Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease : systematic review.

Objectives: To ascertain the prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease and its association with the disease. Design: Systematic review of studies reporting the prevalence of H pylori in patients with and without gastro-oesophageal reflux disease. Data sources: Four electronic databases, searched to November 2001, experts, pharmaceutical companies, and journals. Main outcome measure: Odds ratio for prevalence of H pylori in patients with gastro-oesophageal reflux disease. Results: 20 studies were included. The pooled estimate of the odds ratio for prevalence of H pylori was 0.60 (95% confidence interval 0.47 to 0.78), indicating a lower prevalence in patients with gastro-oesophageal reflux disease. Substantial heterogeneity was observed between studies. Location seemed to be an important factor, with a much lower prevalence of H pylori in patients with gastro-oesophageal reflux disease in studies from the Far East, despite a higher overall prevalence of infection than western Europe and North America. Year of study was not a source of heterogeneity. Conclusion: The prevalence of H pylori infection was significantly lower in patients with than without gastro-oesophageal reflux, with geographical location being a strong contributor to the heterogeneity between studies. Patients from the Far East with reflux disease had a lower prevalence of H pylori infection than patients from western Europe and North America, despite a higher prevalence in the general population

Are the Health of the Nation's targets attainable? Postal survey of general practitioners' views

The Health of the Nation's targets were introduced by the government in 1992 as part of a strategic approach to health.1 We aimed, in 1996, to elicit the views of general practitioners on the attainability of these targets

Systematic review: the perceptions, diagnosis and management of irritable bowel syndrome in primary care – A Rome Foundation Working Team Report

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109270/1/apt12957.pd

Review article: the economic impact of the irritable bowel syndrome

Background: Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. Aim: To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Methods: Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. Results: Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742–$7547, UK £90–£316, France €567–€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran$92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. Conclusions: costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions

Impaired glucose tolerance: qualitative and quantitative study of general practitioners' knowledge and perceptions

Objective: To investigate general practitioners' knowledge of and attitudes to impaired glucose tolerance. Design: Mixed methodology qualitative and quantitative study with semistructured interviews, focus groups, and questionnaires. Setting: 34 general practitioners in five primary care groups in the north east of England. Results: All the general practitioners had knowledge of impaired glucose tolerance as a clinical entity, but they had little awareness of the clinical significance of impaired glucose tolerance and were uncertain about managing and following up these patients. Attitudes to screening were mixed and were associated with reservations about increased workload, concern about lack of resources, and pessimism about the effectiveness of lifestyle interventions. Some general practitioners felt strongly that screening patients for impaired glucose tolerance and subsequent lifestyle intervention medicalised an essentially social problem and that a health educational approach, involving schools and the media, should be adopted instead. A minority expressed a positive attitude towards a pharmacological approach. Conclusion: Awareness of impaired glucose tolerance needs to be raised, and guidelines for management are needed. General practitioners remain to be convinced that they have a role in attempting to reduce the incidence of type 2 diabetes by targeting interventions at patients with impaired glucose tolerance

Screening and identifying diabetes in optometric practice: a prospective study

Background: Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. Aim: The study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Design and setting: Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. Results: Of 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. Conclusion: Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings

The politics of central bank reform : post­financial crisis institutional reform in the USA and UK

Defence date: 23 June 2020 (Online)Examining Board: Professor Pepper Culpepper (Supervisor, formerly EUI/University of Oxford);  Professor Dorothee Bohle (EUI);  Professor David Coen (University College London);  Dr Manuela Moschella (Scuola Naormale Superiore)The prudential role of central banks has been greatly strengthened since the 2008 financial crisis. Yet domestic institutional dynamics have produced significant divergence in institutional reform. This thesis examines central bank institutional reforms in the United States (US) and United Kingdom (UK). These cases were selected due to variation in the institutional outcomes. The thesis controls for a variety of potential sources of institutional variation, such as the size of the financial sector, the impact of the crisis, changes of government, and central bank independence. Five propositions are suggested to explain how the institutional reforms are facilitated: by institutional constraints; by bureaucratic politics; thorough the self-interest of politicians concerned with electoral reward; in response to lobbying by the financial industry lobby; or in response to proposals from an epistemic community of regulatory experts. The case studies find that the number of political institutional constraints and the structure of bureaucratic power produce distinct modes of institutional change and explain the variation in institutional outcomes. The framework is applied to a comparative analysis of central bank reform in the US and UK. Prior to the 2008 US and 2010 UK general elections, the mains candidates and political parties attempted to deflect blame for the crisis by putting forward competing visions of institutional reform. This thesis argues that high veto possibilities and diffuse bureaucratic power in the US forced the Obama Administration to leave the existing architecture in largely place, while circumventing opposition by creating new institutional structures (institutional layering). In contrast, low veto possibilities in the UK facilitated institutional displacement; but by concentrating bureaucratic power, it also enabled the central bank to reshape reform in line with its own interests (institutional subversion). The findings provide new insights into the endogenous political and bureaucratic drivers of post-crisis administrative reform

Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review

Objectives: To ascertain the prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease and its association with the disease. Design: Systematic review of studies reporting the prevalence of H pylori in patients with and without gastro-oesophageal reflux disease. Data sources: Four electronic databases, searched to November 2001, experts, pharmaceutical companies, and journals. Main outcome measure: Odds ratio for prevalence of H pylori in patients with gastro-oesophageal reflux disease. Results: 20 studies were included. The pooled estimate of the odds ratio for prevalence of H pylori was 0.60 (95% confidence interval 0.47 to 0.78), indicating a lower prevalence in patients with gastro-oesophageal reflux disease. Substantial heterogeneity was observed between studies. Location seemed to be an important factor, with a much lower prevalence of H pylori in patients with gastro-oesophageal reflux disease in studies from the Far East, despite a higher overall prevalence of infection than western Europe and North America. Year of study was not a source of heterogeneity. Conclusion: The prevalence of H pylori infection was significantly lower in patients with than without gastro-oesophageal reflux, with geographical location being a strong contributor to the heterogeneity between studies. Patients from the Far East with reflux disease had a lower prevalence of H pylori infection than patients from western Europe and North America, despite a higher prevalence in the general population

A mechanistic multi-centre, parallel group, randomised placebo controlled trial of Mesalazine for treatment of irritable bowel syndrome with diarrhoea (IBS-D)

Introduction: Immune activation has been reported in the mucosa of irritable bowel syndrome patients with diarrhoea (IBS-D) and some small studies have suggested that Mesalazine may reduce symptoms. We performed a double blind, randomised placebo controlled trial of 2g Mesalazine twice daily versus placebo for 3 months in Rome III criteria IBS-D patients. Primary outcome was daily average stool frequency during weeks 11-12; secondary outcomes were abdominal pain, stool consistency, urgency and satisfactory relief of IBS symptoms. Methods: Participants were randomised after a 2-week baseline stool diary. All participants completed a 12-week stool diary and at the end of each week recorded the presence of “satisfactory relief of IBS symptoms”. Results: 136 patients with IBS-D (82 F, 54 M) were randomised, 10 patients withdrew from each group. Analysis by intention to treat showed the daily average stool frequency during weeks 11 and 12 were mean (SD), 2.8 (1.2) in Mesalazine and 2.7 (1.9) in placebo group with no significant group difference (95% confidence interval) 0.1 (-0.33,0.53); p=0.66. Mesalazine did not improve abdominal pain, stool consistency nor percentage with satisfactory relief compared to placebo during the last 2 weeks follow up. Conclusion: This study does not support any clinically meaningful benefit or harm of Mesalazine compared with placebo in unselected IBS with diarrhoea. More precise subtyping based on underlying disease mechanisms is needed to allow more effective targeting of treatment in IBS. (ClinicalTrials.gov number NCT01316718

Proton pump inhibitor prescribing patterns in the UK: a primary care database study

Purpose: To determine the prevalence and pattern of proton pump inhibitor (PPI) prescription and the practices employed to reduce PPI use in the UK general population. Methods: The UK's Clinical Practice Research Database was used to identify individuals who were issued with ≥1 PPI prescription during the period 1990–2014. Point and period prevalence of PPI use were estimated annually. Additionally, new users of PPI therapy who had 5 years of follow-up data were included in a cohort analysis to describe patterns of cessation and duration of PPI use. Results: Both the period and point prevalence of PPI use increased between 1990 and 2014 (period prevalence increased from 0.2 to 15.0% and point from 0.03 to 7.7%). A total of 596 334 new users of PPI therapy in the cohort study received 8 784 272 prescriptions. Of these, 26.7% used PPI therapy long term (≥1 year continuously), while 3.9% remained on PPI therapy for 5 years. Clear attempts to step down dose were identified in 39.9% of long-term users, while this was 47% in patients whose initial indication did not mandate long-term use. Conclusion: A considerable increase in PPI use was observed in UK general practice. Of long-term PPI users, 60% did not have an attempt to discontinue or step down. Considerable opportunities may therefore exist to reduce the cost and side effects of PPI use through improving adherence to recommended withdrawal strategies