| Practice patterns in screening for varices: an American survey. | |
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MedLine Citation:
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PMID: 19251491 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND AIMS: Guidelines recommend screening for gastroesophageal varices. Regional studies suggest screening is underutilized, but information from across the United States is unavailable. We explored practice patterns and adherence to guidelines in a random sample of physicians and sought to define whether differences existed according to practice type, setting and years of practice. MATERIALS AND METHODS: Surveys were randomly sent to 600 gastroenterologists and hepatologists. Descriptive data is presented as percentage and comparisons were performed by chi-square analysis. Significance was defined at a p value <0.05. RESULTS: 180 completed surveys were returned. Mean age was 48.9+/-10 years and 87% were male. 50% were community-based and 74% had been in practice >10 years. 53% (78% hepatologists versus 45% of gastroenterologists) screened consistently (>75% of the time), (p<0.001). No differences in screening frequency were found according to practice setting or years in practice. 62% screened all cirrhotics whereas 38% screened based on clinical characteristics. In patients without gastroesophageal varices, 60% repeated esophagogastroduodenoscopy in 2-3 years. In those with small gastroesophageal varices, repeat esophagogastroduodenoscopy was recommended in 1-2 years by 73%. In patients with small and large varices, 40% and 54% of physicians respectively, recommended prophylaxis. 6% of physicians recommend prophylaxis regardless of the presence or size of varices. CONCLUSIONS: Screening for varices is under-implemented. Many screened based on clinical findings that have not been shown to reliably predict high-risk gastroesophageal varices. Continued education and removal of financial barriers to screening are central to increasing screening rates and improving patient outcomes. |
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Authors:
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A S Barritt; M R Arguedas |
Publication Detail:
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Type: Journal Article Date: 2009-02-28 |
Journal Detail:
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Title: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver Volume: 41 ISSN: 1878-3562 ISO Abbreviation: Dig Liver Dis Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-11 Completed Date: 2009-12-02 Revised Date: 2012-03-08 |
Medline Journal Info:
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Nlm Unique ID: 100958385 Medline TA: Dig Liver Dis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 676-82 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology and Hepatology, University of North Carolina-Chapel Hill, NC 27599-7080, United States. abarritt@unch.unc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Endoscopy, Digestive System Esophageal and Gastric Varices / diagnosis*, etiology, therapy Female Gastroenterology Guideline Adherence Humans Liver Cirrhosis / complications Male Mass Screening / utilization* Middle Aged Physician's Practice Patterns / statistics & numerical data* Practice Guidelines as Topic United States |
| Grant Support | |
ID/Acronym/Agency:
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T32 DK007634-09/DK/NIDDK NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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