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Gastroesophageal reflux disease after diagnostic endoscopy in the clinical setting

World Journal of Gastroenterology 2013年第16期19卷 2514-2520页

作者： nora B Zschau Jane M Andrews Richard H Holloway mark n schoeman Kylie Lange William CE Tam Gerald J Holtmann Department of Gastroenterology and Hepatology Royal Adelaide Hospital Faculty of Health Sciences University of AdelaideAdelaide Department of Gastroenterology and Hepatology Lyell McEwin Hospital Department of Gastroenterology and Hepatology University of Queensland School of Medicine Princess Alexandra Hospital

AIM: To investigate the outcome of patients with symptoms of gastroesophageal reflux disease (GERD) referred for endoscopy at 2 and 6 mo post endoscopy. METHODS: Consecutive patients referred for upper endoscopy for assessment of GERD symptoms at two large metropolitan hospitals were invited to participate in a 6-mo non-interventional (observational) *** two institutions are situated in geographically and socially disparate areas. Data collection was by selfcompletion of questionnaires including the patient assessment of upper gastrointestinal disorders symptoms severity and from hospital records. Endoscopic finding using the Los-Angeles classification, symptom severity and it's clinically relevant improvement as change of at least 25%, therapy and socio-demographic factors were assessed. RESULTS: Baseline data were available for 266 patients and 2-mo and 6-mo follow-up data for 128 and 108 patients respectively. At baseline, 128 patients had erosive and 138 non-erosive reflux disease. Allmost all patient had proton pump inhibitor (PPI) therapy in the past. Overall, patients with non-erosive GERD at the index endoscopy had significantly more severe symptoms as compared to patients with erosive or even complicated GERD while there was no difference with regard to medication. After 2 and 6 mo there was a small, but statistically significant improvement in symptom severity (7.02 ± 5.5 vs 5.9 ± 5.4 and 5.5 ± 5.4 respectively); however, the majority of patients continued to have symptoms (i.e. , after 6 mo 81% with GERD symptoms). Advantaged socioeconomic status as well as being unemployed was associated with greater improvement. COnCLUSIOn: The majority of GORD patients receive PPI therapy before being referred for endoscopy even though many have symptoms that do not sufficiently respond to PPI therapy.

关键词： Gastroesophageal reflux disease Epidemiology Proton pump inhibitor Acid suppressive therapy Endoscopy Barrett’s esophagus Functional gastrointestinal disorders

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non-physician endoscopists: A systematic review

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World Journal of Gastroenterology 2015年第16期21卷 5056-5071页

作者： Maximilian Stephens Luke F Hourigan mark Appleyard George Ostapowicz mark schoeman Paul V Desmond Jane M Andrews Michael Bourke David Hewitt David A Margolin Gerald J Holtmann Department of Gastroenterology and Hepatology Princess Alexandra Hospital Faculty of Medicine and Biomedical Sciences University of Queensland Department of Gastroenterology and Hepatology RBWH Department of Gastroenterology and Hepatology Gold Coast Hospital QLD 4215 Department of Gastro-enterology and Hepatology Royal Adelaide Hospital and University of Adelaide St Vincent’s Hospital University of MelbourneMelbourne VIC 3010Australia Department of Gastroenterology and Hepatology Westmead HospitalUniversity of Sydney School of Medicine University of Queensland Department of Gastroenterology Queensland Elizabeth II Jubilee HospitalCoopers PlainsBrisbane QLD 4108Australia Department of Colon and Rectal Surgery Ochsner Clinic Foundation Ochsner Clinical SchoolUniversity of Queensland

AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy ***:The literature was searched for publications reporting nurse endoscopy using several databases and specific search *** were screened against eligibility criteria and for *** searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of nonphysician *** publications included a total of 28883 procedures performed by non-physician ***:The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter.17/26 studies related to flexible sigmoidoscopies,5 to upper GI endoscopy and 6 to *** studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist *** distribution of publications showed the majority of research was conducted in the United States(43%),the United Kingdom(39%)and the netherlands(7%).Most studies conclude that after appropriate training nurseendoscopists safely perform ***,in relation to endoscopic competency,safety or patient satisfaction,all studies had major methodological *** were often not randomized(21/26studies)and not appropriately *** relation to cost-efficiency,nurse endoscopists were less costeffective per procedure at year 1 when compared to services provided by physicians,due largely to the increased need for subsequent endoscopies,specialist follow-up and primary care ***:Contrary to general beliefs,endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the *** significant shortcomings and biases limit the validity and

关键词： nurse endoscopist Cost-benefit Servicemodel Patient satisfaction Outcome parameter

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