Functional oesophageal disorders are a frequent cause of oesophageal symptoms. Patients are diagnosed as having a functional oesophageal disorder if they have normal standard oesophageal tests such as oesophageal manometry and reflux studies. Structural disorders, motility disorders with a histopathology basis and gastro-oesophageal reflux disease (GORD) are therefore excluded. A systematic and evidence-based approach to investigation, diagnosis and treatment is required. There are four functional oesophageal disorders defined by the Rome III consensus: functional heartburn, functional chest pain, functional dysphagia and globus. Despite the Rome diagnostic criteria for functional oesophageal disorders, the evidence base for many current therapies is not as robust. In this paper, we discuss the functional oesophageal disorders and their prevalence. We discuss diagnostic algorithms proposed by us and based on current evidence. We also discuss current therapies based on current evidence.

Functional gastroduodenal disorders are chronic, heterogeneous conditions experienced by adults worldwide. The Rome III consensus recognizes four syndromes: functional dyspepsia, belching disorders, nausea and vomiting disorders and ruminating syndrome. Considerable advances have occurred in the field of functional gastroduodenal disorders. This review provides an overview of the definitions, epidemiology, clinical features, investigations and treatments of some of these disorders. Functional dyspepsia is divided into post-prandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The prevalence of functional dyspepsia is about 11–20% in the western world. Dysfunctional gastrointestinal motility and hypersensitivity are involved in the generation of symptoms in some patients. Several classes of drugs are used to treat patients with functional dyspepsia, and the increasing understanding of pathophysiology will greatly affect future treatment regimens. Belching disorders may have either a behavioural or a physiological background, and therefore behavioural and speech therapies show promise, but definitive studies are required. The effect of fundoplication and drugs, such as a selective gamma-aminobutyric acid agonist baclofen, on belching await confirmatory studies on their usefulness. Mechanisms of functional nausea and vomiting are poorly understood, and their treatment currently focuses on pharmacological and non-pharmacological therapies, including antidepressants and psychological approaches.

Irritable bowel syndrome (IBS) is a prevalent disorder affecting around 12% of the population and is present worldwide. It constitutes approximately 40% of consultations in secondary care gastroenterology clinics. Given the prevalence of the disease, it exerts a significant societal burden, through increased health care costs, and personal burden, through a reduced quality of life. The aetiology of IBS is multifactorial and incompletely understood. In a similar manner the management of IBS is also multifactorial and encompasses the establishment of a therapeutic relationship, exclusion of other organic causes and the delineation of predominant bowel habit. Specific pharmacotherapy is directed towards symptomatic management. This review provides a focused summary of the epidemiology, clinical features, differential diagnosis and management of IBS.

Adverse reactions to food are common in the general population. Distinguishing between food allergies and food intolerance is necessary in order to avoid unnecessary dietary restrictions. These may adversely affect nutrition, social interaction and quality of life. Recognition of risk factors for the development of food allergies can help facilitate an early diagnosis and seek to prevent life-threatening reactions to food. Accurate recognition of clinical manifestations, followed by the appropriate use and interpretation of tests, helps improve diagnosis. The management of food allergies to optimize prevention, and the diagnosis and management of these conditions, is an area that is controversial and still developing. This review focuses on the epidemiology, pathogenesis, diagnosis and management of food allergy.

The aim of this article was to analyse the results of the transanal haemorrhoidal dearteralization (THD) technique in the treatment of haemorrhoidal disease. A case series of 42 patients (36 men and six women) with grade II and III haemorrhoids who underwent THD between September 2011 and October 2012 was carried out. Patients were subjected to three to six ligations and those with prolapse had mucopexy. Following surgery, patients were evaluated after 1 week, 3 months and 1 year. Forty-one patients presented with bleeding per rectum as the main complaint and one had only discharge. All cases were carried out as day-case surgeries. Twenty-six patients had six ligations, and 16 had between three and five. The mucopexy was carried out in 34 patients. The mean operative time was 46.8 ± 9.4 minutes. Twenty-six patients (62%) had post-operative pain, four of whom had severe pain (score > 7) which required analgesia. Thirty-three patients (79%) did not have any complications and nine (21%) had an immediate post-operative complication which was not severe. After 1 year, seven patients (17%) had recurrence of bleeding. The THD technique has shown that it is effective in terms of less pain and fewer complications in the population we studied. It can be carried out safely as a day-case surgery.

Acute pancreatitis has always been a clinical challenge. Timely assessment of severity in patients with acute pancreatitis is of prime importance in guiding an optimal management for these patients. Over the years, a number of single and multiparameter predictors have been identified and tested for assessing the severity of this disease. The main aim of this study was to test the reliability of serum procalcitonin (PCT), a marker of systemic inflammation, as an effective single biomarker in determining the severity of acute pancreatitis early in the disease process. We conducted a retrospective study on 166 patients who were categorized into two groups of mild versus severe acute pancreatitis based on the Glasgow scoring system. The value of PCT as a prognostic marker was obtained at the time of admission and compared with other biochemical markers such as haematocrit and white blood cell count. Out of 166 patients, 30 were graded as severe and the rest (136 patients) were graded as mild cases of acute pancreatitis according to the modified Glasgow criteria. In predicting severity of acute pancreatitis at the time of admission, sensitivity and specificity of serum PCT were 60% and 82%, respectively. In the setting of computerized tomography (CT) scan, a finding of severe acute pancreatitis (acute necrotic collection/acute necrotizing pancreatitis) corresponded to serum PCT of 62% sensitivity and 71% specificity and Glasgow score of 54% sensitivity and 83% specificity. There was a moderate degree of positive correlation between PCT and length of hospital stay. The association between PCT and intensive care unit (ICU) admissions is considered to be extremely statistically significant with P < 0.0001. Serum measurements of PCT may be valuable in predicting the severity of acute pancreatitis early in the disease process.

Bronchiolitis is a major cause of respiratory morbidity in young children and usually affects children younger than 2 years; peak age is infants between 3 and 6 months. Peak season is usually between November and March, but also between March and July. Bronchiolitis is the most common cause of hospital visits in infancy, leading to significant morbidity, and even mortality, putting pressure on paediatric wards and emergency and intensive care units. Respiratory syncytial virus (RSV) accounts for up to 80% of cases. Investigations usually are not required. Treatment is symptomatic in the vast majority of bronchiolitis cases. Proper history and examination will help to determine the correct diagnosis and ultimately the most appropriate treatment. If community physicians are able to diagnose bronchiolitis with certainty, are aware of the referral criteria and are able to educate the parents, bronchiolitis can be managed at home, which may help decrease pressure on hospitals.

Twin reversed arterial perfusion (TRAP) sequence (acardiac twin) is a rare complication of monochorionic pregnancy characterized by single arterial to arterial vascular anastomosis between twins. In this unique haemodynamic arrangement, the structurally normal pump twin will perfuse its abnormal co-twin (acardiac) in a retrograde manner through these anastomoses, with potential for cardiac overload and heart failure in the pump twin and high fetal mortality. Definitive fetal intervention has been recommended in the literature for high (> 50%) twin weight ratio (TWR). We present a case of twin reversed arterial perfusion managed expectantly as no signs of cardiac decompensation were encountered in the pump twin.