In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.

Physicians, Primary Care ; Prevalence ; Specialization ; Gastroesophageal Reflux ; Ambulatory Care ; Esophagitis ;

Background: Gastric volvulus is an emergency which warrants immediate correction. It presents clinically with epigastric pain radiating to the back and or left thoracic area or left upper abdominal quadrant, retching and difficulty in passing a nasogastric tube.Case Report: This is a case of a 55-year old male, who had a six-year history of mild, intermittent epigastric pain, bloatedness and occasional retching.Two weeks prior to admission, he had severe, nonradiating epigastric pain accompanied by coffee-ground vomitus, and melena. Chest radiograph revealed an air fluid level in the left lower lungfield. Upper gastrointestinal endoscopy revealed twisting of the rugal folds at a constriction seen at the midportion of the gastric body. Upper gastrointestinal series showed that the stomach was located intraabdominally, but the fundus was seemingly connected to the duodenum, while the distal esophagus was connected to the distal part of the stomach. Exploratory laparotomy was done which revealed a Morgagni hernia with the stomach located in the thorax and rotated along its transverse axis. Reduction and repair of hernia were done.Conclusion: Gastric volvulus mimics many conditions including gastric distention, cardiopulmonary diseases, cholecystitis, gastric and duodenal ulcer andpancreatitis. Therefore, it can be included in the differential diagnosis of chronic abdominal pain.
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OBJECTIVE: To determine the applicability and feasibility of current guidelines to the prevailing healthcare situation in the Philippines.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Gastrointestinal Hemorrhage ; Gastrointestinal Diseases ; Standards ; Analysis

Background : Quality of life (QoL) is arguably as important as the survival rate in patients with hepatocellular carcinoma (HCC). However, very few studies have evaluated the factors that determine good or poor QoL in patients with HCC.Objectives:To correlate baseline QoL (EORTC-QLQC30) with baseline laboratory and clinical parameters among HCC patients.Patients and Method: Thirty nine consecutive newly-diagnosed HCC patients were recruited, Spearman;s rank correlation was used to correlate the QoL scores, which consisted of 15 domians, wirg continous baseline variables while the Mann-Whitney U or kruskal Wallis tests were used for categorial variables.Results: The mean age of the cohort was 61.3 +- 14.5, majority of whom were male(89.7). Majority had childs Pugh Turcott (CPT) score af A (61.5%) and barcelona Clinic Liver cancer (BCLC) stage A-B (76.9%). A third (33.3%) knew of their diagnosis at the time of QoL between the 2 groups (p>0.05). There was no consistent pattern in the correlation between laboratory parameters with QoL, with some running contrary to conventional reasoning (Higher international normalized ratio correlation with better role function[p=0.02] and less pain [0.035]; CPT score A associated with lower global health status compared to CPT B/C [p=0.028]). On the other hand, BCLC staging was a more sensible relection of QoL with BCLC A/B patients having higher physical (p=0.014) and social (p=0.049) function, and lower symptom scores for nausses/vomiting (p=0.041) and dyspnea (p=0.004) than patients with BCLC C/D.Conclusion: baseline EORTC-QLC-C30 of patients with HCC has no consistent correlation with the severity of liver dysfunction. Correlation of some domains of the EORTC-QLQ-C30 with BCLC staging suggests that umor burden is the main determinant of QoL in HCC patients. Further studies are needed to determine whether baseline QoL predicts survival independent of HCC staging.
Hepatocellular Carcinoma