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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Amongst primary care patients with dyspeptic symptoms, those with reflux-like symptoms or gastro-oesophageal reflux disease are expected to benefit most from empirical proton pump inhibitor therapy. Recognition of this patient group, however, is difficult. The Carlsson–Dent gastro-oesophageal reflux disease questionnaire was developed to justify the selection of primary care patients for empirical proton pump inhibitor treatment.Aim : To evaluate the diagnostic test characteristics of the Carlsson–Dent questionnaire in a primary care population.Methods : A prospective, open-label, multi-centre diagnostic prevalence study was conducted amongst primary care adults with reflux symptoms. All patients completed the questionnaire and underwent gastroscopy. If no abnormalities were found, the patients were prescribed 2 weeks of treatment with omeprazole (20 mg daily). Receiver operating characteristic curve analysis was used to determine the overall discriminative value of the questionnaire. Diagnostic test characteristics of both the cut-off score (total diagnostic score) in the questionnaire and the physician's provisional classification were measured using oesophagitis and omeprazole treatment success as the reference tests.Results : Of the 536 patients included, 515 underwent endoscopy. No abnormalities were found in 286 (55%). Omeprazole treatment success occurred more frequently in patients with a total diagnostic score of 〉 7 and oesophagitis II–IV in patients with a total diagnostic score of 〉 9. The diagnostic test characteristics of the questionnaire were comparable with those of the physician's provisional classification. The area under the receiver operating characteristic curve did not exceed 0.65. Kappa values for observer agreement with the gold standard were far below 0.4.Conclusion : The diagnostic performance of this version of the Carlsson–Dent questionnaire was poor. It equalled the physician's clinical judgement and therefore its value for clinical use is limited.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The percentage of patients receiving long-term treatment with acid suppressive drugs, mainly proton pump inhibitors, is higher than the prevalence of diseases that are commonly accepted as the proper indication for long-term proton pump inhibitor use.Aim : To evaluate whether a patient-directed intervention (direct mail) reduced the prescription of antisecretory medication for dyspepsia in general practice.Methods : A cluster-randomized trial was performed. One hundred and thirteen chronic users of proton pump inhibitors were recruited by 20 general practitioners. An unsolicited information leaflet was sent to patients that suggested stopping or reducing the use of proton pump inhibitors. The number of patients who stopped or reduced proton pump inhibitor use was measured at 12 and 20 weeks after the intervention. Secondary outcome measures were dyspepsia symptom severity and perceived quality of life measured at 12 weeks after the intervention.Results : Fourteen of the 59 (24%) intervention group patients stopped or reduced their use of proton pump inhibitors, compared with three of the 45 (7%) control group patients (relative risk ratio 3.56; CI 95%: 1.088–11.642). Dyspepsia symptom severity and quality of life did not change.Conclusions : A simple patient-directed intervention reduced the volume of long-term prescriptions of proton pump inhibitors in patients with dyspepsia.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: : To identify the most accurate and efficient test for diagnosing Helicobacter pylori infection in primary care patients.〈section xml:id="abs1-2"〉〈title type="main"〉Study design: A whole blood test, an ELISA, and carbon13 urea breath test (CUBT) were evaluated in a primary care setting and validated against two different gold standards that used gastric biopsies.〈section xml:id="abs1-3"〉〈title type="main"〉Population: Primary care patients who had dyspeptic complaints lasting at least 2 weeks and were referred for endoscopy.〈section xml:id="abs1-4"〉〈title type="main"〉Outcomes measured: Positive and negative predictive values, sensitivity and specificity were determined for all three noninvasive H. pylori tests.〈section xml:id="abs1-5"〉〈title type="main"〉Results: Data from the three non-invasive H. pylori tests were available for 136 primary care dyspeptic patients referred for endoscopy. They were compared with data from the gold standards. The positive predictive value of the whole blood test was in the range 71–75%, the ELISA 83–86%, and the CUBT 88–92%, while the negative predictive values were in the ranges 72–77%, 96–100%, and 95–98%, respectively. The sensitivity of the whole blood test was in the range 36–42%, the ELISA 93–100%, and the CUBT 92–97%, while the specificities were in the ranges 92–93%, 90–91% and 93–95%, respectively. The positive predictive value of the ELISA dropped significantly at lower H. pylori infection rates.〈section xml:id="abs1-6"〉〈title type="main"〉Discussion: Both the ELISA and CUBT are effective in the primary care setting, while the whole blood tests produces inferior results. ELISA might, however, be less suitable for detecting H. pylori infection in a population with a low rate of infection.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1573-2568
    Keywords: FUNCTIONAL DYSPEPSIA ; GASTRIC EMPTYING ; META-ANALYSIS ; 99Tc SCINTIGRAPHY ; GASTROINTESTINAL MOTILITY
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Functional dyspepsia is a common disorder witha diverse pathophysiological background, but the role ofmotility disorders in functional dyspepsia remainsunclear. We aimed to quantify the relationship between disturbed gastric emptying andfunctional dyspepsia, using a meta-analytic approach.Through a structured literature search of Medline andEmbase from 1983 to 1996, we selected all studies inwhich scintigraphic solid-phase gastric emptying wasmeasured in both functional dyspeptic patients andcontrols. Seventeen studies involving 868 dyspepticpatients and 397 controls were pooled. Gastric emptying in patients with functional dyspepsia was 1.46(1.23-1.69) times slower than controls; the proportionof patients with abnormally slow emptying was either 37%(34-40%, simple numeric pooling) or 39% (29-49%,weighted pooling). We conclude that gastric emptying ofsolids in patients with functional dyspepsia is 1.5times slower than in healthy controls and that asignificant delay of emptying is present in almost 40% of patients with functionaldyspepsia.
    Type of Medium: Electronic Resource
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