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Complications of Gastrooesophageaalreflux disease (GORD) are associated with supine or combined reflux. Upright reflux has been reported to be of less severity, but some reports have suggested a correlation between oesophagitis and post-prandial reflux (PPR).200 patients with reflux symptoms were analysed to establish the relative frequencies of uptight, supine and combined rellux, Further analysis was then carried out to establish the contribution of PPR. PPR was defined as % pH < 4 during periods of 60 minutes after eating, Results: 144 patients had abnormal pH profile, significant upright reflux being detected in 111 (77. I%), This was combined with significant supine reflux in 74 (66.6%) of the above. 37 (25.7%) of the total abnormal population had upright reflux alone and 33 (22.9%) had supine reflux only. In the pure upright refluxers (group A) PPR was < pH 4.0 for a mean of 17.1% of the total post-prandial time, and accounted for 30.2% of the total reflux time. In combined retluxers (group B) the mean duration of PPR was 27.6% of the post prandial time and accounted for 23.4% of total reflux. Supine refluxers (group C) PPR duration was 5.2% which represented 13% of total reflux in this group.Total % PPR % Restored to Normal Group A (n=37) 9.5 (7.5) 17,1(16.3) 51.0"** Group B (n = 74) 22.5 (16.6) 27.6 (21,1) 8.1% Group C (n = 33) 10.9 (8.3) 5.2 (4.2) 0%Mean % (+SD) *** p < 0.00I, Chi-square test.Elimination of PPR by subtracting PPR time from total reflux time restored 19 (51%) of group A and 6 (8.1%) of group B patients to within normal range, It is concluded that PPR is a significant factor in upright reflux which has implications for treatment. 2HOW GOOD IS OPEN COMMON BILE DUCT EXPLORATION?

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Conclusion -1) Individual's risk of requiring secondary intervention over time can be predicted on each surveillance visit. 2) This prediction can be used to set the interval to the next surveillance imaging, based on an agreed level of risk. 3) Such personalised surveillance renders each surveillance visit equally clinically effective there by improving the clinical and cost effectiveness of the overall surveillance programme, compared to current practice of employing uniform intervals to all patients.