scholarly journals THE SYMPTOMS OF UPPER GASTROINTESTINAL, PSYCHOSOCIAL CO-MORBIDITY, EFFECTS ON PATIENTS & HEALTH CARE SEEKING IN GENERAL PRACTICE

2020 ◽  
Vol 4 (12) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Health Care ◽  
General Practice ◽  
Care Utilization ◽  
Multivariable Logistic Regression Analysis ◽  
Odds Ratios ◽  
Upper Gi ◽  
Co Morbidity ◽  
Gi Symptoms ◽  
Gastrointestinal Problems ◽  
Upper Gastrointestinal

There is also a limited understanding of the pathophysiology of upper gastrointestinal (GI) effects. In patients with functional gastrointestinal problems, psychological symptoms have been shown to be more frequent, although it is disputed if they are directly related to GI symptoms or rather indicate reasons for seeking health treatment. The aim of our research was to compare co-morbidity between patients with and without upper GI symptoms, particularly psychological and social problems. Furthermore, we explored whether the occurrence of psychiatric and social disorders was part of a larger trend of health care utilization due to sickness. Case control research focused on the population based on the second Dutch National Survey of General Practice (conducted in 2001). Cases and controls (individuals not experiencing any of these complaints) matched by gender, age, PCP-practice and ethnicity were contrasted (adults attending their primary care provider (PCP) with upper GI symptoms). The key outcome indicators were communication duration, somatic and psychosocial diagnosis prevalence, (psycho) pharmacological agent dosage levels, and referral rates. Using odds ratios, the Chi square test and multivariable logistic regression analysis, the data was analyzed. As a result, data was analyzed for 13,389 patients with upper GI signs and 13,389 control patients. Twice as often as controls (8.6 vs 4.4 times/year), patients with upper GI symptoms attended their PCP. There were not only more psychiatric and emotional issues in people with upper GI signs, but also more clinical problems in their PCP (odds ratios (ORs) ranged from 1.37 to 3.45). Drugs of any ATC type (ORs range from 1.39 to 2.90), including psychotropic agents, have been used most commonly in patients with upper GI symptoms. When we corrected for non-attending control patients, the found variations were less pronounced. In the multivariate regression study, patients with upper GI effects were more closely correlated with communication frequency and not psychiatric or social co-morbidity. To conclude, people with upper GI symptoms most often attend their PCP for some organ system issues, even psychosocial problems. The correlation between upper GI symptoms and psychological issues is misleading and could represent higher health care standards in general. Keywords: gastrointestinal

scholarly journals Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients

1970 ◽  
Vol 8 (1) ◽  
pp. 25-28 ◽  
Author(s):  
VN Ravikumar ◽  
K Rudresh ◽  
U Jalihal ◽  
R Satish ◽  
R Manjunath
Keyword(s):  
Weight Loss ◽  
Epigastric Pain ◽  
Cd4 Count ◽  
Common Finding ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Mucosal Involvement ◽  
The Mean ◽  
Upper Gastrointestinal ◽  
Oesophageal Candidiasis

Background: Human Immunodeficiency Virus (HIV) infected patient frequently report upper gastrointestinal (GI) symptoms; however their prevalence and diagnostic approach is not well known. Objective: The objective of this study was to study clinical, endoscopic and histopathological changes in HIV infected patients with upper GI symptoms and their correlation with CD4 count. Materials and methods: We evaluated 50 HIV infected patients who presented to M.S. Ramaiah hospital with upper GI symptoms. All patients answered questionnaire assessing upper GI symptoms and underwent upper GI endoscopy. Mucosal biopsy was taken wherever mucosal abnormality seen. Results: In our study, the mean age of patients was 40.98 yrs, of which 80% were males. Vomiting (36%), epigastric pain (36 %), weight loss (34 %) and anorexia (34%) were the predominant symptoms. Esophagogastroduodenoscopy (EGD) findings revealed- Oesophageal candidiasis in 28.0%, esophagitis in 22.0%, gastritis in 20.0 %, duodenitis in 14 %, normal upper GI mucosa in 18 % patients. Oesophageal candidiasis was the most common finding on histopathological examination and the mean CD4 count was 157.92 cells/μl. Conclusion: Vomiting, epigastric pain, weight loss and anorexia were most frequent symptoms. Oral candidiasis was the most common oral lesion. Oesophageal candidiasis, oesophagitis and oesophageal ulcers were the common findings on EGD. Patient with CD4 count less than 200cells/μl had more frequent upper GI mucosal involvement than in patients with CD4 count more than 200. Majority of the patients with GI symptoms had upper GI mucosal changes and opportunistic infections. Thus endoscopic and histopathological evaluation is advisable for the early diagnosis and treatment of upper GI complications in patients with HIV infection. Key words: AIDS; Oesophageal candidiasis; Esophagogastroduodenoscopy; HIV; Upper gastrointestinal symptoms. DOI: 10.3126/kumj.v8i1.3217 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 25-28

scholarly journals Contribution of acid and duodenogastrooesophageal reflux to oesophageal mucosal injury and symptoms in partial gastrectomy patients

Gut ◽  
1997 ◽  
Vol 41 (3) ◽  
pp. 297-302 ◽  
Author(s):  
M F Vaezi ◽  
J E Richter
Keyword(s):  
Patient Group ◽  
Partial Gastrectomy ◽  
Mucosal Injury ◽  
Acid Reflux ◽  
Glass Electrode ◽  
Oesophageal Reflux ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Gastrointestinal

Background—The role of acid and pepsin in causing symptoms and oesophagitis is well established; however, the significance of duodenogastro-oesophageal reflux (DGOR) in this disorder is unclear.Aims—To understand the role of acid and DGOR in causing upper gastrointestinal (GI) symptoms and oesophageal mucosal injury in partial gastrectomy (PG) patients.Methods—Thirty two PG patients with upper GI symptoms were studied. Twenty four hour ambulatory acid and bilirubin measurements were obtained with Bilitec 2000 using glass electrode and fibreoptic sensor. Upper GI symptoms and oesophagitis were correlated with either acid or DGOR.Results—The PG patients were a heterogeneous group: 28% (9/32) had mixed reflux (acid+/DGOR+); 50% (16/32) had only DGOR (acid−/DGOR+); and 22% (7/32) had neither (acid−/DGOR−). Upper GI symptoms were associated with both mixed reflux (69%) and DGOR (24%). Six patients (67%) in the acid+/DGOR+ group had oesophagitis; no acid−/DGOR+ or acid−/DGOR− patients had oesophagitis. Mixed reflux showed a significant (p<0.0001) association with oesophagitis, while DGOR did not (p=0.3).Conclusions—(1) The majority of upper GI symptoms and all cases of oesophagitis in the PG patients occurred in patients who had mixed refluxate (acid and DGOR); (2) DGOR without simultaneous acid reflux may cause symptoms, but was not associated with oesophagitis in this patient group.

scholarly journals A clinico-endoscopic study of upper GI disorders in rural population

2018 ◽  
Vol 5 (3) ◽  
pp. 1111
Author(s):  
Ramesh Ainapure ◽  
Vishal Tanga
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Symptoms ◽  
Upper Gastrointestinal Tract ◽  
Common Finding ◽  
Gastrointestinal Disorders ◽  
Oesophageal Varices ◽  
Early Management ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal disorders are commonly seen in routine clinical practice. The definitive diagnosis of upper gastrointestinal disorders rest on endoscopic evaluation and biopsy if required for planning proper treatment. The objectives of the study were to determine the spectrum of disease in upper gastrointestinal tract and to establish endoscopy as an effective tool in the proper diagnosis of various upper gastrointestinal tract disorders.Methods: A prospective study was conducted among patients who presented with upper gastrointestinal symptoms at Gadag Institute Medical College, from August 2016 to August 2017, Gadag. After history taking and physical examination, patients were subjected to fibre-optic upper GI scopy.Results: The result of present study showed male predominance associated with the upper GI disorders. Gastritis (45.65%) was the most common finding followed by normal exam (17.39%), GERD (6.83%), oesophageal cancer (2.17), Oesophagitis (4.34), gastric ulcer (9.31%), and gastric cancer (3.10%), duodenitis (5.90%) and oesophageal varices at 5.27% Gastritis is the most common upper GI disorder seen the patient population.Conclusions: Upper GI endoscopy is an effective and appropriate approach for initial investigation to assess patients with GI symptoms. Thus, it helps early management gastric disorders.

scholarly journals Multimorbidity in Māori and Pacific patients: cross-sectional study in a Dunedin general practice

2018 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Tim Stokes ◽  
Mayur Azam ◽  
Fiona Doolan Noble
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Care Delivery ◽  
Cross Sectional Study ◽  
Socioeconomic Deprivation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Health ◽  
Co Morbidity

ABSTRACT INTRODUCTION Multimorbidity is a major issue in primary health care. AIM To determine the prevalence of multimorbidity and polypharmacy in one general practice in relation to age, sex and socioeconomic deprivation in Māori and Pacific patients. METHODS A cross-sectional study using data manually extracted from electronic medical records was conducted using a stratified random sample of Māori and Pacific patients aged ≥ 35 years who were enrolled with a large urban Dunedin general practice. The data were analysed to identify the number and type of morbidities, and prevalence of multimorbidity and polypharmacy in relation to age, sex and socioeconomic deprivation. RESULTS Half (52.5% [95% CI 44.5–60.4]) of Māori and 64.3% (95% CI 51.9–75.4) of Pacific patients had multimorbidity; 22.8% (95% CI 16.6–30.1) of Māori and 10.0% (95% CI 4.1–19.5) of Pacific patients had physical and mental health co-morbidity. Fewer (13.6% [95% CI 8.7–19.8]) Māori than Pacific patients (32.9% [95% CI 22.1–45.1]) had polypharmacy. The prevalence of multimorbidity in both Māori and Pacific patients increased with age and with increasing levels of socioeconomic deprivation. The eight most prevalent chronic conditions in both Māori and Pacific patients were obesity, anxiety or depression, hypertension, asthma or chronic obstructive pulmonary disease, gout, diabetes, cardiovascular disease and osteoarthritis. CONCLUSION The high prevalence of multimorbidity in Māori and Pacific patients requires the New Zealand health system to deliver culturally competent primary health care and to re-orientate health-care delivery around multimorbidity.

scholarly journals The Intensity of Hospital Care Utilization by Dutch Patients With Lung or Colorectal Cancer in their Final Months of Life

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481984657 ◽  
Author(s):  
Yvonne de Man ◽  
Femke Atsma ◽  
Mariska G. Oosterveld-Vlug ◽  
Linda Brom ◽  
Bregje D. Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Hospital Care ◽  
Health Care Services ◽  
Administrative Database ◽  
Care Utilization ◽  
Odds Ratios ◽  
Care Services ◽  
Inappropriate Care ◽  
Intensity Of Care

Understanding the overuse and underuse of health-care services in the end-of-life (EoL) phase for patients with lung cancer (LC) and colorectal cancer (CRC) is important, but knowledge is limited. To help identify inappropriate care, we present the health-care utilization profiles for hospital care at the EoL of patients with LC (N = 25 553) and CRC (N = 14 911) in the Netherlands between 2013 and 2015. An administrative database containing all in-hospital health-care activities was analyzed to investigate the association between the number of days patients spent in the emergency department (ED) or intensive care unit (ICU) and their exposure to chemotherapy or radiotherapy. Fewer patients received hospital care as death neared, but their intensity of care increased. In the last month of life, the average numbers of hospital bed days, ICU days, and ER contacts were 9.0, 5.5, and 1.2 for patients with CRC, and 8.9, 6.2 and 1.2 for patients with LC in 2015. On the other hand, the occurrence of palliative consultations ranged from 1% to 4%. Patients receiving chemotherapy 6 months before death spent fewer days in ICU than those who did not receive this treatment (odds ratios: CRC = 0.6 [95% confidence interval: 0.4-0.8] and LC = 0.7 [0.5-0.9]), while those receiving chemotherapy 1 month before death had more ED visits (odds ratios: CRC = 17.2 [11.8-25.0] and LC = 15.8 [12.0-20.9]). Our results showed that patients who were still receiving hospital care when death was near had a high intensity of care, yet palliative consultations were low. Receiving chemotherapy or radiotherapy in the final month of life was significantly associated with more ED and ICU contacts in patients with LC.

scholarly journals Upper Gastrointestinal Symptoms in General Population of a District in Bangladesh

2014 ◽  
Vol 4 (2) ◽  
pp. 79-88
Author(s):  
Irin Perveen ◽  
Mufti Munsurar Rahman ◽  
Madhusudan Saha
Keyword(s):  
General Population ◽  
Gastrointestinal Symptoms ◽  
Duration Of Symptoms ◽  
Upper Gi ◽  
Number Of Patients ◽  
Gi Symptoms ◽  
Number Frequency ◽  
Symptom Prevalence ◽  
Upper Abdominal ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal (GI) symptoms are common complaints affecting 25--40% of the general population and are common causes of health care utilisation and substantially affect the quality of life. In day-to-day practice our clinicians have to face good number of patients with various upper GI symptoms. But we have limited data on the prevalence of different upper GI symptoms in our community. Objective: The present study aimed to find out the prevalence of different upper GI symptoms in the general population of a district in Bangladesh. Materials and Methods: This population-based observational study was conducted in a selected district of Bangladesh. Three thousand subjects selected by cluster sampling method were interviewed by a valid bowel disease questionnaire. Student’s t test and chi-square tests were used for comparison of different variables with significance level set at 0.05. Results: Among the study population 1523 were men and 1477 were women with a mean age of 33.91 ± 16.43 years. A total of 2273 (75.8%) persons had at least one upper GI symptom, 2072 (69.1%) had 2 or more symptoms and 1705 (56.8%) had 3 or more symptoms in the prior 3 months. Nine hundred sixty three subjects (32.1%) had upper abdominal pain, 1265 (42.16%) had bloating, 1354 (45.13%) had heart-burn, 1166 (38.87%) had chest pain, 1347 (44.9%) had early satiation and 258 (8.6%) had vomiting. Around 249 (8.3%, male 123, female 126, P=0.691) was diagnosed as functional dyspepsia, 187 (6.2%, male 82, female 105, P=0.059) as gastroesophageal reflux disease (GERD) and 55 (1.83%, male 27, female 28, P=0.892) as upper abdominal bloating. Only one woman fulfilled the criteria for functional gallbladder or sphincter of Oddi dysfunction. Approximately 40.56% dyspeptic patients had overlapping GERD symptoms. Symptom prevalence was found to decrease with increased number, frequency and duration of symptoms. Conclusion: Upper GI symptoms are prevalent in our community. Multiple upper GI symptoms do exist simultaneously. Symptom prevalence varies with number, frequency and duration of symptoms. DOI: http://dx.doi.org/10.3329/jemc.v4i2.19458 J Enam Med Col 2014; 4(2): 79--88

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