Laparoscopic surgery also has its own inherent risks related to the procedure. Currently there is no clear-cut consensus http://www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html about which form of treatment is suited for which patient. This study is an attempt to help us tackle this diagnostic and therapeutic challenge of gastroesophageal reflux disease. This study specifically focuses on patients in the urban Indian setup. 2. Materials and Methods This study was a prospective interventional study carried out at a teaching public hospital in Mumbai from May 2010 to September 2012 after obtaining the institute’s ethics committee approval. All patients with suspected gastroesophageal reflux disease were evaluated for their symptoms and quality of life. Diagnosis of gastroesophageal reflux disease was confirmed by endoscopy and esophageal manometry.

50 such patients (with the necessary inclusion and exclusion criteria and giving written informed consent) were chosen for the study. Inclusion Criteria. Newly diagnosed cases of uncomplicated gastroesophageal reflux disease with hiatus hernia patients (aged between 20 and 60 years) with symptoms of gastroesophageal reflux disease whose diagnosis has been confirmed by endoscopy and manometry. Exclusion Criteria. Presence of comorbid conditions like hypertension and diabetes mellitus as well as pregnancy. A detailed history and physical examination was done for all the patients enrolled for the study. An inquiry was made for the presence of predisposing factors��alcohol consumption, tea/coffee drinking (more than two cups/day), smoking/tobacco chewing, sedentary lifestyle, and spicy, oily, and non-vegetarian food.

All patients having symptoms of gastroesophageal reflux (heartburn, regurgitation, dysphagia, angina-like chest pain, and respiratory symptoms: cough and hoarseness) had their symptoms evaluated by the visual analogue scale (scored between 1 and 10) A score was given from 1 (worst possible symptom) to 10 (no symptom) [2]. The patients were subjected to upper gastrointestinal endoscopy (to look for presence of hiatal hernia and grade of esophagitis) and high resolution esophageal manometry (to look for pressure of lower esophageal sphincter, relaxation of lower esophageal sphincter, presence of hiatal hernia, and motility of esophageal body) to confirm the diagnosis.

Hiatus hernia was diagnosed when the high pressure zone produced by the lower oesophageal sphincter gastroesophageal junction was at least 2cm higher than the high pressure zone produced by the diaphragmatic crura (double high pressure zone or double hump). Only patients showing presence of hiatal hernia on both endoscopy and manometry were included in the study. Patients diagnosed to have Entinostat gastroesophageal reflux (with the necessary inclusion and exclusion criteria) were given a trial of conservative management (lifestyle changes and medications).