Conversely, a mean time to endoscopy ≤ 15 hours was significantly associated with improved survival among 312 patients in an independent population.10 However, the door-to-scope time was not a highly sensitive PD0332991 cost (72%) or specific (59%) indicator of mortality because the Model for End-Stage Liver Disease score on admission, the failure to control bleeding during initial esophagogastroduodenoscopy,

and the presence of hematemesis were more influential in determining mortality. Additional studies are required to ensure that rapid endoscopy is being performed for all patients with evidence of severe AVH. The relationship between the quality and the case volume has been studied extensively with the general notion that more experience could reduce population mortality and improve the efficiency of care. In contrast to other acute conditions, a significant relationship has not been identified between the volume and the outcomes after AVH.11, 12 Issues of inadequate risk adjustment and the absence of key predictors within claims data have likely contributed to the negative findings. From the standpoint of endoscopy, there appears to be broad consensus on the use of variceal band Selleckchem RG-7388 ligation versus sclerotherapy in the treatment of AVH.8 However, the use of antibiotic

prophylaxis and systemic vasoconstrictors is more variable for AVH.2-6 Surprisingly, this degree of variation in the process of care has not been

associated with increased mortality from AVH. The case mix and the severity of disease likely play significant roles, and their influence on outcomes also deserves further study. “
“A 59-year-old Japanese male presented to our hospital for further examination of gastric cancer diagnosed by medical check-up. The patient had a history of hypertension, which was medically treated 3 years ago by administration of a vasodilator, but there was no past history of Orotic acid trauma or abdominal symptoms. An electrocardiogram, chest radiograph, and abdominal plain film were also normal. On computed tomography (CT) imaging as further examination for gastric cancer, there were no indications of distant metastasis or local advance. Contrast-enhanced CT imaging revealed an enlarged and irregular diameter of the superior mesenteric artery (SMA) with a mural thrombus, but without signs of bowel ischemia or ascites (Figure 1). On the CT coronal image, the thrombus in the false lumen originated 5.3 cm from the SMA origin and extended for approximately 3.7 cm (Figure 2). Although a portion of the true lumen was compressed by the thrombosed false lumen, distal blood flow was preserved. The patient underwent laparoscopy-assisted distal gastrectomy with regional lymph node dissection, resulting in the diagnosis of signet ring cell carcinoma invading the gastric submucosal layer without lymph node metastasis.

Acute exacerbation of chronic HBV infection was defined as an increase of serum alanine aminotransferase (ALT) level more than five times the upper limit of normal. We analyzed

the causes and the clinical course of these patients with acute exacerbation. Results: The most frequent cause of acute exacerbation arised from hepatitis B viral factors; spontaneous reactivation(48.1%) and HBeAg seroconver-sion(10.0%). The next arised from hepatotoxicity; alcohol(8.1%) and drugs including herbal medicines(7.6%). Vemurafenib Accompanying other diseases(12.9%), coinfection by hepatitis A virus(7.2%) or hepatitis D virus(1.9%), the development of hepatocellular carcinoma (HCC)(1.9%), and liver injury(1%) were the Maraviroc mw rest. Spontaneous reactivation of HBV showed the longest period to ALT normalization among the causes of acute exacerbation of which the average duration was 134.5 ± 184.2 days. A total of four patients rapidly deteriorated to fulminant hepatic failure; three of them died, one

transferred to receive liver transplantation. Herbal medicine, alcohol, HCC development and traumatic liver laceration were the causes of liver failure, respectively. Conclusions: The main causes of acute exacerbation in asymptomatic HBV infection were spontaneous reactivation of HBV and HBeAg seroconversion which tented to recover well through antiviral therapy or spontaneously. Otherwise, The greatest care should be taken in managing acute exacerbation of HBV-infected patients by hepatotoxicity or HCC development. Disclosures: The following people have nothing to disclose: Woo Hee Cho, Hyoung Joon Kim, Sun Young Cho, Young Kwang Choo, Sung Soo La, Suk Bae Kim, Il Han Song Background/Aim. Most common occurring HBV variants include precore stop codon (PC) and the dual mutation in basal core promoter region (BCP). We aimed to determine

prevalence of PC and BCP in a multi ethnic chronic hepatitis B population and establish association of these variants with demographical, clinical, virological and histological data. Methods. At inclusion a liver biopsy and a serum sample the same day. Demographical, clinical and biochemical data were collected. HBeAg status [(e+) or (e-)], HBV variants, HBV DNA and HBsAg titers, HBV and IL28B genotypes, histological lesions were determined the day Calpain of liver biopsy. Results: 406 consecutive CHB patients, 101 e(+) and 305 e(-). Wild type (WT), BCP, PC, and BCP+PC found in 18%, 29%, 25% and 28%, respectively. Mean age was 40±12 years, 76% were male, 42% Caucasian, 18% Asian, and 40% Black African. HBV genotype A, B, C, D, and D found in 26%, 11%, 9%; 24%, and 30%, respectively, IL28 genotype CC, TT and CT found in 43%, 26%, and 31%, respectively. Fibrosis stage >F1 found in 39%, Activity grade >1 found in 29%. HBV DNA titers <3.3, 3.3 to 4.3 and >4.3 log IU/ml found in 21%, 20% and 59%, respectively. HBsAg titers <3.3, 3.

Acute exacerbation of chronic HBV infection was defined as an increase of serum alanine aminotransferase (ALT) level more than five times the upper limit of normal. We analyzed

the causes and the clinical course of these patients with acute exacerbation. Results: The most frequent cause of acute exacerbation arised from hepatitis B viral factors; spontaneous reactivation(48.1%) and HBeAg seroconver-sion(10.0%). The next arised from hepatotoxicity; alcohol(8.1%) and drugs including herbal medicines(7.6%). DMXAA Accompanying other diseases(12.9%), coinfection by hepatitis A virus(7.2%) or hepatitis D virus(1.9%), the development of hepatocellular carcinoma (HCC)(1.9%), and liver injury(1%) were the LY2157299 cost rest. Spontaneous reactivation of HBV showed the longest period to ALT normalization among the causes of acute exacerbation of which the average duration was 134.5 ± 184.2 days. A total of four patients rapidly deteriorated to fulminant hepatic failure; three of them died, one

transferred to receive liver transplantation. Herbal medicine, alcohol, HCC development and traumatic liver laceration were the causes of liver failure, respectively. Conclusions: The main causes of acute exacerbation in asymptomatic HBV infection were spontaneous reactivation of HBV and HBeAg seroconversion which tented to recover well through antiviral therapy or spontaneously. Otherwise, The greatest care should be taken in managing acute exacerbation of HBV-infected patients by hepatotoxicity or HCC development. Disclosures: The following people have nothing to disclose: Woo Hee Cho, Hyoung Joon Kim, Sun Young Cho, Young Kwang Choo, Sung Soo La, Suk Bae Kim, Il Han Song Background/Aim. Most common occurring HBV variants include precore stop codon (PC) and the dual mutation in basal core promoter region (BCP). We aimed to determine

prevalence of PC and BCP in a multi ethnic chronic hepatitis B population and establish association of these variants with demographical, clinical, virological and histological data. Methods. At inclusion a liver biopsy and a serum sample the same day. Demographical, clinical and biochemical data were collected. HBeAg status [(e+) or (e-)], HBV variants, HBV DNA and HBsAg titers, HBV and IL28B genotypes, histological lesions were determined the day Mannose-binding protein-associated serine protease of liver biopsy. Results: 406 consecutive CHB patients, 101 e(+) and 305 e(-). Wild type (WT), BCP, PC, and BCP+PC found in 18%, 29%, 25% and 28%, respectively. Mean age was 40±12 years, 76% were male, 42% Caucasian, 18% Asian, and 40% Black African. HBV genotype A, B, C, D, and D found in 26%, 11%, 9%; 24%, and 30%, respectively, IL28 genotype CC, TT and CT found in 43%, 26%, and 31%, respectively. Fibrosis stage >F1 found in 39%, Activity grade >1 found in 29%. HBV DNA titers <3.3, 3.3 to 4.3 and >4.3 log IU/ml found in 21%, 20% and 59%, respectively. HBsAg titers <3.3, 3.

“
“A 56-year-old woman was referred compound screening assay to our hospital due to fever and cholestatic liver

dysfunction. Her eosinophil count was normal and she had no abdominal pain or neurological manifestations. We performed a liver biopsy and found fibrinoid necrosis of the hepatic artery with granulomatous reaction and eosinophilic infiltration in the portal area in the liver. Later, sensory abnormalities of the arms and legs appeared and the eosinophil count increased. Serum immunoglobulin E and immunoglobulin G4 were elevated and rheumatoid factor was strongly positive. Endoscopic retrograde cholangiopancreatography revealed no abnormality of the bile duct and pancreatic duct. We made a diagnosis of Churg–Strauss syndrome and began corticosteroid treatment. Fever and liver function immediately improved. In the present patient, Churg–Strauss syndrome manifested first in the liver, before hypereosinophilia and neural manifestations. We believe that Churg–Strauss syndrome is an autoimmune liver disease, and it is important to

recognize that the liver may be involved in Churg–Strauss syndrome. “
“Primary biliary cirrhosis (PBC) can be complicated by systemic sclerosis (SSc) and, more specifically, limited cutaneous SSc (lcSSc), which was previously called CREST syndrome. Moreover, combined PBC and SSc has been described in many case reports. Although neither the etiology of PBC nor that of SSc has been elucidated, some genetic and immunological factors are known to be shared. Both disorders are autoimmune fibrotic diseases characterized by increased levels of profibrotic cytokines transforming growth factor β (TGFβ) and interleukin-6, which have Cobimetinib solubility dmso recently been suggested to influence T-helper 17 cells and regulatory T cells involved in acquired

immunity. lcSSc is accompanied by CREST symptoms, although complete CREST cases are rare, with relatively high prevalence of Raynaud’s phenomenon, sclerodactyly and telangiectasia, and lower prevalence of calcinosis and esophageal dysmotility. Because patients with anticentromere antibody positive PBC–SSc are at a high risk of developing portal hypertension, particular attention should be paid to the management of gastroesophageal Rapamycin varices. In addition, the management of SSc-related non-hepatic disorders, such as pulmonary fibrosis, pulmonary hypertension, heart disorder, infection and malignancy, is also important for improved outcomes. Because PBC is often complicated by rheumatic disease, hepatologists should keep the possibility of systemic disorder in mind when examining PBC patients. “
“Background and Aim:  Biliary stricture may be benign or malignant and causes obstructive jaundice. Brush cytology is a simple technique for diagnosing the cause of biliary stricture; however, its sensitivity has been reported to be low. A technique that comprises diagnosing the cause of stricture with a satisfactory sensitivity and relieving jaundice is required.

Under these conditions the cells will reaggregate and form EB-like structures that support the continued differentiation of the respective populations. Alb message was only induced in the endoderm-enriched c-kithigh population, clearly demonstrating that Hex functioned to specify a hepatic fate directly in definitive endoderm (Fig. 4E). We have previously demonstrated that BMP-4 signaling induces a hepatocyte fate in activin-induced endoderm

during EB differentiation.18 To further examine the relationship between BMP-4 and Hex, day 6 activin-induced EBs were exposed to BMP-4, to Dox (1 μg/mL) or to both BMP-4 and Dox (1 μg/mL) from days 6 to 10. As previously shown, BMP-4 did induce Alb and Afp mRNA (Fig. 5A). The levels of Alb and Afp mRNA detected in day 14 hepatocyte cultures reached 19.7% and 25.8% of those found in Selleck Vemurafenib day 14 fetal liver, respectively, and were much higher than those induced by 1 μg/mL of Dox (days 6–10). The addition of basic fibroblast growth factor, hepatocyte growth factor, and vascular endothelial growth factor had no effect on Alb and Afp expression (data not shown). Interestingly, the combination of BMP-4 and Dox further increased Alb and Afp mRNA levels to 40.3% and 43.3% of those found in day 14 fetal liver, respectively (Fig. 5A). Expression of Cps1, a gene that encodes carbamoyl-phosphate synthetase 1

expressed in mature hepatocytes, was also synergistically CP868596 induced in the presence of BMP-4 and Dox on day 14 (Fig. 5B). To gain further insight

into the onset of hepatic development in these cultures, we evaluated the expression of Tcf1 and Cebpa, as these transcription factors are known to play a pivotal role in the establishment of the early liver by directly regulating expression of a variety of genes, including albumin, transferrin, and fibrinogen.25 Both BMP-4 and Dox (Hex) induced the expression of Tcf1 and Verteporfin mw Cebpa on day 10 of culture. As observed with the previous set of genes, the combination of BMP-4 and Dox resulted in a synergistic induction of expression of both (Fig. 5C), although the effect on Tcf1 was significantly greater than that observed on Cebpa. Taken together, these results suggest that BMP-4 and Hex function in a synergistic fashion to establish the liver fate, as defined by the up-regulation of expression of Tcf1, Cebpa, Alb, and Afp. In contrast to the above set of genes, neither BMP-4 nor Hex alone induced expression of CYP7a1 or TAT, two genes indicative of hepatic maturation, at day 10 of differentiation (Fig. 5D). The combination of BMP-4 signaling and Hex expression did result in low levels of CYP7a1 and TAT expression at this time. By day 14, Hex but not BMP-4 induced CYP7a1 and TAT expression. These findings indicate that maintenance of appropriate levels of Hex is essential for maturation of the hepatic lineage in culture.

Under these conditions the cells will reaggregate and form EB-like structures that support the continued differentiation of the respective populations. Alb message was only induced in the endoderm-enriched c-kithigh population, clearly demonstrating that Hex functioned to specify a hepatic fate directly in definitive endoderm (Fig. 4E). We have previously demonstrated that BMP-4 signaling induces a hepatocyte fate in activin-induced endoderm

during EB differentiation.18 To further examine the relationship between BMP-4 and Hex, day 6 activin-induced EBs were exposed to BMP-4, to Dox (1 μg/mL) or to both BMP-4 and Dox (1 μg/mL) from days 6 to 10. As previously shown, BMP-4 did induce Alb and Afp mRNA (Fig. 5A). The levels of Alb and Afp mRNA detected in day 14 hepatocyte cultures reached 19.7% and 25.8% of those found in MLN0128 order day 14 fetal liver, respectively, and were much higher than those induced by 1 μg/mL of Dox (days 6–10). The addition of basic fibroblast growth factor, hepatocyte growth factor, and vascular endothelial growth factor had no effect on Alb and Afp expression (data not shown). Interestingly, the combination of BMP-4 and Dox further increased Alb and Afp mRNA levels to 40.3% and 43.3% of those found in day 14 fetal liver, respectively (Fig. 5A). Expression of Cps1, a gene that encodes carbamoyl-phosphate synthetase 1

expressed in mature hepatocytes, was also synergistically Selleck BGB324 induced in the presence of BMP-4 and Dox on day 14 (Fig. 5B). To gain further insight

into the onset of hepatic development in these cultures, we evaluated the expression of Tcf1 and Cebpa, as these transcription factors are known to play a pivotal role in the establishment of the early liver by directly regulating expression of a variety of genes, including albumin, transferrin, and fibrinogen.25 Both BMP-4 and Dox (Hex) induced the expression of Tcf1 and Cyclic nucleotide phosphodiesterase Cebpa on day 10 of culture. As observed with the previous set of genes, the combination of BMP-4 and Dox resulted in a synergistic induction of expression of both (Fig. 5C), although the effect on Tcf1 was significantly greater than that observed on Cebpa. Taken together, these results suggest that BMP-4 and Hex function in a synergistic fashion to establish the liver fate, as defined by the up-regulation of expression of Tcf1, Cebpa, Alb, and Afp. In contrast to the above set of genes, neither BMP-4 nor Hex alone induced expression of CYP7a1 or TAT, two genes indicative of hepatic maturation, at day 10 of differentiation (Fig. 5D). The combination of BMP-4 signaling and Hex expression did result in low levels of CYP7a1 and TAT expression at this time. By day 14, Hex but not BMP-4 induced CYP7a1 and TAT expression. These findings indicate that maintenance of appropriate levels of Hex is essential for maturation of the hepatic lineage in culture.

Under these conditions the cells will reaggregate and form EB-like structures that support the continued differentiation of the respective populations. Alb message was only induced in the endoderm-enriched c-kithigh population, clearly demonstrating that Hex functioned to specify a hepatic fate directly in definitive endoderm (Fig. 4E). We have previously demonstrated that BMP-4 signaling induces a hepatocyte fate in activin-induced endoderm

during EB differentiation.18 To further examine the relationship between BMP-4 and Hex, day 6 activin-induced EBs were exposed to BMP-4, to Dox (1 μg/mL) or to both BMP-4 and Dox (1 μg/mL) from days 6 to 10. As previously shown, BMP-4 did induce Alb and Afp mRNA (Fig. 5A). The levels of Alb and Afp mRNA detected in day 14 hepatocyte cultures reached 19.7% and 25.8% of those found in Selleckchem GW 572016 day 14 fetal liver, respectively, and were much higher than those induced by 1 μg/mL of Dox (days 6–10). The addition of basic fibroblast growth factor, hepatocyte growth factor, and vascular endothelial growth factor had no effect on Alb and Afp expression (data not shown). Interestingly, the combination of BMP-4 and Dox further increased Alb and Afp mRNA levels to 40.3% and 43.3% of those found in day 14 fetal liver, respectively (Fig. 5A). Expression of Cps1, a gene that encodes carbamoyl-phosphate synthetase 1

expressed in mature hepatocytes, was also synergistically http://www.selleckchem.com/products/Erlotinib-Hydrochloride.html induced in the presence of BMP-4 and Dox on day 14 (Fig. 5B). To gain further insight

into the onset of hepatic development in these cultures, we evaluated the expression of Tcf1 and Cebpa, as these transcription factors are known to play a pivotal role in the establishment of the early liver by directly regulating expression of a variety of genes, including albumin, transferrin, and fibrinogen.25 Both BMP-4 and Dox (Hex) induced the expression of Tcf1 and mafosfamide Cebpa on day 10 of culture. As observed with the previous set of genes, the combination of BMP-4 and Dox resulted in a synergistic induction of expression of both (Fig. 5C), although the effect on Tcf1 was significantly greater than that observed on Cebpa. Taken together, these results suggest that BMP-4 and Hex function in a synergistic fashion to establish the liver fate, as defined by the up-regulation of expression of Tcf1, Cebpa, Alb, and Afp. In contrast to the above set of genes, neither BMP-4 nor Hex alone induced expression of CYP7a1 or TAT, two genes indicative of hepatic maturation, at day 10 of differentiation (Fig. 5D). The combination of BMP-4 signaling and Hex expression did result in low levels of CYP7a1 and TAT expression at this time. By day 14, Hex but not BMP-4 induced CYP7a1 and TAT expression. These findings indicate that maintenance of appropriate levels of Hex is essential for maturation of the hepatic lineage in culture.

35 Primary hepatic lymphocytes were stained with PE-Cy7-conjugated anti-CD3 (eBioscience; clone UCHT1, Catalog no. 25-0038; Hatfield, UK) and FITC-conjugated anti-CD56 (BD; Catalog no. 34058; Oxford, UK), and analyzed using Summit 4.3 software (Dako Cytomation). Formalin-fixed, paraffin-embedded liver sections from deidentified controls and subjects with biopsy-proven NASH-related

cirrhosis (n = 6/group) from the Departments of Pathology at Duke University and University Hospital Cassiano Antônio de Moraes were studied HIF inhibitor review in accordance with National Institutes of Health (NIH) and institutional guidelines for human subject research (see Supporting Information Materials and

Methods for immunohistochemistry protocol/antibodies). Cobimetinib mw The results are expressed as mean ± SEM. Statistical significance was determined using Student’s t test. Significance was accepted at the 5% level, *P < 0.05. Compared to control mice that were fed normal chow (n = 25), MCD diet-treated mice (n = 25) developed significant macrovesicular steatosis, ballooning degeneration of hepatocytes, and liver necro-inflammation (Fig. 1A), as well as fibrosis after 8 weeks. The latter was demonstrated by increased Sirius red staining (Fig. 1B,C) and hepatic hydroxyproline quantification (Fig. 1D). Collagen deposition was accompanied Decitabine solubility dmso by the accumulation of alpha-smooth muscle actin (α-SMA)-immunoreactive cells (Fig. 1E,F) and induction of profibrogenic genes, including α-SMA, transforming growth factor beta (Tgf-β), collagen 1α1, mmp9, and timp1 (Supporting Information Fig. 1A-E). These fibrotic livers also demonstrated increased activity of the Hh-pathway, a morphogenic signaling system that orchestrates wound healing responses.36 Sonic hedgehog ligand (Shh) mRNA expression tripled after MCD diet treatment and mRNA levels of the Hh-regulated transcription factor, glioblastoma 2 (Gli2), increased 4-fold. This was accompanied by significant accumulation of Gli2-expressing cells, which tended to localize near portal tracts

and along fibrous septa that contained immature ductular cells and fibroblastic cells (Fig. 2A). mRNA levels of CXCL16, the Hh-inducible NKT cell chemokine, and vascular cell adhesion molecule 1 (VCAM1), a factor that promotes NKT cell adhesion, increased significantly by MCD diet treatment (Fig. 2B,C). Hh-dependent production of CXCL16 by immature ductular cells promotes NKT cell chemotaxis.37 To determine if Hh-pathway activation also promotes NKT cell adhesion, NKT cells were incubated with immature ductular cells in the presence of vehicle or Shh. Shh significantly increased adhesion of NKT cells to ductular cells; this was abrogated by adding 5E1 antibody to neutralize Shh activity (Fig. 2D).

A polypropylene chamber was attached to the cementoenamel junction of each tooth to contain 1 ml distilled

water. Then, ceramic inlays were cemented with chemically polymerized resin cement (Multilink Automix) according to the manufacturer’s instructions. Water elutes were analyzed by HPLC at 4.32 minutes and 24 hours. HEMA LY294002 nmr diffusion amounts were analyzed using two-way ANOVA and Tukey HSD tests (p < 0.05). Results: HEMA was detected in the pulp chamber elutes of all the teeth. The diffused HEMA amounts were not significantly different between the affected caries and the unaffected groups (p= 0.80) or between time periods (p= 0.44). The carious dentin did not influence the amount of HEMA diffused through the dentin to the pulp space. Conclusions: The highest amount of eluted HEMA concentration detected was not viewed as critical for pulp tissue since the diffused HEMA amounts were below the level of cytotoxicity, according to the literature. "
“Speech adaptation after oral rehabilitation is based on a complex interaction of articulatory and myofunctional factors. The knowledge of basic phonetic principles may help clinicians identify phonetic problems associated with prosthodontic treatment. The purpose of this article is to illustrate basic

phonetic terminology, standard Chinese (Putonghua) phonetics, and the anatomic structures relevant for dentistry. In cooperation with a Chinese linguistic specialist, Chinese articulators were selected and are described and compared with English Buparlisib chemical structure phonetics. Established test words and sentences aid the identification of mispronounced articulators and their related dental structures. The pronunciation of most consonants and vowels in standard Chinese is similar to English, but some of them, such as the retropalatals (/zh/ [tʂ], /ch/ [thʂ], /sh/ [ʂ]), have notable differences. Palatal consonants (/j/ [tɕ], /q/ [tɕh], /x/ [ɕ]) are unique to the Chinese phonetic system and are not found in English phonetics. The comprehension of the basic anatomic regions involved

in Chinese phonetics may help prosthodontists treat patients whose native language is standard Chinese. “
“The purpose of this study was to compare shear bond strengths between two different gingiva-colored materials bonded Tolmetin to titanium alloy discs and acrylic resin artificial teeth. For the first part of this study, 30 titanium alloy disc specimens were embedded in autopolymerizing resin. These discs were then divided randomly into two groups: Heat Cure (HT1) and Pink Composite (CT1). The discs were sandblasted with 100 μm aluminum oxide particles. For the HT1 group using silicone molds, a wax-up was performed. After the wax removal step, heat-cured acrylic resin was applied and processed according to the manufacturer’s recommendations. For the CT1 group using silicone molds, metal primer II and gum opaque were applied and light cured; pink composite was then applied and light cured.

In a multiracial country like Malaysia, where we can compare the changes between different Asian races, Rosaida and Goh, in an earlier study identified Indian race as a risk factor for GERD and erosive reflux esophagitis.22 In a time trend study by the same group, Goh et al. recorded a significantly higher rise in esophagitis over a 10-year interval amongst Indians (2.4%–8.1%) compared to Chinese (1.7%–6.4%) and Malays (1.5%–3.7%).68

In another study, Rajendra et al. showed a distinct predisposition to develop Barrett’s esophagus in Indian patients and further showed a predominance of HLA B7 subtype amongst Indians with Barrett’s esophagus.52 While environmental influence would remain fairly consistent across all races, these differences identify Indians as a genetically susceptible SAHA HDAC datasheet race to the influence of Akt inhibitor environmental

factors in the development of GERD. Interestingly a study from the UK lends support to this notion by identifying South Asian race (Indian) versus White Caucasians as a risk factor for GERD.120 While heartburn is the cardinal symptom of GERD and is well recognized in the West, the situation is distinctly different in our part of the world. For example, there is no word in the Chinese vernacular language to describe this symptom. Spechler et al.121 in a survey of outpatients attending clinics in the Boston area, USA, discovered that the majority of patients of East Asian origin did not understand the symptom of heartburn. In the Asian setting many patients complain of chest discomfort which has been loosely classified as non-cardiac chest pains.121–124“Wind” is also a predominant complaint of many patients with reflux disease.125 In many Southeast Asian countries, Malay patients use vernacular terms which

do not translate exactly to the original terms of heartburn and acid regurgitation.126 Endoscopy is a widely used tool for diagnosis PDK4 of upper gastrointestinal complaints and will continue to be so. More Asian centers are now utilizing pH measurements as an adjunct to clinical and endoscopic diagnosis. The advent of the “catheterless” Bravo capsule has allowed more tertiary centers throughout the region to utilize pH measurements. Bilitec and impedance measurements are also more readily available nowadays in many Asian centers. The past 20 years has seen the emergence of reflux disease as an important disease in Asia. Although, it generally remains a mild disease in Asian patients, we know from the Western experience that serious complications can arise, chiefly Barrett’ esophagus and associated adenocarcinoma of the cardio-esophageal junction. Continued efforts must be made to ensure an accurate description of the disease burden and to track the evolution of the disease over time and across the whole region. In particular, translated and validated questionnaires should be utilized for surveys of GERD symptoms in the population.