scholarly journals Early Relief of Upper Gastrointestinal Dyspeptic Symptoms: A Survey of Empirical Therapy with Pantoprazole in Canadian Clinical Practice

2002 ◽  
Vol 16 (7) ◽  
pp. 439-450 ◽  
Author(s):  
David Armstrong ◽  
Farouk Kazim ◽  
Marcel Gervais ◽  
Myron Pyzyk
Keyword(s):  
Peptic Ulcer ◽  
Clinical Practice ◽  
Proton Pump Inhibitor ◽  
Reflux Esophagitis ◽  
Gastrointestinal Symptoms ◽  
Empirical Therapy ◽  
Proton Pump Inhibitor Therapy ◽  
Upper Gastrointestinal Symptoms ◽  
Alarm Features ◽  
Upper Gastrointestinal

BACKGROUND: Upper gastrointestinal symptoms attributable to gastroesophageal reflux disease or peptic ulcer are common, but the outcome of proton pump inhibitor therapy in clinical practice is not well documented.AIM: To assess the range of upper gastrointestinal acid-related symptoms in clinical practice and the rapidity of their response to pantoprazole (40 mg daily), after seven days of therapy.METHODS: A total of 726 Canadian physicians (65.3% family physicians) recorded a working diagnosis and alarm features in eligible patients, who then recorded the severity of eight upper gastrointestinal symptoms in a daily symptom diary during the first week of therapy.RESULTS: Complete data were obtained from 2273 (37.3% male) of 3261 patients; physicians diagnosed reflux esophagitis alone (66.9%), peptic ulcer (9.7%), other upper gastrointestinal disorders (12.3%) and reflux esophagitis with another diagnosis (11.1%). Alarm features were common (29.6%), but a history of gastrointestinal blood loss was rare (less than 1%). Mean daytime heartburn scores decreased from 2.59 to 1.40, and epigastric pain scores decreased from 2.54 to 1.56 over the first week (P<0.00001); the proportions of patients who became symptom-free were 68.1% and 55.4%, respectively. Decreased mean symptom scores were also observed for acid regurgitation (2.21 to 1.35), bloating (2.47 to 1.57), nausea (2.03 to 1.36), slow digestion (2.51 to 1.56) and burping (2.56 to 1.69). The percentage of patients with severe or very severe symptoms decreased from 53.5% to 13.8% at day 7. The physician’s initial diagnosis was not predictive of outcome.CONCLUSIONS: In a predominantly primary care population with upper gastrointestinal acid-related symptoms, proton pump inhibitor therapy produces prompt symptomatic relief in most patients. Potential alarm symptoms are common, and further research is required to determine the absolute risk of alarm symptoms and their implications for empirical therapy.

scholarly journals A One-Year Economic Evaluation of Six Alternative Strategies for the Management of Uninvestigated Upper Gastrointestinal Symptoms in Canadian Primary Care

2010 ◽  
Vol 24 (8) ◽  
pp. 489-498 ◽  
Author(s):  
Alan N Barkun ◽  
Ralph Crott ◽  
Carlo A Fallone ◽  
Wendy A Kennedy ◽  
Jean Lachaine ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Gastrointestinal Symptoms ◽  
Cost Effective ◽  
Upper Gastrointestinal Symptoms ◽  
Management Approaches ◽  
The Cost ◽  
Relevant Range ◽  
Upper Gastrointestinal

BACKGROUND: The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinal symptoms remains controversial.OBJECTIVE: To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.METHODS: The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, quality-adjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined.RESULTS: Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most cost-effective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values.CONCLUSIONS: Although no strategy was the indisputable cost-effective option, CanDys omeprazole may be the strategy of choice over a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

2001 ◽  
Vol 160 (8) ◽  
pp. 497-500 ◽  
Author(s):  
Eleftheria Roma ◽  
Yota Kafritsa ◽  
Joanna Panayiotou ◽  
Roula Liakou ◽  
Andreas Constantopoulos
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Symptoms ◽  
Common Cause ◽  
Upper Gastrointestinal Symptoms ◽  
Upper Gastrointestinal

scholarly journals Repeat Upper Gastrointestinal Endoscopy in Patients with Functional Dyspepsia: Yield, Findings, and Predictors of Positive Findings

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Supot Pongprasobchai ◽  
Natta Asanaleykha ◽  
Pongchirat Tantayakom
Keyword(s):  
Peptic Ulcer ◽  
Functional Dyspepsia ◽  
Reflux Esophagitis ◽  
Gastrointestinal Endoscopy ◽  
Multivariate Analyses ◽  
Upper Gastrointestinal Endoscopy ◽  
Erosive Gastritis ◽  
History Of ◽  
Alarm Features ◽  
Upper Gastrointestinal

Background. No guideline on repeat esophagogastroduodenoscopy (EGD) in functional dyspepsia (FD) exists. This study aimed to define yield, findings, and predictors of positive findings on repeat EGD in FD.Methods. FD patients who underwent at least 2 EGDs during October 2005 to November 2011 were enrolled and reviewed. Yield and findings were analyzed and univariate and multivariate analyses were performed to identify predictors of positive repeat EGD.Results. The median time to repeat EGD was 34 months. Among 146 patients, 115 patients (79%) had negative and 31 (21%) had positive repeat EGD, including erosive gastritis (13.0%), peptic ulcer (7.5%), reflux esophagitis (1.4%), and Barrett’s esophagus (0.7%). Four independent predictors of positive repeat EGD were smoking (HR 3.88, 95% CI 1.31–11.51,P=0.015), hypertension (HR 2.96, 95% CI 1.38–6.36,P=0.050), history of malignancies (HR 3.65, 95% CI 1.16–11.46,P=0.027), and antiplatelets or NSAIDs used within 4 weeks (HR 4.10, 95% CI 1.13–14.90,P=0.032), while alarm features or failure to treatment did not predict positive repeat EGD.  Conclusion. Yield of repeat EGD in FD was substantially low, all findings were acid-related disorders, and there was no malignancy. Smoking, hypertension, history of malignancies, and antiplatelets/NSAIDs use associated with positive repeat EGD.

Su1071 Association Between Upper Gastrointestinal Symptoms, Reflux Esophagitis and Metabolic Syndrome

2013 ◽  
Vol 144 (5) ◽  
pp. S-391
Author(s):  
Kazuhiro Kamada ◽  
Nobuaki Yagi ◽  
Yuji Naito ◽  
Yukiko Tokioka ◽  
Junpei Takaaki ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Reflux Esophagitis ◽  
Gastrointestinal Symptoms ◽  
Upper Gastrointestinal Symptoms ◽  
Upper Gastrointestinal
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