scholarly journals Appropriateness of Indications of Upper Gastrointestinal Endoscopy and its Association With Positive Finding

2018 ◽  
Vol 56 (209) ◽  
pp. 504-509 ◽  
Author(s):  
Tanka Prasad Bohara ◽  
Uttam Laudari ◽  
Abishek Thapa ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi

Introduction:  Upper Gastrointestinal Endoscopy(UGIE) is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for UGIE and have shown that inappropriate indications range from 5% to 49%. The unnecessary UGIE expose patients to the risk. The number of UGIE is rising in our region and we assume so is the number of unnecessary UGIE. With an aim to evaluate the appropriateness of the indications of UGIE and compare its association with positive findings, we conducted a cross-sectional descriptive study. Methods: All patients undergoing diagnostic UGIE during the study period were included in the study. Appropriateness of indications for UGIE was defined as per American Society for Gastrointestinal Endoscopy(ASGE) criteria as “appropriate” and “inappropriate”. UGIE endoscopy findings were classified as “significant” and “insignificant” based on endoscopy findings. The extent of this association between the appropriateness of indications and UGIE findings was expressed as the odds ratio (OR) of finding a relevant diagnosis in patients with an ‘‘appropriate’’ indication compared with those with an ‘inappropriate’’ indication. Results: Seventy-nine patients were included in the study. Fifty- two (65.8 %) of the indications were considered appropriate as per ASGE guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95%CI:1.773 – 13.890, p=0.002) which is statistically significant. Conclusions:  Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.

2020 ◽  
pp. 2740-2748
Author(s):  
James E. East ◽  
George J. Webster

Endoscopy is the procedure of choice in patients with retrosternal or upper abdominal symptoms who require investigation, and is essential in significant gastrointestinal bleeding to identify and—in most cases—treat the cause, with various therapeutic methods possible for erosions, ulcers, and oesophageal varices. More recent developments in the practice of upper gastrointestinal endoscopy include the use of enteroscopy for direct vision of the small bowel, video capsule endoscopy for diagnosis of obscure bleeding lesions, and an expanding range of minimally invasive therapeutic techniques. Endoscopic retrograde cholangiopancreatography is the standard of care for the removal of gallstones from the common bile duct, and palliating obstructing pancreatobiliary tumours.


2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Abdessamad EL KAOUKABI ◽  
Mohamed MENFAA ◽  
Samir HASBI ◽  
Fouad SAKIT ◽  
Abdelkrim CHOHO

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.


2015 ◽  
Vol 22 (07) ◽  
pp. 871-875
Author(s):  
Salman Khan ◽  
Tahir Ghaffar ◽  
Ismatullah Khan

The most common single cause of anemia worldwide is Iron deficiency. It resultsfrom other underlying diseases and to look for its cause is very crucial and is of far greaterimportance than restoring the iron stores and hemoglobin levels. Objectives: To determine thefrequency of common upper gastrointestinal endoscopic findings in elderly patients with irondeficiency anemia presenting with dyspepsia. Study Design: Cross sectional descriptive study.Setting: Department of Medicine, Khyber Teaching hospital, Peshawar. Period: March, 2011 toSeptember, 2011. Materials and Methods: 116 patients, all the patients with iron deficiencyanemia presenting with dyspepsia were subjected to upper gastrointestinal endoscopy todetect common findings as gastric erosions, peptic ulcer and gastric carcinoma. StatisticalAnalysis: Data was analyzed with SPSS 10.0. Results: On upper gastrointestinal endoscopy,normal findings were noted 30 (25.86%) patients and abnormal findings were noted in 86(74.14%) patients including 45 (38.79%) patients with gastric erosions, 30 (25.86%) patientswith peptic ulcer and 11 (9.48%) patients were found with gastric malignancy. Conclusions:Upper gastrointestinal lesions are common in elderly patients with iron deficiency anemiapresenting with dyspepsia and must be screened by gastrointestinal endoscopy.


2017 ◽  
Vol 54 (4) ◽  
pp. 305-307 ◽  
Author(s):  
Diego Michelon DE CARLI ◽  
Amanda Faria de ARAUJO ◽  
Renato Borges FAGUNDES

ABSTRACT BACKGROUND: Barrett’s esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett’s esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher’s exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett’s esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett’s esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett’s esophagus than short segments. Barrett’s esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett’s esophagus represented globally 0.3% and 1.1% in GERD patients.


Author(s):  
Billy Siahaan ◽  
Arles Arles ◽  
Wirhan Azhari

Background: Gastro-esophageal Reflux Disease (GERD) is a disease that is commonly found in daily practice and affecting the patients’ quality of life negatively. GERD-Q is a tool in the form of validated questionnaire that is quite useful and easy to use in daily practice to diagnose GERD by symptoms and signs especially in primary care that do not have endoscopy facilities.  This study was built to assess the correlation between GERD-Q score and esophagitis finding in upper gastrointestinal endoscopy in Pekanbaru. Method: This was a prospective cross-sectional study with sample groups of GERD-Q score ≥8 (high GERD-Q score) and GERD-Q score 8 (low GERD-Q score) which underwent upper gastrointestinal endoscopy to assess reflux esophagitis. GERD-Q score data were obtained by direct interview.Results: This study was participated by 65 subjects with reflux esophagitis and 51 non-esophagitis patients that had undergone upper gastrointestinal endoscopy procedure. The 65 subjects with reflux esophagitis were divided into groups based on severity (LA Classification), Grade A 29 subjects (45%), Grade B 23 subjects (35%), Grade C 11 subjects (16%), and Grade D 2 subjects (3%). The result of this study showed that there was a statistically significant correlation between GERD-Q score category with esophagitis findings from upper gastrointestinal endoscopy (p 0.05, PR = 2.6)Conclusion: There is a statistically significant correlation between GERD-Q score and esophagitis findings from endoscopy but no relevance in esophagitis severity.


2019 ◽  
Vol 11 (2) ◽  
pp. 25-29
Author(s):  
Azizun Nessa ◽  
Muhammad Rabiul Hossain ◽  
Md Habibur Rahman ◽  
SM Mizanur Rahman ◽  
Abdullah Al Mamun ◽  
...  

Introduction: Dyspepsia affects up to 40% of the general population and significantly reduces the quality of life. Dyspeptic symptoms may be associated with endoscopically negative conditions, such as functional dyspepsia, or with organic lesions like peptic ulcer and oesophagitis which are easily detected by endoscopy. On the other hand, such lesions may also be asymptomatic and there is not always a clear cause and effect relationship between endoscopic findings and symptoms. Objective: To determine the prevalence of significant endoscopic lesion and or ultrasonographic findings and their association with dyspeptic symptoms in Bangladeshi rural population. Materials and Methods: This prospective cross sectional study was carried out in Nov 2015 to Dec 2015 in a field mobile hospital of Bangladesh Army, established in Daudkandi, Comilla where total 1094 uninvestigated dyspeptic patients were invited to participate in this cross sectional study and 105 typical dyspeptic patients were finally recruited as per Rome III criteria. Participants underwent clinical assessment through a preformed structured questionnaire and non video upper gastrointestinal endoscopy (UGIE) and ultrasonogram (USG) of hepatobiliary system (HBS). Results: The mean age of 105 participants (male-29; female-76) studied was 36.51±7.26 years with female preponderance (72.38%). Predominant symptoms were epigastric pain (69.52%), flatulence (34.28%), heart burn (28.57%) and diffuse abdominal pain (22.85%). Regarding treatment 48(45.71%) patients took proton pump inhibitors (PPI), 24 patients (22.85%) took H2 receptor blocker and 13 patients (12.38%) were on antacids irregularly. Seventeen patients (16.15%) had no history of medications for dyspepsia. Most of the patients (76.19%) had symptoms of less than 5 years. Organic dyspepsia was found in 68(64.76%) and functional dyspepsia in 37(35.23%) participants. Percentage of functional dyspepsia in male was 24.13% and in female it was 39.47% and the difference was statistically significant (p<0.05). In the organic dyspepsia group, upper GI endoscopy revealed 07(6.66%) duodenal ulcer, 02(1.9%) gastric ulcer, 04(3.8%) prepyloric ulcer and other inflammatory lesions like prepyloric gastritis in 46(43.80%) patients, antral gastritis in 06(5.7%) patients, duodenitis in 08(7.61%) patients and erosive oesophagitis in 03 patients(2.86%). Further USG revealed cholelithiasis in 02(1.90%) and gall bladder (GB) polyp in 01(0.95%) participants which could be the reason for their dyspeptic symptoms. Thirty Seven (35.23%) participants had normal UGIE (and also normal USG of HBS) but they had significant dyspeptic symptoms. Conclusion: Most of the patients (64.76%) in this study had significant upper GI endoscopic findings and labeled as organic dyspepsia and combined use of upper GI endoscopy and USG of HBS provided better yield for aetiological diagnosis of dyspepsia if there is any. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 25-29


2021 ◽  
Vol 8 (18) ◽  
pp. 1201-1205
Author(s):  
Koushik Chakma ◽  
Saumik Chakraborty ◽  
Avik Chakraborty

BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the common medical emergencies throughout the world that may require hospital admission and results in high patient morbidity and mortality. The presentation of UGI bleeding depends on the amount and location of haemorrhage. Upper gastrointestinal endoscopy (UGIE) is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. The present study has been carried out to evaluate the different aetiological causes of UGIB in a tertiary care centre in the North Eastern part of India and compare the same with other studies done globally. METHODS This was a hospital based observational study with cross sectional design carried out in the Department of Medicine at Tripura Medical College & DR BRAM Teaching Hospital, Agartala. Total 376 patients were selected for this study for over a period of 2 years from January 2017 to December 2018. Upper GI endoscopy was performed in all patients after hemodynamic stabilisation. Rockall scoring system was used in non-variceal cases to predict the mortality in patients with upper GI bleeding. RESULTS A total of 376 patients had endoscopy for UGIB which included 260 (69.1 %) males and 116 (30.9 %) females, and the mean age was 47.9 (± 17.0) years. The most common cause of UGIB was peptic ulcer disease (duodenal ulcer and gastric ulcer) consisting of 31.38 %, followed by erosive gastritis (23.94 %), oesophageal varix (11.17 %), portal hypertensive gastropathy (10.64 %), duodenitis (8.51 %). Gastrointestinal malignancy (gastric and oesophageal cancers) was reported in 3.98 % and rare causes of UGIB were Mallory-Weiss syndrome (1.86 %), and esophagitis (1.60 %). Among them 4.26 % of the patients had normal endoscopy findings. CONCLUSIONS In the present study, peptic ulcer disease was the most common cause of upper gastrointestinal bleeding, followed by erosive gastritis. Rockall score of more than 4 was numerically associated with increased incidence of mortality. KEYWORDS Upper Gastrointestinal Bleeding (UGIB), Upper Gastrointestinal Endoscopy (UGIE


2012 ◽  
Vol 19 (02) ◽  
pp. 202-207
Author(s):  
NABIHA FAISAL ◽  
MUHAMMAD MANSOOR UL HAQ ◽  
HAFEEZULLAH SHAIKH ◽  
Pervez Ashraf ◽  
Jamila. H. Esmail

Objective: To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care centerin Karachi. Data source: Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Design of study: Cross sectional descriptivestudy. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi. Period: May 2008–October 2008. Material andmethods: All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinalbleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two eachfrom antrum and body and one from fundus were taken for histology. Results: A total of 123 dyspeptic patients were included in the study. 76(61.8%) patients were males and 47 (38.2%) were females. H pylori was detected in mucosa of 49 (39.8%) patients. The mean age of thepatients was 41.41 ± 13.15 Years (95%CI; 39.06 to 43.75). Rate of H.pylori infection was not found statistical significant with age, gender,duration of symptoms and BMI. Conclusions: The prevalence of H pylori infection in dyspeptic patients was lower than reported in previousstudies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pyloriin our setup.


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