geoffrey modest medical blogs

  An updated systematic review/meta-analysis reaffirmed the general lack of utility of endoscopy in patients who have symptomatic dyspepsia but without alarm features (see   dyspepsia review of endoscopy findings ClinGastroHep2022  in dropbox, or  doi.org/10.1016/j.cgh.2022.05.041 )   Details : -- 15 cross-sectional surveys, including 6 printed from 2010 until January 2022, analyzed the prevalence of dyspepsia as well as endoscopy (EGD) -- EGD was performed in all participating individuals regardless of their symptoms in 6 studies, in all individuals with dyspepsia in 2 studies, and in some patients having EGD regardless of symptoms in the remaining 7 studies -- 41,763 people underwent EGD, of whom 16,900 (40.4%) had dyspepsia       -- the prevalence of dyspepsia in these surveys range from 2.4% to 68.5% with a pooled prevalence of 26.6% (13.6%-42.1%), but with lots of heterogeneity between the studies -- 5 studies were conducted in the West,...

the American College of Gastroenterology updated their recommendations for screening for Barrett's Esophagus (see  barretts screening dx rx amjgastro2015  in dropbox, or doi: 10.1038/ajg.2015.322) background:      --there is increasing prevalence of GERD in the US and worldwide     --GERD is associated with 10-15% risk of Barrett's esophagus (BE), ie in 1-2% of the population, with risk factors of male sex, central obesity, intensity/duration of GERD sx, and >50yo. The most profound risk factors are: those with early onset (<30 yo) and weekly symptoms (OR 31.4), and family history of BE or  esophageal adenocarcinoma (EAC) (OR 12.23). white men with GERD have 2% chance of BE in the third decade of life, increasing to 9% by 6th decade. men have twice the risk as compared to women for both BE and EAC.  alcohol does not increase risk of BE.      --BE is as...