geoffrey modest medical blogs

A systematic review and network meta-analysis found that a ”test and treat” approach to H Pylori infections in patients who have dyspepsia is the optimal strategy (see dyspepsis test and treat H Pylori bmj2019 in dropbox , or doi:  https://doi.org/10.1136/bmj.l6483 ) Details: -- 15 randomized controlled trials with 6162 adult participants with symptoms of dyspepsia were included -- the strategies tested were prompt endoscopy; testing for H Pylori and performing endoscopy in those testing positive (“test and scope”); testing for H Pylori and giving eradication treatment in those who test positive (“test and treat”); empirical acid suppression; or symptom-based management -- trials reported symptom status at follow-up, at least 12 months later -- the strategies were ranked by the P score, the probability of each treatment being ranked is the best in a network analysis Results: -- as compared to symptom-based management:     -- test a...

H pylori in US veterans G      Geoff A. Modest, M.D. Mon 12/16/2019 8:15 AM Geoff A. Modest, M.D.  A new large retrospective US study from the Veterans Health Administration confirmed a large presence of H pylori infections in the US, an increased incidence of gastric cancer, and a decreased risk with adequate H pylori therapy (see   hpylori VA gast ca gastro2019  in dropbox, or doi.org/10.1053/j.gastro.2019.10.019 ). Details: -- 371,813 patients had a diagnosis of H pylori from 1994-2019 -- mean age 62, 92% male, 28% ever-smokers, most were identified as having H pylori by record review showing appropriate therapy (about 75%) -- 2024 (0.54%) developed gastric cancer, with median follow-up of 7.4 years.      --Median age of cancer diagnosis: 69 -- cases by race:      -- white: 214,090 cases (58% of total), futur...

A nationwide population-based Korean study found that changes in metabolic syndrome status were associated with altered risk for cardiovascular events (see  metabolic synd rx dec cv risk aim2019  in dropbox, or doi:10.7326/M19-0563) Det ails: -- 27,161,051 people involved in national health screenings from 2009 to 2014 were evaluated in 2009, 2011, and 2013 for changes in metabolic syndrome (MetS) and cardiovascular outcomes. 9,553,042 people had appropriate data to qualify, in the following groups:     -- MetS-free group: 6,940,663 people without MetS on the three screenings     -- MetS-chronic group: 1,486,485 people with MetS on all three screenings     -- MetS-developed group: 587,088 people without MetS on the initial screen but with MetS on the second and final screen     -- MetS-recovery group: 538,806 people with MetS on initial screen but without MetS on the second a...