Patient selection for therapy reduction after long-term daily proton pump inhibitor treatment for gastro-oesophageal reflux disease: trial and error.

Background: Proton pump inhibitor (PPI) therapy reduction after long-term daily treatment for gastro-oesophageal reflux disease (GORD) symptomatology proves difficult in primary care practice. We aimed to identify patient and/or disease characteristics in long-term daily PPI users predicting a successful switch to less than daily therapy.

Methods: GORD patients who after long-term continuous treatment were able to use less than a daily PPI dose in a placebo-controlled trial were compared to patients who persisted in a daily dosage with respect to general, lifestyle and quality of life characteristics (SF-36 Health Survey) as well as psychological factors (Symptom Check List 90), symptom control on daily PPI (Quality of Life in Reflux and Dyspepsia questionnaire), disease and medication history.

Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome.

Background: Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. The role of pharmacotherapy for IBS is limited and focused mainly on symptom control.

Objectives: The objective of this systematic review was to evaluate the efficacy of bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome.

Exercise therapy for stress-related mental disorder, a randomised controlled trial in primary care.

Background: to investigate whether a structured physical exercise programme (PEP) improves the recovery of general health in patients suffering from Stress-related Mental Disorder (SMD).

Study Design: randomised open trial in general practice. Patients from two regions in the Netherlands were included between September 2003 and December 2005, and followed up for 12 weeks.

Pharmacological dependency in chronic treatment of gastroesophageal reflux disease: a randomized controlled clinical trial.

Background: Despite evidence of the overuse of acid suppressive medication for gastroesophageal reflux disease (GERD), a transfer to noncontinuous therapy after long-term treatment proves difficult.

Aim: To quantify the effect of blinded dosage reduction after long-term therapy on symptom control and quality of life while assessing pharmacological and placebo needs.

Methods: Primary care patients with a history of GERD and long-term treatment were randomized to daily placebo with pantoprazole rescue (n = 141) or daily pantoprazole with placebo rescue (n = 62) upon relief after 4 weeks pantoprazole 20 mg.

Psychological treatments for the management of irritable bowel syndrome.

Background: No consensus exists on the optimal treatment for irritable bowel syndrome (IBS). Psychological treatments are increasingly advocated but their effectiveness is unclear.

Objectives: To evaluate the efficacy of psychological interventions for the treatment of irritable bowel syndrome.

Maintenance treatment for GERD: residual symptoms are associated with psychological distress.

Aim: The aim of this study was to explore determinants of residual reflux symptoms among patients with gastroesophageal reflux disease (GERD) despite maintenance treatment with acid suppressive medication (ASM).

Methods: Primary care GERD patients on chronic ASM were classified as symptom-free (55%) or symptomatic (45%) according to the impact of their residual reflux symptoms (QolRad). They were compared with respect to lifestyle (BMI, alcohol, smoking, physical exercise), compliance (daily ASM dosage), disease history, psychological factors (SCL-90) and quality of life (SF-36).

Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome.

Background: Irritable bowel syndrome (IBS) is a common health problem, often presenting in primary care as well as in internal medicine and gastroenterology outpatient clinics. Therapeutic options are dominated by drug therapies but there is uncertainty about their effectiveness.

Objectives: The primary objective of this review was to evaluate the efficacy of bulking agents, antispasmodic and antidepressant medication for the treatment of IBS.

One-year prognosis of primary care dyspepsia: predictive value of symptom pattern, Helicobacter pylori and GP management.

Background And Aims: Dyspepsia is a highly prevalent, heterogeneous condition with a poorly defined clinical course in family practice. We observed its clinical outcome and identified prognostic factors.

Patients: We studied 583 patients presenting to their general practitioner (GP) with a new episode of dyspeptic complaints.

Participation and successful patient recruitment in primary care.

Objective: The demand for family physicians (FPs) to participate in research is growing. The delicate balance between research participation and the daily practice routine might explain the often-disappointing number of patients recruited. We analyzed practice and physician characteristics associated with successful patient recruitment.

How useful is paracetamol absorption as a marker of gastric emptying? A systematic literature study.

Functional dyspepsia is a common disorder in primary care and gastroenterology units; however, the pathophysiology is poorly understood. Delayed gastric emptying is present in nearly 40% of patients. We evaluated the validity of the paracetamol absorption test in comparison with scintigraphy for gastric emptying assessment.

Dyspepsia management in primary care in The Netherlands: to what extent is Helicobacter pylori diagnosis and treatment incorporated? Results from a survey among general practitioners in The Netherlands.

Background: Many guidelines on the management of Helicobacter pylori (HP)-related dyspepsia have been launched over the past decade. The suggested policies in these guidelines are often more consensus- than evidence-based (test-and-treat policy, test and endoscope), which may cause confusion among primary-care physicians.

Aim: To determine the current management of HP-related dyspepsia by Dutch general practitioners (GPs).

Dyspepsia in primary care: acid suppression as effective as prokinetic therapy. A randomized clinical trial.

Background: While dyspeptic patients in primary care often receive empirical treatment with antisecretory drugs, a substantial number suffer from motility disturbances which may be associated with their complaints. We aimed to compare the effectiveness of treatment with antisecretory treatment with a prokinetic agent in uninvestigated dyspepsia.

Methods: 563 patients presenting dyspeptic complaints to the general practitioner with a low likelihood of organic (ulcer, reflux or malignant) disease, i.

In-practice evaluation of whole-blood Helicobacter pylori test: its usefulness in detecting peptic ulcer disease.

Background: Approximately 10% of patients presenting with dyspepsia to the general practitioner have peptic ulcers; the large majority of which are related to infection with Helicobactor pylori. Office-based tests for H. pylori detection are generally validated and evaluated in selected patient groups.

Helicobacter pylori treatment instead of maintenance therapy for peptic ulcer disease: the effectiveness of case-finding in general practice.

Background: Maintenance therapy with acid-inhibiting medication is common in general practice. Since the eradication of Helicobacter pylori has become the treatment of choice for peptic ulcer disease, H. pylori treatment could replace maintenance therapy in patients with an ulcer history.

What makes the dyspeptic patient feel ill? A cross sectional survey of functional health status, Helicobacter pylori infection, and psychological distress in dyspeptic patients in general practice.

Background: Dyspepsia is prevalent in about 30% of the general population in Europe, but only 25% of people with complaints consult their general practitioner.

Aims: To study the relation between the severity of dyspeptic complaints and the health status of patients presenting to the general practitioner; and the relation with patient characteristics, Helicobacter pylori infection, and psychological distress.

Methods: A cross sectional, general practice based survey of 360 unselected primary care dyspeptic patients from 92 general practices in The Netherlands was conducted.

Disturbed solid-phase gastric emptying in functional dyspepsia: a meta-analysis.

Functional dyspepsia is a common disorder with a diverse pathophysiological background, but the role of motility disorders in functional dyspepsia remains unclear. We aimed to quantify the relationship between disturbed gastric emptying and functional dyspepsia, using a meta-analytic approach. Through a structured literature search of Medline and Embase from 1983 to 1996, we selected all studies in which scintigraphic solid-phase gastric emptying was measured in both functional dyspeptic patients and controls.

A phenotypic male with true hermaphroditism and a 46,XX/46,XY/47,XXY karyotype.

A phenotypic boy presenting with gynaecomastia showed a mixed karyotype of 46,XX/46,XY/47,XXY. The left gonad was normally descended into the scrotum, but proved to be an ovary without any testicular structures. After left gonadectomy, plasma androgen and estrogen levels showed that the right gonad only contained testicular tissue.