Dyspepsia and helicobacter pylori infection: analysis of 200 Kuwaiti patients referred for endoscopy

Dyspepsia is a very common symptom, and is the reason for most referrals for esophagogastroduodenoscopy [EGD]. Peptic ulcer disease [PUD], gastroesophageal reflux and gastric cancer account for a minority of such patients. However, the majority have no significant endoscopic abnormalities [non-ulcer dyspepsia]. Recently, infection with Helicobacter pylori [HP] has been implicated in the pathogenesis of PUD and gastric cancer. Since HP can be diagnosed by noninvasive techniques, it has been suggested that endoscopy should be restricted to HP-positive patients who do not respond to empirical therapy with antimicrobials. The aim of this study was to establish the prevalence of HP among Kuwaiti dyspeptic patients referred for endoscopy and to determine whether demographic and clinical screening, or the presence of HP, can help distinguish groups of patients with significant gastroduodenal pathology from those with non-ulcer dyspepsia. Two hundred randomly selected Kuwaiti patients referred for endoscopy were evaluated prospectively. A detailed personal interview was conducted to establish the demographic and clinical profile of each patient and a diagnostic EGD was performed after the interview. Finally, antral mucosal biopsies were taken to determine the presence of HP. The pre-coded data were analyzed. Results: The main endoscopic findings were normal [32%], non-erosive antral gastritis [26%], duodenitis [17.5%], duodenal ulcer [11.5%], deformed bulb [4%], esophagitis [7%], and erosive gastritis [2%]. The demographic and clinical characteristics of patients did not correlate with endoscopic findings. The overall prevalence of HP infection was 88.5%. There were no statistically significant differences in the prevalence of HP among patients with various endoscopic findings. HP infection is common in Kuwaiti dyspeptic patients referred for endoscopy, irrespective of their demographic and clinical features or the underlying cause of dyspepsia. Noninvasive methods to detect HP are not valid alternatives to endoscopy in the work-up of dyspeptic patients

Promoting therapeutic information to the medical stsff: the evidence based-formulary

The potential of the hospital formulary system to guide physicians in prescribing the best drugs has not been realized. We describe a model for the transfer of clinically relevant research information about drugs to prescribers with the goal of improving prescribing behavior. A key element of the coordinated implementation model is that; physicians practice within an environment where competing influences affect prescribing behavior; drug advertising is one important influence. Clinically relevant research about drugs is necessary, but by itself is not sufficient to ensure its use. We propose a formulary organized by licensed indications and based on the evidence-based paradigm as a central element in an ongoing process to improve prescribing behavior by promoting the use of clinically relevant research

Therapeutic redundancy as a measure of formulary system effectiveness

to investigate the assumption that formilary quality is reflected in the number of redundant therapeutic agents in competitive markets. This inquiry assumes that a formulary system that requires strict adherence to the published clinical research evidence in the drug selection process will minimize the number of redundant therapeutic agents in competitive drug markets by balancing manufacturers promotional influences. Possible explanations for redundant therapeutic products are discussed. Design: a telephone survey was used to compare the number of histamine-2 blockers, angiotensin converting enzyme [ACE] inhibitors, and the number of drugs added to formularies in 1993 in ten randomly selected an four nonrandomly selected university associated teaching hospitals to a similar institution in Saudi Arabia. the difference in the number of histamine -2 blockers in surveyed hospitals formularies and our formulary ranged from no difference in two hospitals to a difference of three more drugs in three institutions. For the ACE inhibitors, the range was from no difference in one hospital surveyed to three more drugs in two hospitals. The proportion of new drugs added to formularies in surveyed hospitals ranged from 25% to 92% versus 37% in our hospital. a formulary system that bases the drug selection process on strict adherence to the published clinical research evidence may reduce the number of drugs in highly competitive therapeutic classes in the formulary. Promotional influence is one possible explanation for redundant therapeutic agents seen in some surveyed hospitals formularies