RESUMEN
Background: In Chile, gastric cancer (GC) is a major cause of cancer related deaths. The current screening strategy consists of an upper gastrointestinal endoscopy (UGE) for people aged 40 years or more with epigastric pain. Aim: To evaluate the diagnostic coverage of the use of UGE for early detection of GC in Chile. Material and Methods: As part of the digestive module of the 2009-10 National Health Survey, 5293 adults over 15 years were asked about the presence of epigastric pain, possible upper gastrointestinal bleeding (PUGB), use of proton pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2RAs), family history of GC and having performed an UGE. Results: Persistent epigastric pain was observed in 3.4% of the population. PUGB signs were observed in 3.3% of the population. The prevalence of PPIs and H2RAs use was 4.3% and 2.2% respectively, reaching 21.6% in people aged 70 years and older. Life span prevalence of UGE was 18.3%, with differences by region, health insurance and educational level. UGE coverage in people aged 40 years or older with and without persistent epigastric pain was 14.4% and 3.2% respectively (Odds ratio 4.8, p < 0.01). The prevalence of UGE was similar among people with or without PUGB or family history of CG. Conclusions: The estimated coverage of the current GC prevention strategy in Chile is 14.4%, evaluated at a population level. Further studies are required to determine the impact of this strategy on early GC diagnosis and mortality.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Endoscopía Gastrointestinal/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Neoplasias Gástricas/prevención & control , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/epidemiología , Distribución por Edad , Chile/epidemiología , Escolaridad , Endoscopía Gastrointestinal/métodos , Hemorragia Gastrointestinal/tratamiento farmacológico , Hemorragia Gastrointestinal/epidemiología , /uso terapéutico , Tamizaje Masivo/métodos , Análisis Multivariante , Prevalencia , Inhibidores de la Bomba de Protones/uso terapéutico , Características de la Residencia/estadística & datos numéricos , Distribución por Sexo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologíaRESUMEN
Background: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. Aim: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. Material and Methods: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. Results: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. Conclusions: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.
Asunto(s)
Animales , Masculino , Ratas , Regulación del Desarrollo de la Expresión Génica , Poli(ADP-Ribosa) Polimerasas/metabolismo , Células de Sertoli/metabolismo , Antioxidantes , Catalasa/genética , Catalasa/metabolismo , Diferenciación Celular , Glutatión Transferasa/genética , Glutatión Transferasa/metabolismo , Poli(ADP-Ribosa) Polimerasas/genética , ARN Mensajero/metabolismo , Ratas Wistar , Células de Sertoli/citología , Superóxido Dismutasa/genética , Superóxido Dismutasa/metabolismoRESUMEN
Extrahepatic biliary trract cancer (aminly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile durignthe last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has ocurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our Country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r= -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallblader cancer mortality rate. It was estimated that increasing cholecystectomies by 12.500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile