ABSTRACT
The guideline 'Gastric symptoms' covers the diagnosis and management of adults with dyspepsia in general practice, the prevention of unnecessary proton pump inhibitor use, and gastric protection during treatment with non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose acetylsalicylic acid derivatives. During an initial episode of dyspepsia no distinction is made between reflux and ulcus symptoms because management is the same: start by prescribing an antacid and, if these provide insufficient effect, progress to a H2-receptor antagonist and subsequently to a proton pump inhibitor (PPI). Testing for Helicobacter pylori should be performed in all patients with persistent or recurrent symptoms, preferably by using the monoclonal stool test. Gastroscopy should be performed with restraint in an H. pylori negative patient < 50 years with persistent or recurrent symptoms but no acute symptoms as there is only a very slight risk of malignancy. - Chronic PPI use is seen in 7% of the population and is associated with infections and osteoporosis. Phasing out of PPI use without good indication seems to be possible in 70% of patients.
Subject(s)
Dyspepsia/diagnosis , General Practice/standards , General Practitioners/standards , Practice Guidelines as Topic , Practice Patterns, Physicians' , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , Gastroscopy , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Humans , Netherlands , Proton Pump Inhibitors/adverse effects , Proton Pump Inhibitors/therapeutic useABSTRACT
OBJECTIVE: To investigate if in the Netherlands, just as in the USA, there has been an increase in the number of calories in recipes. DESIGN: Comparative study. METHODS: This study investigated one potential source of excess calories. In a widely-read Dutch cookery magazine - Allerhande - all dessert recipes in the years 1987 and 2009 that had their calorie content mentioned, were selected. This amounted to 37 recipes in each of those years. The number of kcal and amount of carbohydrates, proteins and fat were compared using the two-tailed t test. RESULTS: It was shown that between 1987 and 2009 the number of kcal per single portion had increased by 20% (70 kcal). This was statistically significant. Linked to this increase, there was also an increase in the amount of carbohydrates and fat, but this was not statistically significant. CONCLUSION: There was a clear increase in the number of kcal per portion between the recipes written in 1987 and 2009. It can be assumed that there is a relationship with the obesity epidemic.
