Abstract
INTRODUCTION Upper gastrointestinal endoscopy, traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to make it more patient-accessible. OBJECTIVES Describe frequency and distribution of the principal symptomatic diseases of the upper gastrointestinal tract and their relation to the main risk factors associated with each in a sample of urban adults who underwent upper gastrointestinal endoscopy in primary care facilities in Havana in selected months of 2007. METHODS A multicenter cross-sectional study was conducted, including 3556 patients seen in the primary health care network of Havana from May through November 2007. The endoscopies were performed at the 22 polyclinics (community health centers) providing this service. Diagnostic quality and accuracy were assessed by experienced gastroenterologists using a validated tool. Patients responded to a questionnaire with clinical, epidemiologic, and sociodemographic variables. Univariate and multivariate analyses (unconditional logistical regression) were used to identify associated risk factors. The significance level was set at p < 0.05 (or confidence interval excluding 1.0). RESULTS The diagnoses were: gastritis (91.6%), duodenitis (57.8%), hiatal hernia (46.5%), esophagitis (25.2%), duodenal ulcer (15.8%), gastric ulcer (6.2%) and malignant-appearing lesions (0.4%). Overall prevalence of Helicobacter pylori infection was 58.4%. The main risk factors for duodenal ulcer were H. pylori infection (OR 2.70, CI 2.17-3.36) and smoking (OR 2.08, CI 1.68-2.58); and for gastric ulcer, H. pylori (OR 1.58, CI 1.17-2.15) and age ≥60 years (OR 1.78, CI 1.28-2.47). H. pylori infection was the main risk factor for gastritis (OR 2.29, CI 1.79-2.95) and duodenitis (OR 1.58, CI 1.38-1.82); and age ≥40 years for hiatal hernia (OR 1.57, CI 1.33-1.84). External evaluation was "very good" or "good" for 99.3% of endoscopic procedures and 97.9% of reports issued. CONCLUSIONS Gastrointestinal endoscopy performed in primary care yielded high quality results and important information about prevalence of the most common diseases of the upper GI tract and associated risk factors. This study provides a reference for new research and can inform objective recommendations for community-based interventions to prevent and control these diseases. The existence of a network of universally accessible diagnostic endoscopy services at the primary care level, will contribute to conducting further research. KEYWORDS Endoscopy, gastrointestinal diseases, upper GI tract, prevalence, risk factors, primary care, Cuba.
Highlights
Upper gastrointestinal endoscopy, traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to make it more patient-accessible
Gastrointestinal endoscopy performed in primary care yielded high quality results and important information about prevalence of the most common diseases of the upper GI tract and associated risk factors
This study provides a reference for new research and can inform objective recommendations for community-based interventions to prevent and control these diseases
Summary
Traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to make it more patient-accessible. In Cuba and most countries, prevalence studies of upper gastrointestinal (GI) tract diseases in the general population are virtually nonexistent; reports generally refer to frequency of these diseases in case series on endoscopies and hospital admissions, which are not representative of what occurs in the general population. In such studies, the diseases most commonly found are gastritis, peptic ulcer (both duodenal and gastric), hiatal hernia and gastric cancer.[1,2,3,4,5]. The international literature contains some evidence regarding endoscopic diagnosis performed at the primary care level—for example, in the United States and the United Kingdom, where the majority of procedures were done at the initiative of physicians in the public sector, but not as part of an integrated population-wide program.[7,8,9,10] In this respect, the Cuban experience appears to be unique
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