J Fam Pract

Esophagogastroduodenoscopy performed by a family physician. A case series of 793 procedures.

Pierzchajlo RP. Ackermann RJ. Vogel RL.
Department of Family & Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA.
BACKGROUND: Primary care physicians are performing an increasing number of gastrointestinal endoscopies. The purpose of this research is to present a large case series of diagnostic esophagogastroduodenoscopies (EGDs) performed by a family physician in a solo rural practice. METHODS: We present a retrospective chart review, including demographic characteristics, indications, endoscopic and pathologic findings, and complications for every EGD performed by a family physician over a 7-year period. RESULTS: Seven hundred ninety-three EGDs were performed on 602 patients (421 women, 181 men), with a mean age of 51.8 years. In 99% of procedures, the second portion of the duodenum was intubated. The most common indications for EGD were abdominal pain (60.5%), gastrointestinal bleeding (23.0%), dysphagia (11.6%), and heart-burn (10.7%). A total of 451 biopsies were obtained in 385 procedures, mostly from the distal esophagus (38%) or gastric antrum (37%). Common endoscopic diagnoses were gastritis (54%), esophagitis (25%), and normal study (15%). There were only two malignancies detected, one gastric lymphoma and one carcinoma metastatic to the stomach. One minor complication (0.13%) occurred, an immediate urticarial rash after intravenous meperidine. CONCLUSIONS: Experienced family physicians can safely and competently perform diagnostic EGD and provide this important service to their community.

Do gastrointestinal symptoms accompanying sore throat predict streptococcal pharyngitis? An UPRNet study. Upper Peninsula Research Network.

Kreher NE. Hickner JM. Barry HC. Messimer SR.
Department of Family Practice, Michigan State University College of Human Medicine, Escanaba, MI, USA.
BACKGROUND: The purpose of this study was to determine whether gastrointestinal (GI) symptoms are more common in streptococcal than nonstreptococcal pharyngitis, and, if so, whether these symptoms are useful diagnostic predictors. METHODS: Patients aged 4 and older presenting consecutively to one of three family practice clinics and one emergency department with the chief complaint of sore throat were invited to participate in the study. A nurse administered a brief symptom checklist; after documenting clinical signs, the clinician assessed and treated the patient. All patients were screened for group A streptococcus using the Abbott Test Pack Plus. Patients were enrolled from January 1996 through March 1996. Significant associations of signs and symptoms with streptococcal pharyngitis were determined by chi square, likelihood ratios were calculated, and logistic regression was used to compare diagnostic prediction models with and without GI symptoms. RESULTS: Six hundred fifty-seven consecutive patients with the presenting complaint of sore throat were enrolled in the study. The mean age of the patients enrolled was 19 years; the median age was 14. Thirty-two percent of the children (ages 4 to 18), 23% of the adults (ages 19 to 74), and 29% of all patients had streptococcal pharyngitis. Symptom frequencies for streptococcal and nonstreptococcal pharyngitis, respectively, were: nausea (39% vs 31%, P = .14); vomiting (14% vs 7%, P = .004); abdominal pain (27% vs 26%, P = .621); and any GI symptom (47% vs 41%, P = .45). When included in a predictive model with other significant predictors of streptococcal pharyngitis including age, palatal petechiae, absence of cough, and anterior cervical adenopathy, the addition of nausea or vomiting added slight predictive power to the models, but abdominal pain and "any GI symptom" did not. CONCLUSIONS: Nausea and vomiting are somewhat more common in streptococcal than in nonstreptococcal pharyngitis, but appear to have limited usefulness as clinical predictors of streptococcal pharyngitis.

Diagnostic utility of the digital rectal examination as part of the routine pelvic examination.

Campbell KA. Shaughnessy AF.
Harrisburg Family Practice Residency Program, PA 17105-8700, USA.
The digital rectal examination (DRE) is an uncomfortable procedure that adds time to the routine pelvic examination. Patients may postpone or defer their pelvic examination because of this discomfort. Although commonly recommended and performed, there is little evidence that this screening test provides unique or useful information. The goal of this project was to determine the diagnostic yield of routine DRE in otherwise healthy female patients who were younger than 40 years of age at the time of the examination. A total of 272 DREs were documented. Case findings were recorded in 8 (3%) of the patients. One notation reflected a previous diagnosis of ulcerative colitis; the rest of the findings were incidental. None of these findings were categorized as diagnostic, producing a diagnostic yield of 0 (95% confidence interval, 0 to 1.35). The results of this study do not support the continued use of the DRE as part of the routine pelvic examination in women younger than 40 years old.