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Background-Both acid and duodenal contents are thought to be responsible for the mucosal damage in Barrett's oesophagus, a condition often treated medically. However, little is known about the eVect of omeprazole on duodenogastric reflux (DGR) and duodenogastro-oesophageal reflux (DGOR). Aims-To study the eVect of omeprazole 20 mg twice daily on DGR and DGOR, using the technique of ambulatory bilirubin monitoring. Methods-Twenty three patients with Barrett's oesophagus underwent manometry followed by 24 hour oesophageal and gastric pH monitoring. In conjunction with pH monitoring, 11 patients (group 1) underwent oesophageal bilirubin monitoring and 12 patients (group 2) underwent gastric bilirubin monitoring, both before and during treatment with omeprazole 20 mg twice daily. Results-In both groups there was a significant reduction in oesophageal acid (pH<4) reflux (p<0.005) and a significant increase in the time gastric pH was above 4 (p<0.005). In group 1, median total oesophageal bilirubin exposure was significantly reduced from 28.9% to 2.4% (p<0.005). In group 2, median total gastric bilirubin exposure was significantly reduced from 24.9% to 7.2% (p<0.005). Conclusions-Treatment of Barrett's oesophagus with omeprazole 20 mg twice daily results in a notable reduction in the exposure of the oesophagus to both acid and duodenal contents. In addition, delivery of duodenal contents to the upper gastric body is reduced. (Gut 1998;43:603-606)

ERAS in principle seems logical and safe for esophagectomy. However, the underlying evidence is poor and lacking. Despite this, a number of recommendations for practice and research can be made.

No abstract

In this study four mesoscale forecasting systems were used to investigate the four-dimensional structure of atmospheric refractivity and ducting layers that occur within evolving synoptic conditions over the eastern seaboard of the United States. The aim of this study was to identify the most important components of forecasting systems that contribute to refractive structures simulated in a littoral environment. Over a 7-day period in April-May of 2000 near Wallops Island, Virginia, meteorological parameters at the ocean surface and within the marine atmospheric boundary layer (MABL) were measured to characterize the spatiotemporal variability contributing to ducting. By using traditional statistical metrics to gauge performance, the models were found to generally overpredict MABL moisture, resulting in fewer and weaker ducts than were diagnosed from vertical profile observations. Mesoscale features in ducting were linked to highly resolved sea surface temperature forcing and associated changes in surface stability and to local variations in internal boundary layers that developed during periods of offshore flow. Sensitivity tests that permit greater mesoscale detail to develop on the model grids revealed that initialization of the simulations and the resolution of sea surface temperature analyses were critical factors for accurate predictions of coastal refractivity.