P Moayyedi

..pylori. Patients who remain symptomatic with this strategy may be investigated with endoscopy, but most will have functional dyspepsia...

..Sleep disturbance is common in patients with GERD but there has been little evaluation of this problem in primary care in patients already taking therapy...

..As with any therapy, therefore, it is advisable to prescribe PPIs only to patients for whom these drugs have been proven beneficial...

..PPI therapy is also likely to be a cost-effective strategy for non-erosive reflux disease at generic but not at proprietary prices...

..A cross-sectional survey was performed to evaluate the association between H. pylori and adult height...

..Reflux symptoms were less common in East Asian populations with only 7% having heartburn at least once per month. Heartburn is a significant problem in Western societies...

..The medical community should be consistent and if we are instituting other population screening programmes without randomized controlled trial evidence then H. pylori testing and treatment should also be considered...

..23 to 0.32). H. pylori eradication is therefore recommended in children with GERD that are having an endoscopy. However, when the diagnosis of GERD is being made clinically or by pH monitoring, it is not necessary to screen for H. pylori...

..We conducted a systematic review to evaluate whether PPI therapy had any effect in nonulcer dyspepsia and constructed a health economic model to assess the cost-effectiveness of this approach...

..Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted...

..Upper gastrointestinal symptoms occur in 40% of the population. An accurate diagnosis would help rationalize investigation and treatment...

..Although the exact cause remains uncertain, these symptoms may be connected to eating habits or to changes in gastrointestinal motility...

..Whether this phenomenon is due to anxiety, test bias, or merely chance, more evidence is needed; widespread screening in the general population is premature...

..However, the most common causes of symptoms of the gastrointestinal tract are functional. It is important that clinicians obtain a thorough history so that the disorder of the patient can be accurately defined...

..We expressed the data in terms of cost per quality-adjusted life months (QALM), as this was a 4-week trial...

..RCTs have suggested this approach may be cost saving but more data are needed on whether H. pylori eradication will reduce gastric cancer mortality before this strategy can be recommended...

..Patients with Barrett's oesophagus are at increased risk of oesophageal adenocarcinoma. Observational studies have suggested increase in overall mortality also but data are conflicting...

..Aim To conduct an individual patient data meta-analysis of randomized controlled trials (RCTs) of 'test and treat' vs. empirical acid suppression in adults with uncomplicated dyspepsia in primary care...

..Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting...

..We assessed prevalence of uninvestigated dyspepsia in a cohort of individuals, some of whom were exposed to bacterial dysentery in May 2000, as well as risk factors for dyspepsia in exposed individuals...

..pylori infection in children is 14 days; and H. pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures...

..Alarm features are used to prioritize access to urgent investigation, but there is little information concerning their utility in the diagnosis of colorectal cancer...

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..Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially...

..The results of cost-benefit analysis may provide more transparent guidance for policy makers, doctors and patients...

..To assess the safety of bismuth used in Helicobacter pylori (H pylori) eradication therapy regimens...

..Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but are not without risks...

..The prevalence of coeliac disease (CD) may be increased in individuals with dyspepsia, but evidence is conflicting...

..2% of these developed IBS. We used this cohort to study genetic susceptibility to post-infectious (PI)-IBS...

..The role of endoscopic therapy is uncertain. Anti-reflux surgery is probably as effective as PPI therapy although there is a low operative mortality and morbidity...

..Dyspepsia and irritable bowel syndrome (IBS) are common conditions that can coexist in patients. We performed a systematic review and meta-analysis to estimate prevalence of IBS in dyspepsia...

..Systematic reviews suggest that FOBT is effective in reducing CRC mortality but the data on overall mortality from any cause has rarely been synthesized...

..We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the efficacy of all available 5-HT agents in IBS...

..There will be some bias in the type of patient referred for diagnosis and this usually decreases the specificity of symptom diagnosis...

..The association between proton pump inhibitor therapy and hip fracture is a good illustration of this dilemma. We use this example to highlight an approach that can be taken to critically evaluate the evidence for harms of medication...

..Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals...

..These individuals are frequently diagnosed with irritable bowel syndrome (IBS) based on their symptoms; however, some may require additional testing or referral to specialists before this diagnosis is made...

..There have been concerns raised about the possible association of PPIs with enteric infections...

..To determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome...

..As both drugs have very short half-lives, taking them with a large time gap between drugs (e.g., morning and night) may theoretically decrease the chance of interaction...

..Although flawed systematic reviews could compromise optimal decision making, their accuracy has received limited investigation. We assessed conduct of systematic reviews of pharmaceutical interventions for irritable bowel syndrome (IBS)...

..A multidisciplinary group of 34 experts from 15 countries developed this update and expansion of the recommendations on the management of acute nonvariceal upper gastrointestinal bleeding (UGIB) from 2003...

..The United States had the most variation in the number of gastroenterologists per 100,000 of the population among states...

..Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome (IBS), but evidence is conflicting. We conducted a systematic review and meta-analysis of the prevalence of SIBO in IBS...

..The natural history of the condition has been studied extensively, but few studies have examined factors that predict its new onset or health care-seeking behavior...

..pylori in particularly high-risk population settings. The evidence for these recommendations is summarized in this report, and the global and U.S. implications are considered...

..This article compares and contrasts dyspepsia management guidelines from several geographical regions...

..Gastric cancer is a major health burden in the Asia-Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer...

..To determine the cost effectiveness of Helicobacter pylori "test and treat" compared with empirical acid suppression in the initial management of patients with dyspepsia in primary care...

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..pylori-associated diseases...

..35) and of higher socioeconomic status (adjusted OR=1.58, 95% CI: 1.16, 2.15 (top tertile vs. bottom tertile)). White Caucasian ethnicity, male gender, and higher socioeconomic status are independent risk factors for Barrett's esophagus...

..CONCLUSIONS: Prompt endoscopy confers a small benefit in terms of cure of dyspepsia but costs more than "test and treat" and is not a cost-effective strategy for the initial management of dyspepsia...

..There is evidence for a small benefit of eradicating H. pylori in nonulcer dyspepsia, and this is confirmed by updating the Cochrane systematic review...

..Further research is necessary to compare existing outcome measures to determine which are the most reliable, valid, and responsive instruments...

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..CONCLUSIONS: H. pylori eradication therapy reduces the recurrence of peptic ulcer disease and is cost-effective...

..The use of Helicobacter pylori eradication therapy is advocated in an increasing variety of situations. It is therefore important to optimise current strategies to eradicate H pylori infection...

..89; 95% CI: 0.77-1.03). CONCLUSIONS: There were significant reductions in total dyspepsia-related health care costs. The savings made were greater than the initial cost of H pylori screening and treatment...

..The objective of this study was to explore uncertainty in controversial areas of the 2005 American Gastroenterology Association position statement on the management of dyspepsia...

..pylori) is acquired mainly in childhood, with studies demonstrating this is related to living conditions. Effects of sibling number and birth order on prevalence of infection have not been extensively studied...

..The influence of adult socioeconomic status, co-habitation, gender, smoking, coffee and alcohol intake on risk of Helicobacter pylori infection is uncertain...

..In particular, more research is needed on visceral adipose tissue and risk of esophageal adenocarcinoma, and whether obesity is an important risk factor for the development of neoplasia in those with Barrett's esophagus...

..Finally important new data are presented regarding the management of dyspepsia at the primary care level with the confirmation that the H. pylori 'test and treat' strategy in the appropriate setting is more cost-effective than endoscopy...

..However, few have reported the effect of quality of life on the development of dyspepsia. A 10-year longitudinal follow-up study examining the effect of quality of life on subsequent dyspepsia was performed...

..Decisions such as these are often made with little assessment of patient preferences. We have elicited patient preferences for the optimal use of time in the outpatient clinic...

..CONCLUSIONS: There was insufficient evidence on the efficacy of psychological therapies in NUD. This emphasizes the need for appropriately powered well-designed trials in this area...

..We aimed to assess the frequency of intestinal metaplasia in 125 consecutive patients with columnar-lined esophagus and to determine the optimal biopsy protocol to detect intestinal metaplasia...

..The detection of dysplasia requires increased surveillance and usually intervention either endoscopically or with surgery...

..The detection of dysplasia requires increased surveillance and usually intervention either endoscopically or with surgery...

..All studies were small and there was evidence of publication bias or other small study effects. CONCLUSION: PPI therapy reduces symptoms in NCCP and may be useful as a diagnostic test in identifying abnormal esophageal acid reflux...

..Comparing health care in terms of cost per quality adjusted life year (QALY) gained is one approach to this problem although there are concerns about whose values should be elicited and how QALYs are measured...

..This has important implications for the development of future questionnaires in gastroesophageal reflux and other gastrointestinal diseases...

..Dyspepsia is common, and the condition is often chronic, with a relapsing and remitting nature. Factors influencing the decision to consult a physician with symptoms remain unclear...