Purpose: A number of disorders cause dysphagia, which is the perception of an obstruction during swallowing. The purpose of this study was to determine the prevalence of dysphagia in primary care patients.Methods: Adults 18 years old and older were the subjects of an anonymous survey that was collected in the clinic waiting room before patients were seen by a physician. Twelve family medicine offices in HamesNet, a research network in Georgia, participated.Results: Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P ‫؍‬ .002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P ‫؍‬ .001). Sixty-four percent of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency [odds ratio (OR) ‫؍‬ 2.15, 95% CI 1.41-3.30], duration (OR ‫؍‬ 1.91, CI 1.24 -2.94), and concern (OR ‫؍‬ 2.64, CI 1.36 -5.12) of swallowing problems as well as increased problems eating out (OR ‫؍‬ 1.72, CI 1.19 -2.49) were associated with increased odds of having talked to a physician. Conclusions: This is the first report of the prevalence of dysphagia in an unselected adult primary care population. Dysphagia occurs commonly in primary care patients but often is not discussed with a physician. (J Am Board Fam Med 2007;20:144 -150.)Swallowing is a complex motor reflex requiring coordination among the neurologic system, the oropharynx, and the esophagus. A number of disorders, both benign and malignant, interfere with the swallowing process and cause dysphagia.1 Patients with dysphagia suffer significant social and psychological burdens associated with their symptoms of difficulty with swallowing, including anxiety with meals or avoidance of eating with others. 2The diagnosis of dysphagia is important because of the associated morbidity and mortality. Untreated dysphagia can lead to dehydration, malnutrition, respiratory infections, and death.2 The elderly with symptoms of dysphagia are at increased risk of the complications of dysphagia, including aspiration pneumonia. 3 Several studies have identified the elderly as being at risk for the development of dysphagia. 4,5 The prevalence of solid-food dysphagia was found to be 7% in elderly patients (62 years old and older) in a family medicine clinic in a medical university.

Introduction: This study examined barriers to colorectal cancer (CRC) screening in people living in rural areas.Methods: We identified 2 rural counties with high rates of CRC and randomly contacted county residents by telephone using a published listing.Results: Six hundred thirty-five of the 1839 eligible respondents (34.5%) between the ages of 50 and 79 years living in McDuffie and Screven counties, Georgia, agreed to complete the survey. The mean age was 62.2 years (SD, ؎7.5 years); 72.4% were women, 79.4% were white, and 19.5% were African American. African-American respondents had lower CRC screening rates (50.4%) than whites (63.4%; P ‫؍‬ .009). Significantly more African Americans compared with whites reported barriers to CRC screening. Based on logistic regression analyses, having a physician recommend CRC screening had the strongest association with having a current CRC screening, regardless of race.Conclusions: Important racial differences existed between African Americans and whites regarding the barriers to CRC screening and factors impacting current screening. However, endorsement of a small set of questionnaire items-not race-had the strongest association with being current with screening. Physician recommendation for CRC screening had the strongest association with being current with CRC screening. (J Am Board Fam Med 2012;25:308 -317.)

PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in fi lling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODSWe identifi ed relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confi dence intervals. RESULTSWe analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confi dence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported.CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and effi cacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective. Ann Fam Med 2009;7:56-62. DOI: 10.1370/afm.939. INTRODUCTION C olorectal cancer1-4 is the third most common cancer and second leading cause of cancer mortality in the United States.5 Guidelines recommend colonoscopy as a suitable screening method, 1,4,6,7 and evidence is increasing that colonoscopy may be the most cost-effective approach. 3,[8][9][10][11][12][13][14] As a result, the demand for screening colonoscopy is rapidly growing. The resources needed to screen every eligible person using colonoscopy do not currently exist in the US medical system, however, 15 and fewer than one-third of those who are eligible for colonoscopy are screened. 3,16 There has been a recent call for monitoring quality indicators in endoscopy to support continuous quality improvement among endoscopists. Proposed measures for quality include reach-the-cecum rates, adenoma detection rates, advanced adenoma detection rates, and withdrawal times. 14,17,18 In the United States, a comprehensive task force of the American Society of Gastrointestinal Endoscopists and the American College of Gastroenterology has recommended acceptable standards for these qual- 19 In the United Kingdom, the Joint Advisory Group on GI Endoscopy (JAG) established standards for colonoscopies regardless of specialty. These standards state t...

Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. (J Am Board Fam Med 2015; 28:134 -145.)

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