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The ampulla of Vater encompasses the openings of both the common bile duct (CBD) and pancreatic duct (PD). Presently ERCP has allowed better observation of the papillae in ectopic locations. The diagnosis of ectopic papillae can be done by radiological studies also but they are expensive and not affordable by all patients so most of the cases of ectopic papillae are identified by ERCP. An ectopic location, distal to the second part, in the third or fourth parts of duodenum has been described frequently but a proximal location is rare. Only a few cases have been found to be located in the gastric, pyloric and duodenal bulb areas. We report three such rare cases of anomalous ectopic ampullae discovered during the performance of ERCP from the Department of Gastroenterology, Combined Military Hospital, Dhaka and also a short review of the literature. In these three subjects one papilla was located in the pylorus and other two in the first part of the duodenum. All of them presented with features of choledocholithiasis with cholangitis. They were successfully managed by therapeutic ERCP. Clinical implications of these rare anomalies and anatomical variations can assist the gastroenterologists in effective patient management.

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Data Synthesis: The need for objective, evidence-based guidance on the role of probiotics is becoming increasingly important as public awareness grows. This consensus is intended as a practical reference to help physicians make appropriate, evidence-based recommendations to patients who might benefit from probiotic treatment. Overall, the randomised, placebo-controlled trials included in this article support, with a high evidence level, the therapeutic effects of probiotic agents for several disorders including antibiotic or Clostridium difficile-associated diarrhea, irritable bowel syndrome, and the inflammatory bowel diseases. Although probiotic research is a rapidly evolving field, there are sufficient data to justify a trial of probiotics for treatment or prevention of some of these conditions. However, the capacity of probiotics to modify disease symptoms is likely to be modest and varies among probiotic strains and not all probiotics are right for all diseases. The goal of this review is to provide clinicians with an overview of the rationale and data which support or refute the role of probiotics for treating commonly encountered gastrointestinal disorders.