Bowel dysfunction in survivors of gynaecologic malignancies.

PURPOSE: To assess the prevalence of bowel dysfunctions after treatment for gynaecological cancer and the impact on the quality of life. METHODS: We identified a cohort of 217 eligible women treated with radiotherapy (RT) with curative intention, alone or as combined treatment, for gynaecological malignancies at three institutions in Catalonia (Spain). Demographic, diagnosis and treatment modality were reviewed. Patients were sent validated questionnaires to assess bowel function and a set of questions asking on the changes after RT in bowel function, urinary function, sexuality, pain and lymphoedema. RESULTS: Questionnaires were returned by 109 patients (50.2%) with a mean age of 65 ± 11 years. Of them, 71.8% had been treated for endometrial cancer and 28.2% for cervical cancer. Overall, 42.7% of patients reported bowel dysfunction, affecting their quality of life in 36% of cases. Symptoms were more frequent in patients who had undergone external beam RT compared to brachytherapy. The most common symptom was defecatory urgency which was reported by more than 40% of patients according to the St Mark's score, although it was less common in other questionnaires. Overall, faecal incontinence ranged between 10 and 15%, and usual loose stools and diarrhoea were reported by 13.5% and 5.1%, respectively. CONCLUSION: Prevalence of bowel symptoms after treatment of gynaecological malignancies is high. A systematic evaluation using validated questionnaires should be performed in order to allow the decision-making process and also because there are a number of treatments available to improve the quality of life of cancer survivors.

Impact of mHealth technology on adherence to healthy PA after stroke: a randomized study.

BACKGROUND: Physical activity (PA) is a key health behavior in people with stroke including risk reduction of recurrent stroke. Despite the beneficial effects of PA, many community-dwelling stroke survivors are physically inactive. Information and communication technologies are emerging as a possible method to promote adherence to PA. OBJECTIVE: The aim of this study is to investigate the effectiveness of a mobile-health (mHealth) App in improving levels of PA. METHODS: Forty-one chronic stroke survivors were randomized into an intervention group (IG) n=24 and a control group (CG) n=17. Participants in the IG were engaged in the Multimodal Rehabilitation Program (MMRP) that consisted on supervising adherence to PA through a mHealth app, participating in an 8-week rehabilitation program that included: aerobic, task-oriented, balance and stretching exercises. Participants also performed an ambulation program at home. The CG received a conventional rehabilitation program. Outcome variables were: adherence to PA, (walking and sitting time/day), walking speed (10MWT); walking endurance (6MWT); risk of falling (TUG); ADLs (Barthel); QoL (Eq-5D5L) and participant's satisfaction. RESULTS: At the end of the intervention, community ambulation increased more in IG (38.95 min; SD: 20.37) than in the CG (9.47 min; SD: 12.11) (p≤.05). Sitting time was reduced by 2.96 (SD 2.0) hours/day in the IG and by 0.53 (SD 0.24) hours in the CG (p≤.05). CONCLUSIONS: The results suggest that mHealth technology provides a novel way to promote adherence to home exercise programs post stroke. However, frequent support and guidance of caregiver is required to ensure the use of mobile devices.

Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough?

Background and purpose. Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. Materials and methods. Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. Results. Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. Conclusion. Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life

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Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough?

BACKGROUND AND PURPOSE: Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. MATERIALS AND METHODS: Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. RESULTS: Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. CONCLUSION: Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life.

[Glucose metabolism alterations and follow-up study of a non-diabetic adult population]. / Alteraciones del metabolismo de la glucosa y estudio de seguimiento de una población adulta no diabética.

OBJECTIVE: To determine the appearance of type 2 diabetes mellitus (DM2) and impaired fasting glucose (IFG) at five years of follow-up in a known non-diabetic population. DESIGN: nested case control studies (case s-control into a cohort) developed in two stages: 1) identification and characterization of the cohort and 2) follow-up. STUDY POPULATION: representative sample of a non-diabetic population between 40 and 75 years old attended in a Primary Health Center. IDENTIFICATION: 326 persons, 2.1% of whom were diagnosed of previously unknown DM2 and 7.3% of IFG. Insulin resistance (IR) was higher in patients with IFG and pancreatic function of beta cells (PFBC) was higher in the population without glucose metabolism alteration. FOLLOW-UP: 121 persons, 9.7 % of whom evolved to DM2 (all with IFG). IFG proportion at the end of the follow-up was 23.96%. CONCLUSIONS: At 5 years of follow-up, more than 1/3 of the population studied developed DM2 or IFG. These diagnoses were related with IR and PFBC.

Alteraciones del metabolismo de la glucosa y estudio de seguimiento de una población adulta no diabética / Glucose metabolism alterations and follow-up study of a non-diabetic adult population

Objetivo. Determinar la aparición de diabetes mellitus (DM) y glucemia basal alterada (GBA) a los cinco años de seguimiento de una población no diabética conocida. Material y métodos. Diseño: estudio casos-control anidado (casos-control dentro de una cohorte) desarrollado en dos fases, la de identificación y caracterización de la cohorte a estudio y la de seguimiento. Población a estudio: muestra representativa de población no diabética de 40 a 75 años atendida en un Centro de Atención Primaria. Resultados. Fase de identificación: 326 personas de las que un 2,1% fueron diagnosticadas de DM2 no conocida previamente y un 7,3% de GBA. La resistencia a la insulina (RI) fue superior en los pacientes con GBA y la función de la célula beta pancreática (FBP) fue superior en la población sin alteraciones del metabolismo de la glucosa. Fase de seguimiento: 121 personas. Un 9,7% evolucionaron a DM2 (todos con GBA previa) siendo la proporción de GBA al final del seguimiento de 23,96%. Conclusiones. A los cinco años de seguimiento, más de un tercio de la población estudiada evolucionó a DM o a GBA, estando la aparición de estas alteraciones relacionada con la RI y con la FBP (AU)

Objective. To determine the appearance of type 2 diabetes mellitus (DM2) and impaired fasting glucose (IFG) at five years of follow-up in a known non-diabetic population. Patients and methods. Design: nested case control studies (case s-control into a cohort) developed in two stages: 1) identification and characterization of the cohort and 2) follow-up. Study population: representative sample of a non-diabetic population between 40 and 75 years old attended in a Primary Health Center. Results. Identification: 326 persons, 2.1% of whom were diagnosed of previously unknown DM2 and 7.3% of IFG. Insulin resistance (IR) was higher in patients with IFG and pancreatic function of beta cells (PFBC) was higher in the population without glucose metabolism alteration. Follow-up: 121 persons, 9.7 % of whom evolved to DM2 (all with IFG). IFG proportion at the end of the follow-up was 23.96%. Conclusions. At 5 years of follow-up, more than 1/3 of the population studied developed DM2 or IFG. These diagnoses were related with IR and PFBC (AU)

[Indication of bone densitometry in women over 40 years of age]. / Indicación de densitometría ósea en mujeres mayores de 40 años.

OBJECTIVE: To evaluate the indication of bone densitometry (BD) and to know the prevalence of risk factors (FR) for osteoporotic fracture in primary care. DESIGN: Cross-sectional, descriptive study. SETTING: Urban centre of health of Terrassa, Barcelona (52.000 h). PARTICIPANTS: Women over 40 years old than went to urgencies of the centre selected by consecutive sampling stratified by age (n=416). MAIN MEASUREMENTS: Registry of FR for osteoporotic fracture according to the criteria of the Agència d'Avaluació de Tecnologies Mèdiques (AATM), hygienic-dietetic recommendations received and made BDs. RESULTS: The average age was of 60+/-13 years. The FR for osteoporotic fracture more prevalence were: low calcium intake (32.1%), increased age (27.5%), no lactation (24.9%), and precocious menopause (16.4%). They had received dietetic recommendations 35.7%, of exercise 65.5% and solar exhibition 18.1%. Of the 177 (42.7%) cases in that the BD was indicated only it made in 45 (25.4%) and of 237 (57.3%) without indication of BD they were made 41 (17.2%). To have made BD is related of statistically significant way to antecedent of osteoporotic fracture (P<.001) and to iatrogenic menopause (P<.001). The 41.2% of the BDs were asked for by the primary care physician, the 34.1% by the rheumatologist and the 16.5% by the gynaecologist. The indication of BD varies between the different scientific societies: AATM 42.7%, semFYC 45.7%, FORE 49.8%, SER 61.1%, and NOF 64.3%. CONCLUSIONS: Although FR of prevalence osteoporosis are most modifiable from primary care, a low degree of advice exists on healthful habits of life. A low accomplishment of BDs is detected and half is not adapted its indications according to the criteria of the AATM. There is great variability in the indication of BD between the different scientific societies.

Indicación de densiometría ósea en mujeres mayores de 40 años / Indication of bone densiometry in women over 40 years of age

Objetivo. Evaluar la indicación de densitometría ósea (DMO) y conocer la prevalencia de factores de riesgo (FR) de fractura osteoporótica en atención primaria. Diseño. Estudio descriptivo transversal. Emplazamiento. Centro de salud urbano de Terrassa, Barcelona (52.000 habitantes). Participantes. Mujeres > 40 años que acudían a urgencias del centro seleccionadas por muestreo consecutivo estratificado por edad (n = 416). Mediciones principales. Registro de FR de fractura osteoporótica según los criterios de la Agència d’Avaluació de Tecnologies Mèdiques (AATM), recomendaciones higiénico-dietéticas recibidas y DMO realizadas. Resultados. La edad media fue de 60 ± 13 años. Los FR de fractura osteoporótica más prevalentes fueron: baja ingesta de calcio (32,1%), edad avanzada (27,5%), ausencia de lactancia (24,9%) y menopausia precoz (16,4%). Habían recibido recomendaciones dietéticas un 35,7%, de ejercicio un 65,5% y de exposición solar un 18,1%. De los 177 (42,7%) casos en que estaba indicada la DMO, tan sólo se realizó en 45 (25,4%); de los 237 (57,3%) casos sin indicación de DMO se realizaron 41 (17,2%). Haber realizado una DMO se relaciona de manera estadísticamente significativa con el antecedente de fractura osteoporótica (p < 0,001) y con la menopausia iatrogénica (p < 0,001). El 41,2% de las DMO fue solicitado por el médico de familia, el 34,1% por el reumatólogo y el 16,5% por el ginecólogo. La indicación de DMO varía entre las distintas sociedades científicas: AATM, 42,7%; semFYC, 45,7%; FORE, 49,8%; SER, 61,1%; y NOF, 64,3%. Conclusiones. A pesar de que los FR de osteoporosis más prevalentes son los más modificables desde atención primaria, hay un bajo grado de consejo sobre hábitos de vida saludables. Se detecta una baja realización de DMO y, en la mitad de los casos, su indicación no es adecuada según los criterios de la AATM. Hay una gran variabilidad en la indicación de DMO entre las distintas sociedades científicas

Objective. To evaluate the indication of bone densitometry (BD) and to know the prevalence of risk factors (FR) for osteoporotic fracture in primary care. Design. Cross-sectional, descriptive study. Setting. Urban centre of health of Terrassa, Barcelona (52.000 h). Participants. Women over 40 years old than went to urgencies of the centre selected by consecutive sampling stratified by age (n=416). Main measurements. Registry of FR for osteoporotic fracture according to the criteria of the Agència d’Avaluació de Tecnologies Mèdiques (AATM), hygienic-dietetic recommendations received and made BDs. Results. The average age was of 60±13 years. The FR for osteoporotic fracture more prevalence were: low calcium intake (32.1%), increased age (27.5%), no lactantion (24.9%), and precocious menopause (16.4%). They had received dietetic recommendations 35.7%, of exercise 65.5% and solar exhibition 18.1%. Of the 177 (42.7%) cases in that the BD was indicated only it made in 45 (25.4%) and of 237 (57.3%) without indication of BD they were made 41 (17.2%).To have made BD is related of statistically significant way to antecedent of osteoporotic fracture (P<.001) and to iatrogenic menopause (P<.001). The 41.2% of the BDs were asked for by the primary care physician, the 34.1% by the rheumatologist and the 16.5% by the gynaecologist. The indication of BD varies between the different scientific societies: AATM 42.7%, semFYC 45.7%, FORE 49.8%, SER 61.1%, and NOF 64.3%. Conclusions. Although FR of prevalence osteoporosis are most modifiable from primary care, a low degree of advice exists on healthful habits of life. A low accomplishment of BDs is detected and half is not adapted its indications according to the criteria of the AATM. There is great variability in the indication of BD between the different scientific societies

[Intervention of the family physician in the diagnosis of cancer]. / Intervención del médico de familia en el diagnóstico del cáncer.

OBJECTIVE: To find the intervention of family doctors (FD) in diagnosing tumour pathology. DESIGN: Retrospective descriptive study. SETTING: Urban primary care centre. PATIENTS: Patients over 14 diagnosed with cancer. MEASUREMENTS: Selection of patients from the computerised records between November 1989 and March 1997. Review of clinical histories, analysing: 1. Personal details, 2. Type of cancer, 3. Intervention of the FD in the diagnosis, 4. Symptom of initial consultation, 5. Further tests requested by FD, 6. Interval between consultation and diagnosis, 7. Survival and 8. interval between diagnosis and death. FD intervention in diagnosis was evaluated: 1. Impossible intervention, 2. No intervention, with suspect signs not valued (SSNV) or with suspect signs valued (SSV), 3. Diagnostic intervention, incomplete (Iin) or complete (Ico). RESULTS: 438 tumours were detected: in 256 men (59%) and 171 women (41%). The most common kind in men was lung cancer (46 cases, 17%), and in women breast cancer (59 cases, 34%). In 233 cases (53%) the intervention of the FD was impossible. In 29 cases (6.5%) the FD's intervention was nil (15 cases with SSNV, 14 cases with SSV). Of the 174 cases (39.6%) in which the FD intervened, full diagnosis was made in 40% (69 cases). The mean of the interval between the first consultation and the diagnosis was significantly less when FD intervention existed, at 1.95 months (CI, 0.63-1.06) in Ico and 2.9 months (CI, 0.51-2.19) in Iin, than when there was no intervention, with delays of 5.58 months (CI, 1.46-3.53) with SSNV and 10.5 months (CI, 8.45-12.54) with SSV (p = 0.000). CONCLUSIONS: The family doctor can play an important part in cancer diagnosis. His/her active intervention can reduce the interval between consultation and diagnosis.

[Intervention for alcoholism control among chronic drinkers in primary care]. / Intervención antialcohólica en bebedores crónicos en atención primaria.

OBJECTIVE: To evaluate the evolution of alcohol consumption in chronic drinkers after a primary care alcohol intervention over two years. DESIGN: Prospective intervention study. SETTING: Urban primary care centre. PATIENTS: Males between 20 and 60 years old who consumed 100 or more grams of alcohol per day for at least the previous two years. MEASUREMENTS AND MAIN RESULTS: Detoxification (out-patient or hospital according to the degree of dependency) and habit-breaking, which consisted of psychological support (techniques of brief counselling, brief motivating interview) and/or referral to the care and observance centre (COC) for individual and/or group psychotherapy, took place. A minimum of eight visits were programmed and consumption was assessed in gr/day at the start and at one (1 m), three (3 m), six (6 m), twelve (12 m), eighteen (18 m) and twenty-four months (24 m). 64 out of 129 (49.5%) responded to the appointment. Control visits: nil observance (0 visits) 6 patients (9%), and excellent observance (> or = 9 visits) 21 patients (33%). INTERVENTIONS: Psychotherapy treatment: psychological support 55 patients (86%), referral to the COC 4 (6%), group psychotherapy 2 (3%), and non-treatment 6 (9%). Data on mean consumption: start 131 g/day (SD = 52), 12 m 31 (SD = 41), and 24 m 38 (SD = 42). Mean reduction of consumption at 24 months according to the observance: insufficient -19%, acceptable -71.1%, excellent -83.9% (p = 0.001). CONCLUSIONS: Low response to appointments. Evolution of alcohol consumption was similar to that in other studies. Clear relationship between number of visits and consumption at the end of the study. Given the positive findings, we think a primary care intervention on alcohol is essential.

Intervención del médico de familia en el diagnóstico del cáncer / Intervention of family doctors in cancer diagnosis

Objetivo. Conocer la intervención del médico de familia (MF) en el diagnóstico de la patología tumoral. Diseño. Estudio descriptivo retrospectivo. Emplazamiento. Centro de atención primaria urbano. Pacientes. Pacientes mayores de 14 años diagnosticados de cáncer. Mediciones. Selección de pacientes a partir de registro informatizado desde noviembre de 1989 hasta marzo de 1997. Revisión de historias clínicas analizando: a) datos de filiación; b) tipo de cáncer; c) intervención del MF en el diagnóstico; d) síntoma de consulta inicial; e) pruebas complementarias solicitadas por el MF; f) intervalo consulta-diagnóstico; g) supervivencia, y h) intervalo diagnóstico-éxitus. La intervención del MF en el diagnóstico se valoró: a) intervención imposible; b) intervención nula (con signos de sospecha no valorados (SSNV) o con signos de sospecha valorados (SSV)), y c) intervención diagnóstica (incompleta (IIn) o completa (ICo)). Resultados. Se detectaron 438 tumores: en 256 varones (59 por ciento) y en 171 mujeres (41 por ciento). El tipo más frecuente en el varón fue el cáncer de pulmón (46 casos, 17 por ciento) y el de mama en la mujer (59 casos, 34 por ciento). En 233 casos (53 por ciento) la intervención del MF fue imposible. En 29 casos (6,5 por ciento) su intervención fue nula (15 casos con SSNV, 14 con SSV). De los 174 casos (39,6 por ciento) en los que intervino, llegó al diagnóstico completo en un 40 por ciento de los mismos (69 casos). La media del intervalo entre la primera consulta y el diagnóstico fue significativamente inferior cuando existió intervención del MF, siendo 1,95 meses (IC, 0,63-1,06) en ICo y 2,9 meses (IC, 0,51-2,19) en IIn, que cuando la intervención era nula, siendo 5,58 meses (IC, l,46-3,53) con SSNV y 10,5 meses (IC, 8,45-12,54) con SSV (p = 0,000). Conclusiones. Importante papel del MF en el diagnóstico del cáncer disminuyendo su intervención activa el intervalo consulta-diagnóstico (AU)

[Analysis of indications and diagnosis of the gastroscopies requested by primary care physicians]. / Análisis de las indicaciones y diagnósticos de las gastroscopias solicitadas por médicos de atención primaria.

OBJECTIVES: To analyse the pathology diagnosed on the basis of the gastroscopies requested from a primary care centre (PCC). Assessment and treatment of Helicobacter pylori (HP) infection. DESIGN: Retrospective and descriptive. SETTING: Urban PCC. PATIENTS: Those over 14 who had a gastroscopy for a diagnostic purpose, requested by their primary care doctor during 1997. MEASUREMENTS: Review of clinical records and gastroscopy reports analysing: personal data, reasons for request, prior treatment, diagnoses, treatment to eradicate HP, later referral to the digestion specialist and waiting-time for the gastroscopy. RESULTS: 206 gastroscopies were performed, 139 for epigastralgia (67%) and 73 for heartburn (35%). 161 patients (78%) had had previous treatment, with alkalines used in 94 cases (45%). The most common diagnoses were: 54 normal (26%), 60 hiatus hernias (30%), 43 oesophagitis (21%), 18 duodenal ulcers (9%) and 4 gastric ulcers (2%). The Helicobacter pylori study was positive in 67 cases, with triple treatment (amoxycillin, clarithromycin and omeprazole) to eradicate it given for 7 days in 36 cases (54%). Referral to the specialist of 3% of the patients. Waiting-time for the performance of the gastroscopy: 60 days (SD: 35). CONCLUSIONS: Gastroscopy is a diagnostic method habitually used in our PCC. The pathology diagnosed is mainly treated in primary care. Given the current controversy about actions at determined clinical entities, standardisation of criteria used by professionals at different care levels is very important. This standardisation should affect the indications of the examinations, and the treatment and follow-up of the pathologies. The reduction in waiting-time for a gastroscopy could possibly modify the prescription and duration of the prior treatment.

Intervención antialcohólica en bebedores crónicos en atención primaria / Primary care intervention against alcohol in chronic drinkers

Objetivo. Evaluar la evolución del consumo de alcohol en pacientes bebedores crónicos tras la intervención antialcohólica efectuada en atención primaria durante 2 años. Diseño. Estudio prospectivo longitudinal de intervención. Emplazamiento. Centro de atención primaria urbano. Pacientes. Varones de 20-60 años de edad consumidores de 100 o más gramos de alcohol al día durante, como mínimo, los dos últimos años. Mediciones y resultados principales. Se realizó desintoxicación (ambulatoria u hospitalaria según el grado de dependencia) y deshabituación que consistía en apoyo psicológico (técnicas de consejo breve, entrevista breve motivacional) y/o derivación al centro de atención y seguimiento (CAS) para psicoterapia individual y/o grupal. Se programaron un mínimo de 8 visitas y se valoró el grado de consumo en g/día al inicio y a los 1 (m1), 3 (m3), 6 (m6), 12 (m12), 18 (m18) y 24 meses (m24). Responden a la citación 64/129 (49,5 por ciento). Visitas control: no seguimiento (0 visitas), 6 pacientes (9 por ciento), y seguimiento excelente (>= 9 visitas), 21 pacientes (33 por ciento). Intervención. Tratamiento psicoterápico: apoyo psicológico, 55 pacientes (86 por ciento); derivación al CAS, 4 (6 por ciento); psicoterapia de grupo, 2 (3 por ciento), y no tratamiento, 6 (9 por ciento). Datos de consumo: medias de consumo: inicio, 131 g/día (DE, 52); m12, 31 (DE, 41), y m24, 38 (DE, 42). Porcentaje medio de reducción del consumo a los 24 meses según el seguimiento: insuficiente, -19 por ciento; aceptable, -71,1 por ciento, y excelente, -83,9 por ciento (p = 0,001). Conclusiones. Baja respuesta a la citación. Evolución en el consumo de alcohol similar a la descrita en otros estudios. Clara relación entre el número de visitas y el consumo al final del estudio. Dados los resultados positivos, nos parece fundamental la intervención antialcohólica desde atención primaria (AU)

Análisis de las indicaciones y diagnósticos de las gastroscopias solicitadas por médicos de atención primaria / Analysis of the indications and diagnoses of the gastroscopies requested by primary care doctors

Objetivo. Analizar la patología diagnosticada a partir de las gastroscopias (GC) solicitadas desde un centro de atención primaria (CAP). Valoración y tratamiento de la infección por Helicobacter pylori (HP). Diseño. Descriptivo, retrospectivo. Emplazamiento. CAP urbano. Pacientes. Mayores de 14 años a quienes se realizó una GC con finalidad diagnóstica, solicitada por su médico de atención primaria (AP), durante 1997. Mediciones. Revisión de historias clínicas y de informes de las GC analizando: datos de filiación, motivo de solicitud, tratamiento previo, diagnósticos, tratamiento erradicador de HP, derivación posterior al digestólogo y tiempo de espera para la realización de la GC. Resultados. Realización de 206 GC principalmente por epigastralgia en 139 pacientes (67 por ciento) y pirosis en 73 (35 por ciento). Tratamiento previo en 161 pacientes (78 por ciento) utilizándose los alcalinos en 94 casos (45 por ciento). Diagnósticos más frecuentes: 54 normales (26 por ciento), 60 hernias de hiato (30 por ciento), 43 esofagitis (21 por ciento), 18 úlceras duodenales (9 por ciento) y 4 gástricas (2 por ciento). Estudio de HP positivo en 67 casos, realizándose tratamiento erradicador triple (amoxicilina, claritromicina y omeprazol) durante 7 días en 36 de ellos (54 por ciento). Derivación al especialista del 3 por ciento de los pacientes. Tiempo de espera para la realización de la GC: 60 días (DE, 35). Conclusiones. La GC es un método diagnóstico de uso habitual en nuestro CAP y la patología diagnosticada es asumida mayoritariamente desde el ámbito de la AP. Dada la controversia existente de actuación en determinadas entidades clínicas, es muy importante la estandarización de criterios de los profesionales de los distintos niveles asistenciales en las indicaciones de las exploraciones, así como en el tratamiento y seguimiento de las patologías. La reducción de la espera para la realización de la GC posiblemente podría modificar la prescripción y duración del tratamiento previo (AU)