METHODS: A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations.
RESULTS: A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer.
CONCLUSIONS: These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.
METHODS: A cross-sectional study of consecutive adult patients attending an open access endoscopy list for the primary indication of dyspepsia was conducted. Independent epidemiological and clinical factors for CSEF were determined prospectively.
RESULTS: Data for 1167/1208 (96.6 %) adults (mean age 49.7 ± 15.9 years, 42.4 % males, ethnic distribution: 30.5 % Malays, 36.9 % Chinese and 30.8 % Indians) were analysed between January 2007 and August 2008. Three-hundred and eight (26.4 %) patients were found to have CSEF, most often those with age ≥45 years (30.3 vs 19 %, P < 0.0001), male gender (34.1 vs 20.7 % female, P < 0.0001), lower education levels (i.e. primary or no education), smoking (36.7 vs 24.9 %, P = 0.003), H. pylori infection (40.6 vs 21.8 %, P < 0.0001), and duration of dyspepsia ≤5 months (32.8 vs 24.4 %, P = 0.006). Age ≥ 45 years (OR 1.82, 95 % CI = 1.38-2.48), male gender (OR 1.84, 95 % CI = 1.53-2.59), H. pylori infection (OR 2.36, 95 % CI = 1.83-3.26), and duration of dyspepsia ≤5 months (OR 1.44, 95 % CI = 1.13-2.03) were subsequently identified as independent risk factors for CSEF.
CONCLUSION: CSEF are found in 26.4 % of Asian adults with uninvestigated dyspepsia. Duration of symptoms <5 months, among other recognised factors, is predictive of CSEF.
CASE PRESENTATION: A 76-year old male patient, presented to the department with a chief complaint of sensitivity in his upper right back tooth due to attrition. After assessing the pulp status, root canal therapy was planned for the tooth. During the procedure, it was noticed that the dental bur slipped out of the hand piece and the patient had accidentally ingested it. The patient was conscious and had no trouble while breathing at the time of ingestion of the bur although he had mild cough which lasted for a short duration. The dental procedure was aborted immediately and the patient was taken to the hospital for emergency care. The presence and location of the dental bur was confirmed using chest and abdominal x-rays and it was subsequently retrieved by esophagogastroduodenoscopy (EGD) procedure under general anaesthesia on the same day as a part of the emergency procedure. The analysis of this case reaffirms the importance of the use of physical barriers such as rubber dams and gauze screens as precautionary measures to prevent such incidents from occurring.
CONCLUSION: Ingestion of instruments are uncertain and hazardous complications to encounter during a dental procedure. The need for physical barrier like rubber dam is mandatory for all dental procedures. However, the dentist should be well trained to handle such medical emergencies and reassure the patient by taking them into confidence. Each incident encountered should be thoroughly documented to supply adequate guidance for treatment aspects. This would fulfil the professional responsibilities of the dentist/ clinician and may help avoid possible legal and ethical issues. This case report emphasizes on the need for the usage of physical barriers during dental procedures in order to avoid medical emergencies.