| Differences in the diagnostic yield of upper gastrointestinal endoscopy in dyspeptic patients receiving proton-pump inhibitors and H2-receptor antagonists. | |
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MedLine Citation:
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PMID: 12170401 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND STUDY AIMS: Patients attending for diagnostic oesophagogastroduodenoscopy (OGD) for dyspeptic symptoms are often receiving acid-suppression therapy that has not been discontinued prior to endoscopy, and this may reduce the diagnostic yield of endoscopy. The aim of this study was to compare the diagnostic yield of OGD in uncomplicated dyspepsia in patients receiving no medication, those receiving acid-suppression therapy, and those receiving nonsteroidal anti-inflammatory drugs (NSAIDs) at the time of endoscopy. PATIENTS AND METHODS: A total of 6825 diagnostic OGDs performed in our unit between 1993 and 2001 were analysed. Patients were excluded if they had sinister symptoms, were receiving NSAIDs, or were undergoing repeat or surveillance endoscopy. RESULTS: A total of 4233 OGDs (62 %) fulfilled the criteria for uncomplicated dyspepsia. Of the patients examined in these procedures, 1367 (32 %) were receiving acid-suppression therapy. A total of 724 patients (53 % of those on therapy) were receiving proton-pump inhibitors (PPIs), 393 of whom (54 %) had positive endoscopic findings (oesophagitis 31 %, gastritis 16 %, duodenal ulcer/duodenitis 16 %). A total of 643 (47 % of the patients on therapy) were receiving H 2 -receptor antagonists, 443 of whom (69 % of this group) had positive endoscopic findings (oesophagitis 30 %, gastritis 21 %, duodenal ulcer/duodenitis 31 %). A total of 2866 patients were not receiving acid-suppression therapy, 1805 of whom (63 %) had endoscopic findings (oesophagitis 37 %, gastritis 14 %, duodenal ulcer/duodenitis 24 %). The endoscopic yield was significantly lowest in the PPI group, except for the diagnosis of oesophagitis. Overall, 17 carcinomas were detected in patients referred with simple dyspepsia, and in five of these cases the patients were receiving acid suppression. CONCLUSIONS: The widespread use of acid suppression in the treatment of simple dyspepsia prior to endoscopy leads to a reduction in the endoscopic recognition of mucosal lesions caused by acid-peptic disease, but not to a high healing rate for these lesions, and it may mask malignancy. |
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Authors:
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R M S Mitchell; J S A Collins; R G P Watson; T C K Tham |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Endoscopy Volume: 34 ISSN: 0013-726X ISO Abbreviation: Endoscopy Publication Date: 2002 Jul |
Date Detail:
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Created Date: 2002-08-09 Completed Date: 2002-09-18 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0215166 Medline TA: Endoscopy Country: Germany |
Other Details:
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Languages: eng Pagination: 524-6 Citation Subset: IM |
Affiliation:
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Dept. of Gastroenterology, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom. michael_mitchell@talk21.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents, Non-Steroidal / therapeutic use Digestive System Diseases / complications, diagnosis* Dyspepsia / diagnosis, drug therapy*, etiology Endoscopy, Gastrointestinal* Esophageal Diseases / diagnosis Female Histamine H2 Antagonists / therapeutic use* Humans Male Middle Aged Proton Pumps / antagonists & inhibitors* |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents, Non-Steroidal; 0/Histamine H2 Antagonists; 0/Proton Pumps |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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