Dyspepsispatienten i almen praksis Læge ph.d. Jon Eik Zwisler
Ekspeditionskontor? 3-5% af alle konsultationer Mere end 95% af medicin Langtidsbrug Gastroskopi er hyppig ved dyspepsi - men oftest normal Mange forskellige og vigtige årsager til dyspepsi
Overordnet - beslutningsprocessen
Dyspepsi i praksis Faresignaler? Alder? Tidligere Andet? Skopi? Dyspepsi-medicin? Helicobacter-test? Andet?
Gastro-oesophageal refluks sygdom Dyspepsi Sure opstød og hals-brand dominerende symptomer Dyspepsi Refluks
Udredningsstrategier Gastroskopi? Helicobacter pylori test? Syrehæmmende behandling? Se forløbet an?
Dyspepsiudredning i praksis 417 randomly selected primary care physicians from 29 countries Empirical treatment: 66.1% (range: 50-81%) Test and treat strategy: 13.2% (range: 5-25%) Endoscopy 17.9% (range: 4-24%) Huang, J Gastroenterol.Hepatol 2003 New data from 417 randomly selected primary care physicians from 29 countries report with respect to the management of patients with first-time dyspepsia, 66.1% (range: 50-81%) of respondents would treat their patients empirically, compared to only 17.9% (range:3.8-24%) who would choose endoscopy and 13.2% (range:5-25%) favouring a test and treat strategy {Huang, J Gastroenterol.Hepatol 2003}
Brug af medicin
Hvem bruger syrehæmmende medicin? This figure shows the distribution of usage pattern of antisecretory drugs through the years 1993-2002. The amount here as million DDD antisecretory medication/year. The trend is clear: a growing overall use, but here seen to be based on a growing long-term use. Several other studies have confirmed that this also is the same in other western countries. This study also showed that 59% of the long-term users were not investigated with endoscopy or Hp-test. Lassen et al, Aliment pharmacol and therapeut 2004, 20 (5)
Helicobacter pylori test Fordele: Patienter med Helicobacter pylori-positive ulcus behandles. Ulemper: Helicobacter pylori-positive uden ulcus har kun ringe gavn af behandling.
Test-and-treat i praksis Test: Helicobacter pylori test i praksis Treat: Eradikationsbehandling og evt. kontrol i praksis.
Mulighed for optimering Helicobacter pylori-test Medicinkontrol og patientvejledning NSAID og ulcusygdom