Optimizing cardiovascular and chemopreventive benefits of aspirin: what role for the proton-pump inhibitors?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75584/1/j.1365-2036.2004.02347.x.pd

The Cystic Duct Remnant: An Unusual Case of a Biliary Intraluminal Filling Defect

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72892/1/j.1572-0241.1988.tb06086.x.pd

Helicobacter pylori test-and-treat intervention compared to usual care in primary care patients with suspected peptic ulcer disease in the United States

The Helicobacter pylori ( H. pylori ) “test-and-treat” strategy in uninvestigated dyspepsia is an effective alternative to prompt endoscopy. Our aims were to determine whether the combination of an educational session and availability of office-based H. pylori testing (test-and-treat intervention [TTI]) increases use of the test-and-treat strategy by primary care practitioners and whether it improves patient outcomes. Methods : We conducted a 1-yr prospective trial of patients with suspected peptic ulcer disease in six primary care centers, three with TTI and three designated as usual care controls (UCC). Results : H. pylori testing was performed in 81% of 54 TTI patients and in 49% of 39 UCC patients ( p = 0.004). TTI and UCC patients had similar gastroenterology referral rates (24% vs 33%, p = 0.33), endoscopy or upper GI radiography rates (30% vs 31%, p = 0.91), and primary care visits per patient (3.1 ± 2.8 vs 3.1 ± 2.6, p = 0.92). TTI patients were less likely than UCC patients to receive repeated antisecretory medication prescriptions (35% vs 66%, p = 0.003). Symptomatic status at 1 yr and satisfaction with medical care did not differ between groups. Median (and interquartile range) annualized disease-related expenditures per patient were $454 ($162–932) for TTI and $576 ($327–1435) for UCC patients ( p = 0.17). Conclusions : The combination of an educational session and availability of office-based H. pylori testing may increase acceptance of the test-and-treat strategy by primary care providers. It remains to be determined whether increased use of the test-and-treat strategy yields significant improvements in clinical and economic outcomes compared to usual care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74830/1/j.1572-0241.2002.07118.x.pd

The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas

Several innovative imaging modalities, including endoscopic ultrasound, have increased the number of available preoperative staging methods in patients with adenocarcinoma of the pancreas. Our goal was to estimate the clinical outcomes and cost-effectiveness of alternative staging strategies for pancreatic adenocarcinoma. METHODS : Decision analysis was used to simulate alternative staging strategies. Cost inputs were based on Medicare reimbursements; clinical inputs were obtained from the available literature. Model endpoints of interest were cost per curative resection and appropriateness of treatment allocation based on pathological stage. RESULTS : Endoscopic ultrasound followed by laparoscopy yielded the lowest cost per curative resection ($37,600) and minimized the number of unnecessary surgical explorations (5.4 per 100 patients staged). Requiring angiographic confirmation when endoscopic ultrasound demonstrated an unresectable tumor yielded an intermediate cost-effectiveness ratio and virtually eliminated the risk of overstaging. Laparoscopy alone maximized the resection rate, but each additional resection would cost approximately$2 million relative to a strategy employing both endoscopic ultrasound and angiography. CONCLUSIONS : Staging strategies incorporating endoscopic ultrasound may improve treatment allocation and are cost-effective relative to angiography-based strategies. A staging protocol that does not incorporate an imaging modality to detect vascular invasion dramatically increases the cost per additional curative resection compared with more comprehensive staging protocols.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74623/1/j.1572-0241.2000.02191.x.pd

Effect of Naproxen on Gastroesophageal Reflux and Esophageal Function: A Randomized, Double-Blind, Placebo-Controlled Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75450/1/j.1572-0241.1995.tb09312.x.pd

Management of Patients on Nonsteroidal Anti-inflammatory Drugs: A Clinical Practice Recommendation From the First International Working Party on Gastrointestinal and Cardiovascular Effects of Nonsteroidal Anti-inflammatory Drugs and Anti-platelet Agents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72218/1/j.1572-0241.2008.02200.x.pd

Changing perceptions and practices regarding aspirin, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs among US primary care providers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74775/1/j.1365-2036.2008.03836.x.pd

Prolonged Effect of Omeprazole on the 14 C-Urea Breath Test

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73649/1/j.1572-0241.1996.tb08294.x.pd