The most prevalent ‘inappropriate indication’ Epigenetics Compound Library for PPI usage was for uninvestigated anaemia in stable patients who had no evidence of GIT bleeding. The most prevalent ‘borderline indication’ for PPI usage was for endoscopic findings of gastropathy/gastritis(excluding peptic ulcer disease). Conclusion: PPI usage is pravelent in hospitals. Less than half of the total PPI usage amongst hospitalized patients has evidence-based indications to support their use. Overuse of PPI has a negative

impact on health care cost and may lead to certain adverse effects. Steps to curb inappropriate PPI use should address a few factors including indications to initiate PPI, reassessing need for on-going use while in hospital or upon discharging patients and upon out-patient reviews. Key Word(s): 1. PPI; 2. inappropriate use; 3. guidelines;

4. hospitalized; Presenting Author: TSZ TING LAW Additional Authors: KWAN KIT CHAN, DANIEL KING HUNG TONG, SAM WAI HO WONG, FION SIU YIN CHAN, SIMON LAW Corresponding Author: TSZ TING LAW Affiliations: – Objective: Esophageal perforation is uncommon and the prognosis could be Alectinib cell line dismal if managed inappropriately. Methods: Records of patients with esophageal perforation treated between 1997 and 2012 were retrospectively reviewed. Demographics, etiology and outcomes were analyzed. Results: Thirty-seven patients [23 men, median age 66 years (range 19–98)] were included. Eighteen patients (48.6%) had spontaneous perforation (Boerhaave’s syndrome: n = 14; esophageal cancer: n = 4), 13 (35.1%) were iatrogenic and 6 (16.2%) occurred after foreign body ingestion. Prior to presentation, 25 (67.6%) had had MCE公司 no pre-existing esophageal pathology; 6 had cancer, and 7 other had benign pathologies. Diagnosis was made >24 hours from onset of symptoms in 5 patients (13.5%). The perforation site was located

in the intra-thoracic esophagus in 24 patients (64.9%).Nineteen patients had emergency operations at presentation: 12 underwent primary repair (which was successful in 10), 6 had surgical drainage or exclusion, and 1 had esophagectomy. Of the 18 managed non-operatively, 10 had stenting performed, of whom 2 later required esophagectomy. Overall 6 patients (16.2%) required esophagectomy as definitive treatment. The overall mortality rate was 21.6%. Hospital mortality rate was 15.8% and 27.8% in the operative and non-operative group respectively. Fever (≥38.5°C), hypotension, pre-existing esophageal pathology and malignancy were associated with in-hospital mortality (p = 0.02, 0.03, <0.01, <0.01 respectively). A modified perforation severity score that comprised of 9 clinical parameters was studied. Early diagnosis (<24 h) was significantly associated with a low perforation score (p = 0.04). A high perforation score was associated with mortality (p < 0.01). Conclusion: Spontaneous esophageal perforation was the most commson etiology. Timely diagnosis and repair has a high successful rate.