role in dyspepsia is still being debated. A recent meta-analysis suggested that there is a small benefit of about 10% over placebo. Considering the pathophysiology as acid reflux and dysfunctional motility as being the main problem, the combination of a prokinetic like domperidone and a PPI like pantoprazole may offer improved response to empiric treatment. Starting the patient on high potency drugs or combination treatment (step-down approach) is therefore a new strategy that has potential impact to improve response. Potential advantages of the step-down approach include faster healing, maximum symptom relief and a more rapid improvement in the patient's quality of life. Adherence to treatment is also an issue for a chronic and relapsing illness like dyspepsia and GERD. Adherence to prescribed self-administered medication is low in patients with chronic conditions. It is estimated to average only 50%. Fixed dose and sustained release formulations are designed to decrease the number of pills to be taken and the frequency of dosing Le. simplifying the treatment regimen thereby improving adherence. Dyspepsia is a multi-factorial syndrome. Abnormalities include disturbances of GI motor and sensory function as well as specific psychological disorders including depression and anxiety. An intensive medical treatment targeting GI abnormalities with psychological interventions will result to better long-term improvement of symptoms.
DYSPEPSIA ; INDIGESTION

BACKGROUND AND OBJECTIVES: Previous studies using older diagnostic criteria indicated chronic Hepatitis B and alcohol as the most common etiologies of HCC in the Philippines. No recent studies updated criteria for diagnosis have been published. This study used the diagnostic criteria from the latest APASL guidelines to describe the demographic profile of patients with HCC.

METHODS: This is a cross-sectional study of adult HCC cases from a liver tumor registry in the Philippine General Hospital from 2009 to 2012. Demographics, AFP levels, BCLC stage, Child-Pugh Score, ECOG performance status, treatments received, and mortality were assessed.

RESULTS: The HCC prevalence rate was 7.8%, mostly occurring between ages 40 to 65 years. It is more common in males (M:F=4:1). Most of the HCC cases were diagnosed at early stages, with less severity of liver functional impairment compared to older studies. Resection was the common treatment undertaken (50%) and overall mortality rate at the time of hospital discharge was 25%. 

CONCLUSION: The profile of HCC patients in this study is similar to previous studies. More cases were recognized at earlier stages with better liver function, implying better treatment outcomes with surgery, although selection bias is recognized.

Human ; Male ; Female ; Middle Aged ; Adult ; Hepatitis B, Chronic ; Prevalence ; Selection Bias ; Hospitals, General ; Liver Neoplasms ; Alcohols

Rationale. COVID-19 pandemic disease, can be transmitted during gastrointestinal procedures, via aerosolized droplets, and via fecal shedding. Both international and local endoscopy societies have issued strategies to alleviate the risk to endoscopy personnel. However, several barriers against the implementation of these recommendations exist thus individual center’s policies are employed whenever applicable. Objectives. This narrative study aims to describe the current experience and set-up in the endoscopy unit of a COVID referral center, discuss the stratification of patients for endoscopy, the operational management of the personnel and endoscopy unit in line with the adapted local and international guidelines and offer endoscopists a quick reference guide to adapt endoscopy practice during the pandemic in a resource-limited setting. Methodology. This paper reviews and consolidates current endoscopy guidelines and describes the single-center experience of Philippine General Hospital. Results. In resource-limited settings, with uncertainties of prolonged COVID-19 impact to healthcare, modification of practice, adherence to strategies and recommendations, empowerment of workforce, establishing the sustainability of resources, training, and service to patients, are essential components to combat current dilemma brought about by this pandemic. Conclusion. Integration of current local and international guidelines encompass all aspects of endoscopy practice during the pandemic. The recommendations cited are aimed to guide other resource-limited endoscopy units for potential changes and guidance in the overall practice.
COVID-19

Gastroenterology ; Endoscopy, Gastrointestinal ; Consensus ; Colorectal Neoplasms ; Survival Rate ; Incidence ; Philippines ; Colonic Polyps ; Adenoma