We evaluated the mechanisms of gastroesophageal reflux in 10 patients with reflux esophagitis and compared the results with findings from 10 controls. The patients had more episodes of reflux (35 +/- 15 in 12 hours, as compared with 9 +/- 8 in the controls) and a lower pressure of the lower esophageal sphincter (13 +/- 8 mm Hg as compared with 29 +/- 9 in the controls) (P less than 0.001). Reflux occurred by three different mechanisms: transient complete relaxation of the lower esophageal sphincter, a transient increase in intra-abdominal pressure, or spontaneous free reflux associated with a low resting pressure of the lower esophageal sphincter. In controls 94 per cent of reflux episodes were caused by transient sphincter sphincter relaxation. In the patients 65 per cent of episodes of reflux accompanied transient sphincter relaxation, 17 per cent accompanied a transient increase in intra-abdominal pressure, and 18 per cent occurred as spontaneous free reflux. The predominant reflux mechanism in individual patients varied: some had normal resting sphincter pressure and reflux that occurred primarily during transient sphincter relaxation, whereas others with low resting sphincter pressures had spontaneous free reflux or reflux that occurred during an increase in intra-abdominal pressure.

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BACKGROUND: Community acquired pneumonia (CAP) is major cause of morbidity and mortality in all age groups. The presentation may be variable and severity of the disease is seen to be more if co-morbid conditions are present, especially chronic lung disease. Etiological variation in various region of country. The present study was designed to evaluate the clinical, bacteriological and radiological profile of CAP in Hadoti region of Rajasthan. MATERIAL AND METHODS: Fifty patients with community acquired pneumonia aged more than 12 years were enrolled in this study. In all the patients demographic data and detailed history were recorded followed by complete physical examination, chest x-ray, blood culture, sputum culture and pleural fluid culture (if available) and other investigation wherever applicable in a preformed proforma were done. RESULTS: Mean age of patients was 49 years. Smoking was the most common predisposing factor (52%). COPD was most common associated co-morbidity. Etiology was determined in only 26 patients, commonest being Streptococcus pneumoniae. Radiologically lobar pneumonia was commonest finding. CONCLUSION: Our observations will be useful to monitor the trends of CAP in the population of the region and will help the physicians to start rational empirical treatment for patients with CAP. There is need for further conventional serologic tests for atypical and viral pathogens in all patients admitted with CAP.

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