Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient-Reported Outcomes of Testing and Treating for Helicobacter pylori Infection

Meltzer, Andrew C.; Winter, Lauren; Kulie, Paige; Benedict, Cameron; Lim, Kelvin; Ishmukhamedov, Otabek; McCarthy, Melissa L.

doi:10.1016/j.annemergmed.2015.02.008

Cited by 8 publications

(2 citation statements)

References 16 publications

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“… 8 A test‐and‐treat strategy has been shown feasible with other ED GI complaints and could also be feasible with infectious diarrhea. 22 One potential criticism of using GI PCR in the ED is that testing will lead to overuse of antibiotics and patients with mild disease will be unnecessarily treated for a condition that is typically self‐limited. As a counterargument, patients who are appropriately treated for diarrhea are known to get better sooner and be less likely to spread to other people.…”

Section: Discussionmentioning

confidence: 99%

A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department

et al. 2022

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Objective This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic management. Methods A prospective, single‐center, randomized control trial was designed to investigate antibiotic use in ED patients with moderate to severe suspected infectious diarrhea, comparing those who received GI PCR to those who received usual testing. ED patients with signs of dehydration, inflammation, or persistent symptoms were randomized to either the experimental arm (GI PCR) or the control arm (usual testing or no testing). Results A total of 74 patients met study criteria and were randomized to either the experimental GI PCR arm (n = 38) or to the control arm (n = 36). Participants in the GI PCR arm received antibiotics in 87% of bacterial or protozoal diarrheal infections (13/15) whereas those in the control arm received antibiotics in 46% of bacterial or protozoal infections (6/13) ( P value 0.042) with 2‐proportion difference 0.41 (95% confidence interval 0.07 and 0.68). Conclusions ED use of multiplex GI PCR led to an increase in antibiotic use for bacterial and protozoal causes of infectious diarrhea compared to usual testing. This increase in antibiotics appears to be appropriate given patients’ moderate to severe symptoms and a definitive identification of a likely bacterial or protozoal cause of symptoms. Results should be interpreted with caution because of the small sample size.

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Section: Discussionmentioning

confidence: 99%

A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department

et al. 2022

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“…An important consideration for the GRACE‐2 writing group was the feasibility of the guideline for physicians and patients in various practice settings. We debated including recommendations for testing for conditions such as Helicobacter pylori but noted that some forms of testing such as exhaled carbon dioxide or immunological testing might not be available within an ED time frame in some settings 87,88 . Similarly, we chose not to investigate the utility of MRI of the abdomen and pelvis in the ED for patients with recurrent and undifferentiated abdominal pain, as many sites might not have availability of this testing on a regular basis.…”

Section: Methodsmentioning

confidence: 99%

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Broder

Silva

Bellolio

et al. 2022

Academic Emergency Medicine

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This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐2) from the Society for Academic Emergency Medicine is on the topic “low‐risk, recurrent abdominal pain in the emergency department.” The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low‐risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid‐minimizing strategy for pain control. EXECUTIVE SUMMARY The GRACE‐2 writing group developed clinically relevant questions to address the care of adult patients with low‐risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient‐intervention‐comparison‐outcome‐time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low‐risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.

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Screening of long non‐coding RNAs markers in plasma of children with chronic gastritis

Shen

et al. 2020

Chronic Diseases and Translational Medicine

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ObjectiveThe study aimed to detect and analyze long non‐coding RNAs (lncRNAs) in plasma of children diagnosed with chronic gastritis, and to explore its biological functions and involved signaling pathways.MethodsThe plasma samples were collected from six children that were diagnosed with chronic gastritis by physical examination, gastroscopy, and pathological examination and six healthy children. The plasma samples were assayed for determining the expression profiles of lncRNA based upon the gen chip detection. The specific expression of lcnRNA in plasma of children with chronic gastritis was analyzed and its biological functions were speculated.ResultsFive lncRNAs (RP11‐697M17.1, RP11‐388M20.9, AFAP1‐AS1, BC062758, and XLOC001406) were significantly up‐regulated, and five lncRNAs (UNQ697, BX571672.5, CYP4F35P, ANKRD20A5P, and AL832737) were observed to be significantly down‐regulated. The lncRNAs RP11‐697M17.1, and UNQ697 were detected with the highest up‐regulation and down‐regulation, respectively. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that the up‐regulated lncRNAs were significantly enriched in 20 signaling pathways such as phosphoinositide‐3‐kinase–protein kinase B (PI3K‐Akt) pathway, and the down‐regulated lncRNAs target genes were significantly enriched in 20 signaling pathways such as the metabolic pathway.ConclusionThe analysis of the lncRNA expression profiles in plasma of children with chronic gastritis revealed that the lncRNA RP11‐697M17.1, and lncRNA UNQ697 may act as plasma markers for predicting chronic gastritis in children.

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Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient-Reported Outcomes of Testing and Treating for Helicobacter pylori Infection

Cited by 8 publications

References 16 publications

A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department

A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Screening of long non‐coding RNAs markers in plasma of children with chronic gastritis

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