Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study.

UNLABELLED: This cross-sectional observational study aimed to determine the nationwide prevalence of gastroesophageal reflux disease (GORD) in French children and adolescents. Four hundred four general practitioners and 180 paediatricians compiled a register of all children and adolescents (n = 10,394, aged 0 to 17 years, mean 3.8 ± 5.6 years) who presented over two 3-day periods. For all children who, in the physician's opinion, showed symptoms of gastroesophageal reflux (GOR), a 24-item questionnaire covering the history and management of GOR was completed. Children with symptoms that impaired their daily lives were defined as having GORD, the remainder as having physiological GOR. Of the patients, 15.1 % showed GOR symptoms. Extrapolation to the overall French population yielded a prevalence of 10.3 % for GOR and 6.2 % for GORD. There was a significantly (p < 0.05) greater use of volume reduction or milk thickeners and dorsal positioning among infants with GORD versus physiological GOR. Significantly (p < 0.05) more of the infants and children with GORD received pharmacological therapy. The use of proton pump inhibitors increased with age but was significantly (p < 0.05) higher among those with GORD. CONCLUSIONS: Ten percent of French children and adolescents show GOR symptoms and 6 % have GORD. Clinical presentation and treatment vary in different age groups, but those with GORD are more likely to require pharmacological treatment.

Assessment of cardiovascular risk in primary care patients in France.

BACKGROUND: Current guidelines for the prevention of cardiovascular disease emphasize the importance of assessing global cardiovascular risk, but there is evidence that risk is often assessed inaccurately. AIMS: To compare general practitioner-reported global cardiovascular risk in French primary care patients with estimates based on established risk-scoring systems, and to identify factors accounting for any mismatch between the analyses. METHODS: Data on patients, aged 50 years or older, seen during two 3-day periods were provided by 619 general practitioners. Physicians rated each patient's cardiovascular risk as low, moderate or high, according to their perception; in addition, risk was assessed using the Framingham and Systematic coronary risk evaluation (SCORE) risk-scoring systems. RESULTS: A total of 13,446 patients aged greater or equal to 50 years were included. Of 11,241 patients with no previous history of cardiovascular disease, 47% were considered by their physicians to be at low risk of cardiovascular disease and 14% to be at high risk. In that population, 72% of patients rated as high risk according to the Framingham system and 77% rated as high risk according to SCORE system were incorrectly assessed by their physicians; similar results were observed in patient cohorts based on whether or not patients had received treatment for dyslipidaemia. Weighted kappa analysis showed poor agreement between physician risk assessment and both the Framingham and SCORE risk-scoring systems. CONCLUSION: This study underlines the mismatch between GP-estimated cardiovascular risk and the risk assessed using scoring systems, especially for high-risk patients.

Sleep disturbances associated with gastro-oesophageal reflux disease: prevalence and impact of treatment in French primary care patients.

AIM: To evaluate the prevalence of sleep disturbances in French patients with gastro-oesophageal reflux disease and the impact of gastro-oesophageal reflux disease treatment on sleep. METHODS: A registry was compiled of all gastro-oesophageal reflux disease patients seen during a 2-week period by 1983 French primary care physicians. Data from the first two patients with nocturnal gastro-oesophageal reflux disease symptoms and gastro-oesophageal reflux disease-related sleep disturbances seen by each physician were derived from physician questionnaires and medical records. These patients completed a questionnaire during the initial consultation and after 1-month treatment. RESULTS: A total of 33,391 patients were included in the study: physician questionnaires were available for 3269 patients and patient questionnaires for 2876. Nocturnal gastro-oesophageal reflux disease symptoms were reported by 21,337 patients (63.9%) and regular (at least once weekly) gastro-oesophageal reflux disease-related sleep disturbances by 19,313 (61.7%). Multivariate analysis showed that nocturnal gastro-oesophageal reflux disease symptoms, use of hypnotic drugs, and age over 50 years were significant independent predictors of sleep disturbances. The proportion of patients reporting at least one nocturnal gastro-oesophageal reflux disease symptom during the previous week decreased following treatment, from 98.8% to 39.3% (P<0.001). CONCLUSIONS: Nocturnal gastro-oesophageal reflux disease symptoms are common in the French population and are associated with sleep disturbances. Effective treatment can significantly improve sleep duration and quality.

[Spongioplasty in the treatment of hypospadias]. / La spongioplastie dans le traitement des hypospades.

OBJECTIVE: Hypospadias is a frequent anomaly, for which many repair techniques have been proposed. In 2000, we described a method of one-stage anatomical correction, called spongioplasty. The present study evaluated the functional and cosmetic results of this technique. MATERIAL AND METHODS: 154 patients treated by this technique over a 10-year period were reviewed. All complications reported were compared according to the anatomical form, age at the time of surgery, and year of operation. RESULTS: We demonstrate a learning curve lasting about 6 years, after which the complication rate of this technique becomes lower than that associated with other methods, particularly for distal forms. In our experience, this complication rate is lower for an operative age between 5 and 8 months. CONCLUSION: In the light of these results, this type of surgery can be proposed at an earlier age than other techniques.