Gastroesophageal reflux (GER) is defined as the movement of gastric contents into the esophagus. This material, which may contain acid, pepsin, bile acids and pancreatic enzymes, has the ability to irritate or injure tissues not adapted to the presence of this potentially noxious material. As reflux may proceed more proximal than the esophagus, other tissues may he affected, both clinical and experimental data have demonstrated that these events nay lead to a variety of esophageal, head, neck and pulmonary complications. Pulmonary manifestations of GER have been the focus of the medical literature, for the last two decades, and in particular the association of GER and asthma has been well recognized. The latter was suggested first by Sir William Osler more than a century ago. Nowadays its presence is well known in terms of gastric asthma, but the importance is till a matter of debate. The prevalence of GER among patients with asthma is generally reported to be higher than in normal but with a wide range from 30% to 90% in several reports. The mechanism by which GER might induce asthma has been a subject of diversity. There are two potential mechanisms whereby GER could produce bronchoconstriction and therefore exacerbate airflow obstruction in asthmatics, the evidences for these mechanisms were reviewed in the text

Crohn disease is a chronic illness that affects the gastrointestinal tract from the mouth to the anus. Perianal Crohn develops in 31-94% of patients over the course of their illness. It affects the skin in the perianal area, the anal canal and can cause fistulae. It is diagnosed clinically and by other modalities like endoscopy, barium CT scan, endoscopic sonography and magnetic resonance image examination. The treatment of perianal Crohn disease is either medical or surgical. The current medical treatment will be reviewed in this article

Background: Saudi Arabia used to be hyperendemic for HBV infection. Most of infection occurs in early life. HBV vaccine was, therefore, introduced in 1989 as the seventh primary immunogen of the EPI Program. This study is conducted to evaluate the efficacy of this program in Riyadh and Hail Regions. Method and Patients: A cohort follow-up study of children from Riyadh and Hail, who had been vaccinated in 1989, evaluated in 1991 and tested for HBV markers six years later. Results: The files of 303 children from Riyadh and Hail, who were investigated in 1991 retrieved and only 119, were available for testing. Fifty percent of the children have still a protective anti-HBs tittre. One vaccinated child was found to be positive for HBsAg. According to this study, the efficacy rate against HBsAg carriage is 88%. Conclusion: This study demonstrates the tremendous effect of HB vaccine on the HBV infection of Saudi children in these two regions

Background: Controversy still exists about the role and timing of endoscopic retrograde cholangiopancreaicotography (ERCP) in mild to moderate biliary pancreatitis. Routine preoperative ERCP detects persisting common bile duct stones but is associated with definite morbidity and may delay definitive care. Aim of study : The study aims to evaluate the role of ERCP in the management of mild to moderate acute biliary pancreatitis. Patients and methods : The records of 196 patients with diagnosis of mild to moderate acute biliary pancreatitis (ABP) were retrospectively reviewed over four-years period. The various parameters examined were age, sex, clinical presentation, laboratory values, radiological studies, and severity of the attack, preoperative ERCP, surgical intervention and length of hospital stay. Pre operative ERCP was performed in 136 (67%) patients. Indications of ERCP were presence of jaundice, dilated common bile duct on ultrasonography, persistent hyperamylasemia, and associated cholangitis. In 17 patients with old age and multiple medical problems, ERCP served as a definite procedure. Results: Mild to moderate cases accounted for 91% of ABP. Liver function tests (bilirubin, ALP, AST, ALT) were raised in 64% of cases. persistent hyperamylasemia in 4%, dilated CBD was observed in 14% associated cholangitis was present in 11%. Preoperative ERCP was positive in 22 (16%) patients, only where a CBD stones could be found and an endoscopic sphincterotomy) (ES) was performed. Positive predictive values were 25% for the high bilirubin level, 22% for the high ALP level, 50% for the persistent hyperamylasemia, 57% for the dilated CBD, 45% for the associated cholangitis. ERCP was associated with a morbidity rate of 3.6% with no mortality. The procedure was regarded as unnecessary in 84 % of cases, where it increased the length of hospital stay by a mean of 2, 3 days. Conclusion : Preoperative ERCP was therapeutic in only 16% in cases of mild to moderate ABP. It should be done only on selective basis. In elderly patients with multiple medical problems. ERCP and ES can serve as definitive treatment