期刊文献+

Prevention of overuse: A view on upper gastrointestinal endoscopy 被引量:3

Prevention of overuse: A view on upper gastrointestinal endoscopy
下载PDF
导出
摘要 Many upper gastrointestinal(GI) endoscopies worldwide are performed for inappropriate indications. This overuse of healthcare negatively affects healthcare quality and puts pressure on endoscopy services. Dyspepsia is one of the most common inappropriate indications for upper GI endoscopy as diagnostic yield is low. Reasons for untimely referral are: unfamiliarity with dyspepsia guidelines,uncertainty about etiology of symptoms, and therapy failure. Unfiltered openaccess referrals feed upper GI endoscopy overuse. This review highlights strategies applied to diminish use of upper GI endoscopies for dyspepsia. First,we describe the impact of active guideline implementation. We found improved guideline adherence, but resistance was encountered in the process. Secondly, we show several forms of clinical assessment. While algorithm use reduced upper GI endoscopy volume, effects of referral assessment of individual patients were minor. A third strategy proposed Helicobacter pylori test and treat for all dyspeptic patients. Many upper GI endoscopies can be avoided using this strategy, but outcomes may be prevalence dependent. Lastly, empirical treatment with Proton pump inhibitors achieved symptom relief for dyspepsia and avoided upper GI endoscopies in about two thirds of patients. Changing referral behavior is complex as contributing factors are manifold. A collaboration of multiple strategies is most likely to succeed. Many upper gastrointestinal(GI) endoscopies worldwide are performed for inappropriate indications. This overuse of healthcare negatively affects healthcare quality and puts pressure on endoscopy services. Dyspepsia is one of the most common inappropriate indications for upper GI endoscopy as diagnostic yield is low. Reasons for untimely referral are: unfamiliarity with dyspepsia guidelines,uncertainty about etiology of symptoms, and therapy failure. Unfiltered openaccess referrals feed upper GI endoscopy overuse. This review highlights strategies applied to diminish use of upper GI endoscopies for dyspepsia. First,we describe the impact of active guideline implementation. We found improved guideline adherence, but resistance was encountered in the process. Secondly, we show several forms of clinical assessment. While algorithm use reduced upper GI endoscopy volume, effects of referral assessment of individual patients were minor. A third strategy proposed Helicobacter pylori test and treat for all dyspeptic patients. Many upper GI endoscopies can be avoided using this strategy, but outcomes may be prevalence dependent. Lastly, empirical treatment with Proton pump inhibitors achieved symptom relief for dyspepsia and avoided upper GI endoscopies in about two thirds of patients. Changing referral behavior is complex as contributing factors are manifold. A collaboration of multiple strategies is most likely to succeed.
出处 《World Journal of Gastroenterology》 SCIE CAS 2019年第2期178-189,共12页 世界胃肠病学杂志(英文版)
关键词 ENDOSCOPY DYSPEPSIA Medical OVERUSE Guidelines PROTON Pump Inhibitors HELICOBACTER PYLORI Endoscopy Dyspepsia Medical Overuse Guidelines Proton Pump Inhibitors Helicobacter pylori
  • 相关文献

参考文献2

二级参考文献68

  • 1Angelo Zullo,Cesare Hassan,Alessandro Repici,Vincenzo Bruzzese.Helicobacter pylori eradication and reflux disease onset:Did gastric acid get "crazy"?[J].World Journal of Gastroenterology,2013,19(6):786-789. 被引量:4
  • 2Chang-Cheng Chang,Jun-Te Hsu,Jeng-Hwei Tseng,Tsann-Long Hwang,Han-Ming Chen,Yi-Yin Jan.Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity:Report of a case[J].World Journal of Gastroenterology,2006,12(5):800-803. 被引量:104
  • 3John Keohane,Eamonn M M Quigley.Functional dyspepsia:The role of visceral hypersensitivity in its pathogenesis[J].World Journal of Gastroenterology,2006,12(17):2672-2676. 被引量:35
  • 4Bing Zhao,Jing Zhao,Wen-Fang Cheng,Wei-Jia Shi,Wei Liu,Xiao-Lin Pan,Guo-Xin Zhang.Efficacy of Helicobacter pylori Eradication Therapy on Functional Dyspepsia: A Meta-Analysis of Randomized Controlled Studies With 12-Month Follow-up[J].Journal of Clinical Gastroenterology.2014(3)
  • 5Timothy L. Cover,Martin J. Blaser.Helicobacter pylori in Health and Disease[J].Gastroenterology.2009(6)
  • 6Hidekazu Suzuki,Eisuke Iwasaki,Toshifumi Hibi.Helicobacter pylori and gastric cancer[J].Gastric Cancer.2009(2)
  • 7Jaswinder Singh Sodhi,Gul Javid,Showkat Ali Zargar,Syed Tufail,Altaf Shah,Bashir Ahmad Khan,Ghulam Nabi Yattoo,Ghulam Mohamad Gulzar,Mushtaq Ahmad Khan,Mohd Iqbal Lone,Riyaz u Saif,Shaheena Parveen,Abid Shoukat.Prevalence of H elicobacter pylori infection and the effect of its eradication on symptoms of functional dyspepsia in K ashmir, I ndia[J].J Gastroenterol Hepatol.2013(5)
  • 8R. F.Harvey,J. A.Lane,P.Nair,M.Egger,I.Harvey,J.Donovan,L.Murray.Clinical trial: prolonged beneficial effect of Helicobacter pylori eradication on dyspepsia consultations – the Bristol Helicobacter Project[J].Alimentary Pharmacology & Therapeutics.2010(3)
  • 9Xiaobo Li,Huimin Chen,Hong Lu,Weiguang Li,Xiaoyu Chen,Yansheng Peng,Zhizheng Ge.The study on the role of inflammatory cells and mediators in post-infectious functional dyspepsia[J].Scandinavian Journal of Gastroenterology.2010(5)
  • 10L.LAINE.Review article: gastrointestinal bleeding with low‐dose aspirin – what’s the risk?[J].Alimentary Pharmacology & Therapeutics.2006(6)

共引文献38

同被引文献28

二级引证文献10

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部