Use of an open-access gastroscopy service by a general practice: findings and subsequent specialist referral rate

An analysis of 102 open-access gastroscopy requests from one general practice over 38 months showed that the detection rate of abnormalities was 58%. Even though no predetermined investigation criteria were used these results compare favourably with gastroscopy findings generally and are superior to the detection rate of lesions using barium meals. Only 12% of the patients who underwent gastroscopy required subsequent referral to a consultant. This represents a major benefit, hitherto undocumented, of an open-access gastroscopy service. Considerations of accuracy, safety and cost effectiveness coupled with the availability of efficacious drugs appear to favour the case for open-access gastroscopy for general practitioners

Discrepancies in the availability of open access services: comparison between the Northern and Oxford regions

General practitioners have long been aware of variations in the range of open access services available to them.This study compares the availability of 22 open access services in the Northern and Oxford regions and examines possible reasons for variations. From data collected from general practitioners and community managers two striking patterns emerge. First, there is a difference between the regions with wider availability in the Oxford region. Secondly, there are differences in the range of services available between health authorities, sometimes neighbouring, within the same region, although this is less marked in Oxford.These discrepancies probably reflect the situation nationally and it would appear questionable whether there is any policy coordination at regional or national level to ensure an equitable distribution of open access services

Symptoms in patients on long-term proton pump inhibitors: prevalance and predictors

Background Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. Aim To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. Methods A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. Results Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. Conclusions A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients

Helicobacter pylori Eradication in long-term Proton pump inhibitor Users in Primary care (HELPUP): a randomized controlled trial

Background Two-thirds of proton pump inhibitor prescribing in the UK is for long-term therapy. Aim To determine the impact of eradication in long-term proton pump inhibitor users infected with Helicobacter pylori. Methods A total of 184 H. pylori-positive patients were randomly assigned to true or placebo eradication therapy. The primary outcome was the change in proton pump inhibitor usage measured by prescriptions; secondary outcomes were changes of proton pump inhibitor doses, dyspepsia symptoms, general practitioner consultations and quality of life measures. Results In the year following H. pylori eradication proton pump inhibitor prescriptions fell compared with placebo (−1.7, 95% CI: −2.3 to −1.1, P < 0.001); when adjusted to full-dose equivalent prescriptions the reduction was more marked (−2.2, 95% CI: −3.0 to −1.4, P < 0.001). Both general practitioner consultations (−1.0, 95% CI: −1.8 to −0.1, P = 0.026) and symptoms measured on the Leeds Dyspepsia Questionnaire (−3.1, 95% CI: −5.3 to −0.9, P = 0.005) were reduced. Quality of life and self-rating measures also favoured eradication (EQ-5D: 0.09, P = 0.08 and VAS: 5.6, P = 0.002). The Carlsson and Dent Reflux Questionnaire found no difference between groups (−0.3, P = 0.65), possibly balancing decreased overall symptoms with increased prominence of heartburn in the eradication group. Conclusions Helicobacter pylori eradication in infected, long-term proton pump inhibitor users in primary care reduced both the overall severity of symptoms and use of health care

Fedotozine in Functional Dyspepsia: Results of a six week placebo-controlled multicentre trial

Efficacy and safety of fedotozine (FZ), a peripheral K agonist, were compared to that of placebo (PL) in patients with functional dyspepsia. Methods. A phase Ill, double blind, parallel group trial was carried out in UK and Eire by 25 hospital or general practice centers. The entry criteria were: presence of 2 or more post-prandial dyspeptic symptoms occurring at least 3 times a week in the previous 3 months; the symptoms included epigastric pain, early satiety, epigastric fullness or distension, nausea or vomiting, feeling of slow digestion. Each patient had negative gastroduodenoscopy, upper abdominal ultrasound and routine blood tests. Patients completed a diary card daily and rated the overall intensity of their symptoms (main criterion) as well as the intensity of each dyspeptic symptom using a 5 point scale. 333 patients entered the trial. At the end of the run-in period lasting 7 to 14 days, patients with a low symptomatic score were excluded. 271 patients (139 F/132 M, aged 42 ± 14 yrs, m ± SD) were randomized to receive either oral FZ, 30 mg tid (n = 140) or PL tid (n = 131) for 6 weeks. Intent-totreat analysis was performed comparing the mean over the 6wk treatment adjusted for the baseline value (ancova). Results. FZ and PL groups were comparable before treatment. During treatment, the improvement for the overall intensity of dyspeptic symptoms was significantly higher (treatment effect: 0.180; 95% Cl: 0.07 to 0.29; p = 0.002) on FZ group than on PL. So too were epigastric pain (p = 0.004) and nausea (p = 0.01). The difference for sensation of fullness was of borderline statistical significance (p = 0.052). The patient global score, average of the five individual symptoms, was significantly improved in the FZ group (p = 0.021). There was no significant difference in the incidence of adverse events. The number of withdrawals associated with adverse events was comparable on FZ (n = 13) and on PL (n = 10). Biological tolerance was similar for both groups