SciELO - Scientific Electronic Library Online

 
vol.19 issue1Enfermedad estructural y valor predictivo de la historia clínica en pacientes con dispepsia no investigada author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Revista colombiana de Gastroenterología

Print version ISSN 0120-9957On-line version ISSN 2500-7440

Abstract

GOMEZ, Martín A; OLIVARES, Roberto  and  CARDONA, Héctor. Tratamiento empírico de la enfermedad ácido-péptica. Rev Col Gastroenterol [online]. 2004, vol.19, n.1, pp.26-36. ISSN 0120-9957.

Empiric treatment in acid peptic disease (dyspepsia and gerd): prevalence, endoscopic findings and impact in the clinical evolution. Carlos Lleras hospital-ISS. The acid peptic disease (APD) includes two big groups of diseases, dyspepsia and gastroesophageal reflux. In the non-specialized clinical practice, the physician ignores the way to treat these patients, and usually uses in an indiscriminate way the empiric therapy, without keeping in mind the high prevalence of gastric cancer in our country and the way these medications can interfere in the endoscopic findings of the patients. Objective:To estimate the prevalence of the empiric therapy prescription with acid secretion inhibitors in patients with APD (dyspepsia and gastroesophageal reflux) and the way they interfere with the endoscopic findings. Materials and Methods: It is a study of prevalence or cross/sectional study. It included patients that were sent to the gastroenterology service for endoscopy, with the exclusive indication of APD. All the patients were interviewed by a nurse who filled out a form with the following information: identification, gastrointestinal symptoms and medications given for the APD. The patients who received continuous treatment for more than 4 weeks were included in group I and the ones who did not received any treatment were included in group II, the rest were excluded. All the patients went through an endoscopy and then the groups were analyzed according to the endoscopic findings. Results: The total of evaluated patients were 609 with a mean age of 49.5 years, 57.8% were females. The empiric treatment was used in 42.6% of the patients (group I). There were not significant differences in the main characteristics of the two groups, with regard to age and sex. 42.1% of the patients without treatment had structural findings at the endoscopy, against 24.1% of the patients that received PPI, or H2-antagonists (p = 0.0000, OR 2,3 (1.6-3.3). The frequency of esophagitis was of 26.9% in the group that was NOT treated vs 12.3% the treated group (P = 0.000-OR:2.63 (1.66-4.18). Ulcer peptic disease (duodenal and gastric) was present in 10.3% vs 9.2%(p=ns): non treated vs treated group. The gastric cancer was almost twice as frequent in treated patients (4.8%) vs (2.6%) non treated. When the general population was evaluated according to the type of APD we found that 62.2% of patients with GERD that didn’t receive treatment presented with peptic esophagitis, 51.5% of the patients with ERGE that received H2-antagonist had esophagitis compared with 6.3%(p=0.0005 OR 15.23(3.5-76) of those that received PPI. When the group with dyspepsia was analized (440) we found that 6.6% of those that didn’t receive treatment had gastric cancer vs 2.2% of those that received PPI; there were not differences between gastric or duodenal ulcers, but 100% of the patients with duodenal ulcers had H. pylori infection. Conclusions: The therapeutic test is very frequently used in our daily clinical practice (46.2%) and in an indiscriminate way. The patients with GERD that receive therapeutic test show less endoscopic findings in the esophagus (esophagitis), more significant when a PPI was used instead of an H2-antagonist; for this reason in this group it is cost-effective to give therapeutic test but with PPI. On the contrary since the patients with dyspepsia present with a frequency of peptic ulcer disease with H. pylori infection, and as we observed a high percentage of gastric cancer, we don´t justify to give a therapeutic test without previous endoscopy to a patient with dyspepsia.

Keywords : Dispepsip; therapeutic test; endoscopie; gastric cancer.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )

 

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License