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,...

  A patient-centered educational intervention decreased the unnecessary use of upper GI endoscopy (see  dyspepsia web educ dec egd jamaintmed2021  in dropbox or doi:10.1001/jamainternmed.2021.1408 )   Details:  -- open-label RCT, multicenter study at 4 teaching hospitals in the Netherlands from 2017-2019, sponsored by the Dutch Ministry of Health -- 119 patients aged 18 to 69 with uninvestigated dyspeptic symptoms -- median age 48, 40% men, BMI 25, 50% alcohol users, 15% smokers, 80% employed/8% disabled, -- medications: 70% PPI/3% H2-blockers/12% antidepressants/6% NSAIDs sporadically      -- those on antacid therapy were on them for a mean of 80 weeks -- 23% had prior upper GI endoscopy/18% abdominal ultrasound -- excluded patients: those with red flag symptoms, including signs of upper GI hemorrhage (hematemesis, melena, hematochezia, anemia), unintentional weight loss of 5% or higher during a period of 6 to 12 months, or persistent vomiti...