RESUMO
Proton pump inhibitors (PPIs) are effective and suppressing acid, and therefore have efficacy against gastric acid-related disorders. The long-term safety of PPIs is less clear and there have been a number of studies raising concerns regarding risk of pneumonia, fracture, Clostridium difficile, chronic renal failure, and dementia. This latter concern is addressed by a study in this issue of AJG using health care registry data and found there was no association between PPI use and Alzheimer's dementia. Furthermore, there was no increased risk of dementia with long-term use of PPIs or higher doses of PPIs. Discrepancies between studies probably relate to multiple testing and residual confounding and currently there is insufficient evidence to suggest that the association between PPIs and dementia is causal.
Assuntos
Doença de Alzheimer , Clostridioides difficile , Humanos , Inibidores da Bomba de Prótons , Bombas de PrótonAssuntos
Pessoal Técnico de Saúde/normas , Registros Eletrônicos de Saúde/normas , Uso Significativo/normas , Pessoal Técnico de Saúde/educação , Centers for Medicare and Medicaid Services, U.S./economia , Centers for Medicare and Medicaid Services, U.S./normas , Credenciamento/normas , Documentação , Registros Eletrônicos de Saúde/economia , Humanos , Auditoria Administrativa/normas , Uso Significativo/economia , Estados Unidos , Recursos HumanosAssuntos
Codificação Clínica/economia , Registros Eletrônicos de Saúde/economia , Auditoria Financeira/economia , Prática de Grupo/economia , Codificação Clínica/normas , Documentação , Registros Eletrônicos de Saúde/normas , Auditoria Financeira/normas , Prática de Grupo/organização & administração , Prática de Grupo/normas , HumanosAssuntos
Centers for Medicare and Medicaid Services, U.S./economia , Serviços de Diagnóstico/economia , Administração da Prática Médica/economia , Contas a Pagar e a Receber , Centers for Medicare and Medicaid Services, U.S./normas , Serviços de Diagnóstico/tendências , Tabela de Remuneração de Serviços/normas , Tabela de Remuneração de Serviços/tendências , Humanos , Relações Interinstitucionais , Administração da Prática Médica/tendências , Escalas de Valor Relativo , Estados UnidosAssuntos
Contas a Pagar e a Receber , Centers for Medicare and Medicaid Services, U.S./economia , Telemedicina/economia , Centers for Medicare and Medicaid Services, U.S./normas , Centers for Medicare and Medicaid Services, U.S./tendências , Humanos , Telemedicina/métodos , Telemedicina/normas , Estados UnidosRESUMO
BACKGROUND: Studies have also shown that non-ulcer dyspepsia (NUD) patients have higher scores of anxiety, depression, neurotism, chronic tension, hostility, hypochondriasis and tendency to be more pessimistic when compared with the community controls. However, the role of psychological interventions in NUD remains uncertain. OBJECTIVES: This review aims to determine the effectiveness of psychological interventions including psychotherapy, psychodrama, cognitive behavioural therapy, relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores in patients with NUD. SEARCH STRATEGY: Trials were identified by searching the Cochrane Controlled Trials Register (Issue 3-1999), MEDLINE (1966-99), EMBASE (1988-99), PsycLIT (1987-1999) and CINAHL (1982-99). Bibliographies of retrieved articles were also searched and experts in the field were contacted. Searches were updated on 10 December 2002 and 21 January 2004. The searches were re-run on 24 January 2005 and 9 January 2006 and no new trials were found SELECTION CRITERIA: All randomised controlled trials (RCTs) or quasi-randomised studies assessing the effectiveness of psychological interventions (including psychotherapy, psychodrama, cognitive behavioural therapy, relaxation therapy and hypnosis) for non-ulcer dyspepsia (NUD) were identified. DATA COLLECTION AND ANALYSIS: Data collected included both individual and global dyspepsia symptom scores and quality of life (QoL) scores. MAIN RESULTS: We identified only four trials each using different psychological interventions; three presented results in a manner that did not allow synthesis of the data to form a meta-analysis. All trials suggested that psychological interventions benefit dyspepsia symptoms and this effect persists for one year. However, all trials used statistical techniques that adjusted for baseline differences between groups. This should not be necessary for a randomised trial that is adequately powered suggesting that the sample size was too small. Unadjusted data was not statistically significant. The other problems of psychological intervention included low recruitment and high drop out rate, which has been shown to be greater in patients receiving group therapy. AUTHORS' CONCLUSIONS: There is insufficient evidence from this review to confirm the efficacy of psychological intervention in NUD.
