Authors (including presenting author) :
Leung LH
Affiliation :
Department of Family Medicine & Primary Health Care, Kowloon West Cluster, HA
Introduction :
Peptic ulcer disease is a common and important upper gastrointestinal tract condition encountered in Family Medicine. Various clinical factors had been described to be associated with the condition. A number of patients would be referred to hospital Special Outpatient Clinics (SOPCs) for further evaluation, which may overload the public secondary health care sector. Most existing studies were conducted in hospital-based setting or in high risk patients. There is scarcity in updated literature to review such factors in Hong Kong community-based patients.
Objectives :
To examine factors associated with ulcer disease versus non-ulcer endoscopic findings in primary care settings.
Methodology :
A multi-center retrospective cross-sectional study with study period from 1st October, 2015 to 31st December, 2017 was conducted. Five General Outpatient Clinics (GOPCs) were involved in the study. Patients who underwent direct access endoscopy booked from the GOPCs were recruited. Clinical factors (age, gender, epigastric pain, Aspirin use, Non-steroidal anti-inflammatory drug use, smoking status, Helicobacter Pylori status) were collected and analysed. Data were presented as frequency with percentage or mean with standard deviation. Baseline characteristics were compared between ulcer and non-ulcer groups using Pearson’s chi-square test, Fisher’s exact test or Mann-Whitney U test, as appropriate. Associations between subjects’ characteristics and endoscopic outcome were evaluated by multiple binary logistic regression which included factors with P <0.1 in simple regression analyses. Sensitivity analysis that excluded subjects with endoscopic finding of malignancy, a clinical significant non-ulcer outcome classified as “negative” finding in the current study of primary interest of PUD, from the regression analysis was performed. Statistical Package for the Social Sciences software for Windows was used for the analysis of data. A P-value of <0.05 was considered statistically significant.
Result & Outcome :
340 patients were booked oesophagogastroduodenoscopy (OGD) in the study period. Among 297 patients who completed endoscopy, 32 (10.8%) were positive for peptic ulcer disease. Factors associated with positive peptic ulcer disease included ever smoking status (adjusted OR 9.28; 95%CI 2.85-30.25; P <0.001), positive Helicobacter Pylori status (adjusted OR 5.95; 95%CI 2.45-14.42; P <0.001), and presence of epigastric pain on history (adjusted OR 4.40; 95%CI 1.61-12.01; P 0.004). Discussion: clinical factors namely ever smoking status, positive Helicobacter Pylori status, and presence of epigastric pain on history were identified to be associated with endoscopic peptic ulcer disease finding in public community-based GOPC patients without high risk features. By understanding more about such factors, primary care physicians could have better selection of patients for referral or further investigations. Further studies with modified designs might be conducted for evaluation of our findings and associated conditions.
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