Open-Access Upper Gastrointestinal Endoscopy a Decade after the Introduction of Proton Pump Inhibitors and Helicobacter pylori Eradication: A Shift in Endoscopic Findings

Abstract

Background/Aim: Over the past 15 years, there were considerable changes in factors associated with the development and treatment of upper gastrointestinal symptoms, of which the introduction of proton pump inhibitors and Helicobacter pylori eradication in guidelines for treatment of patients with dyspepsia are the most prominent: findings at open-access upper gastrointestinal endoscopy have not been evaluated properly ever since. This study aims to compare the current prevalence of upper gastrointestinal endoscopic findings to the prevalence 15 years ago. Methods: Data about endoscopic findings of consecutive patients for the first time referred for open-access upper gastrointestinal endoscopy between January 2002 and December 2004 was collected from medical files. The prevalence of each specific finding was compared with data described in three historical populations about 15 years ago. Results: The current and historical study population consisted of 1,286 and 3,062 subjects, respectively. The prevalence of peptic ulcer disease and duodenitis significantly decreased by 12.6% (95% CI: 14.5–10.7) and 2.9% (95% CI: 4.5–1.3), respectively. On the other hand, the prevalence of reflux esophagitis and Barrett’s esophagus both significantly increased by 6.9% (95% CI: 4.2–9.6) and 2.1% (95% CI: 0.8–4.4), respectively. Conclusions: Compared to 15 years ago, the prevalence of specific findings at open-access upper gastrointestinal endoscopy has changed considerably.

The incidence of Barrett's oesophagus and oesophageal adenocarcinoma in the United Kingdom and the Netherlands is levelling off

“…5,8 A single-centre Dutch study observed an increase in the prevalence of BO from 2.6 to 4.7% between the 1990s and 2004. 7 A study in Northern Ireland showed a 159% increase from 23.9 to 62 cases per 100 000 PYs between the periods of 1993-1997 and 2002-2005. 5 The rise in incidence may partially be explained by a 'true' increase of BO and partially by better clinical awareness of physicians resulting in more gastroscopies.…”

“…3 Endoscopic surveillance for OAC among patients with BO is therefore recommended. 4 Several studies reported increasing incidence rates (IRs) of BO, [5][6][7][8] although these vary widely, from 23 to 62 cases per 100 000 person-years (PYs). 5,8 A single-centre Dutch study observed an increase in the prevalence of BO from 2.6 to 4.7% between the 1990s and 2004.…”

Prevalence of lesions detected at upper endoscopy: An Italian survey

“…For example, one outstanding dilemma is the frequent overlap between dyspeptic and reflux symptoms [11]. The decline of both H. pylori and peptic ulcer prevalence and the parallel increase in gastro-oesophageal reflux disease may also have an impact on the association between dyspeptic symptoms and endoscopic findings [12].…”

Usefulness of a fast track list for anxious patients in a upper GI endoscopy

“…Moreover, to avoid a type-2 error we would have had to collect an almost unrepeatable number of malignancy diagnoses. It is, however, worth stressing that the painsymptom caused by a probable duodenal ulcer is what forces patients to ask for a reduction inwaiting time [18]. In our opinion, this is an important management finding, insofar as an antacidtherapy could be prescribed to patients who cannot be fast-tracked.…”