Assuntos
Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Gerenciamento Clínico , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Pessoal de Saúde/organização & administração , Gastroenteropatias/prevenção & controle , Pessoal de Saúde/tendências , Humanos , Estados UnidosRESUMO
BACKGROUND: Due to concerns about long-term PPI use in patients with acid reflux, we aimed at minimizing PPI use, either by avoiding initiating therapy, downscaling to other therapies, or introducing endoscopic or surgical options. AIMS: To examine the role of esophageal ambulatory pHmetry in minimizing PPI use in patients with heartburn and acid regurgitation. METHODS: Retrospective cohort analysis of patients with reflux symptoms, who underwent endoscopy, manometry, and ambulatory pHmetry to define the need for PPI. Patients were classified as: (1) never users; (2) partial responders to PPI; (3) users with complete response to PPI. Patients were then managed as: (1) PPI non-users; (2) PPI-initiated, and (3) PPI-continued. RESULTS: Of 286 patients with heartburn and regurgitation, 103 (36%) were found to have normal and 183 (64%) abnormal esophageal acid exposure (AET). In the normal AET group, 44/103 had not been treated and were not initiated on PPI. Of the 59 who had previously received PPI, 52 stopped and 7 continued PPI. Hence, PPI were avoided in 96/103 patients (93%). In the abnormal AET group, 61/183 had not been treated and 38 were initiated on PPI and 23 on other therapies. In the 122 patients previously treated with PPI, 24 were not treated with PPI, but with H2RAs, prokinetics, endoscopic, or surgical therapy. Hence, PPI therapy was avoided in 47/183 patients (26%). CONCLUSIONS: In patients with GER symptoms, esophageal pHmetry may avert PPI use in 50%. In the era of caution regarding PPIs, early testing may provide assurance and justification.
Assuntos
Monitoramento do pH Esofágico/métodos , Refluxo Gastroesofágico , Azia , Efeitos Adversos de Longa Duração/prevenção & controle , Uso Excessivo de Medicamentos Prescritos/prevenção & controle , Inibidores da Bomba de Prótons , Estudos de Coortes , Endoscopia Gastrointestinal/métodos , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Azia/diagnóstico , Azia/tratamento farmacológico , Azia/epidemiologia , Humanos , Efeitos Adversos de Longa Duração/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos , Estudos Retrospectivos , Estados UnidosRESUMO
The FDA recently approved the use of the HPV quadrivalent vaccine, Gardasil, for the prevention of genital warts in males ages 9 through 26. This literature review seeks to examine men's knowledge of and interest in HPV vaccination as this could potentially affect vaccine uptake.
