Management Of Upper Gastrointestinal Disorders Research Articles

Curbing proton pump inhibitor overprescribing: Multifaceted strategies in an academic hospital.

Proton pump inhibitors (PPI) have become essential in the management of upper gastrointestinal disorders, yet they are prescribed without an indication in up to 89% of cases and the number of prescribed PPIs is on the rise. A working group developed several multifaceted strategies in our multihospital trust to curb inappropriate PPI use. We describe herein these strategies and assess their impact on PPI consumption in a hospital belonging to this trust. From 2012 to 2019, our actions included the publication and presentation of a review of emergent PPI side effects, the development of an appropriate use leaflet, medication audits, journal club meetings, and prescription analysis. We considered that a decrease in PPI consumption could be a relevant surrogate criterion for the appropriation and acceptance of these interventions; this was assessed from 2012 to 2019 and expressed as defined daily dose (DDD)/1000 patient-days. There was a clear downward trend in the consumption of PPIs, both in medical and surgical wards. The overall PPI use decreased by 17.1% (from 566 to 468 DDD/1000 patient-days). IV PPI consumption dropped by 37.7% (from 146 to 91 DDD/1000 patient-days), while oral PPIs consumption decreased by 10% (from 420 to 378 DDD/1000 patient-days). Sustained strategies aimed at curbing PPI overprescribing led to a sustained decrease in PPI consumption in our hospital. This decrease encourages us to pursue this strategy and to diversify our actions.

Relation between Knowledge and Anxiety Level of Patients Undergoing Upper Gastrointestinal Endoscopy at Tanta University Hospital

Upper gastrointestinal endoscopy plays a major role in diagnosis and management of upper gastrointestinal disorders. Lack of patient's knowledge regarding endoscopy procedure is the main reason for increasing anxiety. This study aimed to: Assess knowledge and anxiety levels of patients undergoing upper gastrointestinal endoscopy. The study was carried out: In the gastrointestinal endoscopy units, Tanta University Hospital: A convenience sample of adult patients with GI disorders admitted to GI endoscopy units at Tanta University Hospital and scheduled for GI endoscopy were recruit to the study. The research questions include, - What are the levels of knowledge of patients undergoing upper GI endoscopy at Tanta University Hospital? - What are relations between levels of state and trait anxiety and different variables? Tools of the study: Two tools were used, Tool (I) Structured interview questionnaire: This tool was developed and used by the researcher for collection of baseline data and is consisted of three parts: Socio demographic data, patient's clinical information and patient's knowledge regarding upper gastrointestinal endoscopy. Tool (II) The State Trait Anxiety Inventory Scale: The original scale was developed by Spielberger in to evaluate respectively, state and trait anxiety. Results: It was observed that Less than half ( . ) of studied patients had poor knowledge score, while ( ) had severe state anxiety and more than half ( ) had severe trait anxiety. there was a high negative significant correlation (r= - , - respectively) between knowledge and The State Trait Anxiety Inventory Scale. Conclusion: Providing information to the patient before upper gastrointestinal endoscopy, decrease their level of anxiety and improve tolerance level during endoscopy procedure. Recommendations: It was recommended that provision of institutional written policies and guidelines regarding increasing knowledge and declining anxiety for patients undergoing upper gastrointestinal endoscopy.

Use of proton pump inhibitors and risk of ischemic events in the general population

Background and aimsA potential increased risk of cardiovascular events has been suggested for proton pump inhibitors (PPIs), the most commonly prescribed drugs for the management of upper gastrointestinal disorders. We aimed to estimate the risk of hospitalization for cardio/cerebrovascular (CV) events in a cohort of incident PPI users. MethodsA nested case-control study was carried out using regional healthcare utilization databases. For each case (hospitalization for non-haemorrhagic CV event), up-to-five controls randomly selected from the cohort were matched by gender, age at cohort entry, and index date. Exposure was estimated as recency of therapy (current, recent and past users) and number of days covered. Adjusted conditional logistic regression was used to estimate the association between exposure and outcome. ResultsAmong new PPI users, we identified 17,832 cases and 89,160 controls (males 64.9%; mean age 58.9 years). Cases showed a significantly higher prevalence of use of drugs for diabetes, hypertension and hypercholesterolemia than controls. Risk of CV events was significantly higher for current (OR 1.61; 95%CI 1.55–1.68) and recent users (OR 1.15; 95%CI 1.06–1.26) compared to past users. Analogous results were found stratifying for cardiovascular (ORcurrent 1.71; 95%CI 1.63–1.81) and cerebrovascular events (ORcurrent 1.43; 95%CI 1.34–1.54). The increased risk was confirmed in subgroups by antithrombotic, statin use, or exposure duration. The same analysis for H2-antagonists use showed no significant results. ConclusionsIn primary care setting, PPI use was independently associated with increased risk of first-time cardiovascular event, consistent with the evidence that PPIs adversely impact vascular function, underlying the need to promote appropriate prescribing of these drugs.

Endoscopic ultrasound and upper gastrointestinal disorders.

Endoscopic ultrasound (EUS) plays a vital role in management of upper gastrointestinal disorders, particularly cancer of the esophagus, pancreas, stomach, lung (via transesophageal mediastinal staging), and bile duct. Endoscopic ultrasound has also been valuable in detection of early chronic pancreatitis (CP). In cancer of the esophagus, the primary role of EUS is to determine whether disease is localized (T1-2, N0) and appropriate for surgery, locally advanced (T3-4, N1, M1a) (which may benefit from chemoradiation with or without surgery), or metastatic. Pancreatic and bile duct cancers are more complex given the controversy over portal vein resection. In centers that resect tumors invading the portal venous system, the role of EUS is limited to tissue confirmation or identification of metastases to the liver or distant lymph nodes. In centers that do not resect the portal vein invasion, EUS plays an important role in local staging. In lung cancer, EUS is emerging as an accurate, nonsurgical alternative to staging the mediastinum through EUS fine-needle aspiration. Endoscopic ultrasound has an important role in diagnosing CP because of its high degree of sensitivity. This has also led to controversy over whether EUS can overdiagnose CP. For these reasons, we recommend the use of a high threshold for EUS and that CP be diagnosed in conjunction with other standard tests (endoscopic retrograde cholangiopancreatography, pancreatic function tests).

The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders

Esophagogastroduodenoscopy has revolutionized the clinical management of upper gastrointestinal diseases. Millions of EGDs are performed annually in the United States for many indications, such as gastrointestinal bleeding, abdominal pain, dysphagia, or surveillance of premalignant lesions. Esophagogastroduodenoscopy is very safe, with a low risk of serious complications such as perforation, cardiopulmonary arrest, or aspiration pneumonia. It is a highly sensitive and specific diagnostic test, especially when combined with endoscopic biopsy. Esophagogastroduodenoscopy is increasingly being used therapeutically to avoid surgery. New endoscopic technology such as endosonography, endoscopic sewing, and the endoscopic videocapsule will undoubtedly extend the frontiers and increase the indications for endoscopy.

Unsedated transnasal endoscopy: a safe and less costly alternative.

Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications. Unsedated transnasal endoscopy (T-EGD) is a relatively new technique using an ultrathin endoscope. Because it is better tolerated than standard upper endoscopy, it is performed with the patient unsedated, thus avoiding the associated costs and complications of conscious sedation. In this review, the technique of T-EGD and its current experience are discussed. In addition, potential future applications, special considerations, and potential pitfalls are reviewed.

Misoprostol Use in Pregnancy — An Update

Misoprostol is an inexpensive prostaglandin E1 analogue marketed for oral prophylaxis and management of upper gastro-intestinal disorders, particularly those associated with nonsteroidal anti-inflammatory drugs.Vaginally administered misoprostol is a cost-effective medical agent for second trimester termination of pregnancy. In the first trimester, it is effective only after use of an antiprogesterone (mifepristone or methotrexate). Its use in first trimester pregnancy has been associated with newborn facial nerve paralysis if termination of the pregnancy failed to occur.In a much lower dose, vaginal misoprostol has been studied for labour induction at term. Numerous clinical trials have found vaginal misoprostol no less effective than existing approaches, but much less expensive than other prostaglandins. Though it appears to be safe for mother and newborn, there is still concern that it might provoke uterine hyperstimulation. No national body or consensus group has yet endorsed its use in clinical practice for induction of labour.The limited research with oral misoprostol suggests effectiveness with fewer problems of excessive uterine activity. Research into its use for the management of the third stage of labour and post-partum bleeding has now begun.

Development of an economic model for the management of upper gastrointestinal disease in primary care. Preliminary findings.

Health economic models for identifying therapeutic options that maximise health benefits from limited healthcare resources are being developed in a number of therapeutic areas. The development of such a model for upper gastrointestinal (UGI) symptoms to support decision-making by primary care clinicians is of particular importance, given the prevalence of this symptomatology. This economic model was based upon the clinical guidelines aimed at improving the management of UGI disorders at the primary care level that were developed by the International Gastro Primary Care Group. This paper discusses the derivation, methodology and results of the economic model developed to assess the resource implications arising from these clinical guidelines. In order to construct the economic model, it was necessary to identify the following: every therapeutic pathway followed by patients resource use along each pathway the probabilities of following alternative pathways. One crucial factor underlying the interpretation of results obtained from any economic model is the time period covered by the model. The model presented here analysed the initial 12-month treatment period of 'new' patients presenting with UGI symptoms. In order to test the implications of a longer term perspective, the model is currently being developed to analyse resource use over a 24-month period. The model demonstrates that utilising the predominant symptom approach to the diagnosis and treatment of patients with UGI disorders appears to provide significant benefits in terms of patient management and effective resource use. This factor, together with the more intensive use of Helicobacter pylori eradication therapy, provides the potential to reduce the cost of drugs for the treatment of UGI disorders by approximately 15% in the UK. A major strength of the model is its adaptability to a wide range of clinical and cost scenarios. Such adaptability enables the model to effectively reflect the potential resource implications in countries exhibiting significantly different levels of cost and patient management. In this manner, the model provides one valuable method by which clinicians can be supported in optimising the management of UGI disorders within current resource constraints.