Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

BACKGROUND AND AIM: While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. METHODS: This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. RESULTS: Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the second week of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. CONCLUSIONS: The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality.

Importance: Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established. Objective: To evaluate the association of the extent and timing of CIED infection with all-cause mortality. Design, Setting, and Participants: This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023. Exposures: Prospectively identified CIED infections. Main Outcomes and Measures: Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections. Results: Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001). Conclusions and Relevance: Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.

Radio-pathological diagnosis of a retroperitoneal cavernous hemangioma.

Retroperitoneal cavernous hemangioma (RCH) is a rare benign vascular malformation. Only a few cases of RCH were reported. Here we present a case of RCH in a 66-year-old female complaining of long-standing progressive dull abdominal pain.

Correction: Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

[This corrects the article DOI: 10.7759/cureus.48994.].

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports.

BACKGROUND: One of the major perioperative complications for coronary artery bypass graft (CABG) is stroke. The risk of perioperative stroke after CABG is approximately 2%. Carotid stenosis (CS) is considered an independent predictor of perioperative stroke risk in CABG patients. The optimal management of such patients has been a source of controversy. One of the possible surgical options is synchronous carotid endarterectomy (CEA) and CABG. Here, we have presented 4 cases of successful synchronous CEA and CABG. CASE SUMMARY: Our center's experience with 4 cases of significant carotid artery stenosis, which were successfully managed with combined CEA and CABG, are detailed. The first case was a female who presented for CABG after a ST-elevation myocardial infarction. She had right internal carotid artery (ICA) occlusion and 90% left ICA stenosis. The second case was a male who was electively admitted for CABG. It was discovered that he had left ICA occlusion and 90% right ICA stenosis. The third case was a male with a history of stroke, two months prior to admission. He presented with non-ST-elevation myocardial infarction. Preoperatively, it was discovered that he had > 90% right ICA stenosis. The final case was a male who was electively admitted for CABG. It was discovered that he had bilateral > 90% ICA stenosis. We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG. CONCLUSION: Our case series demonstrated that synchronous CEA and CABG was safe. A multicenter study with additional patients is needed. It is necessary for clinicians to screen for CS in high-risk patients with features.

Randomized Pragmatic Trial of Pacemaker Versus Implantable Cardiac Monitor in Syncope and Bifascicular Block.

OBJECTIVES: In this study, the authors tested whether a strategy of empiric permanent pacing reduces major composite events more effectively than acting on the results of an implantable cardiac monitor (ICM). BACKGROUND: Syncope may be caused by intermittent complete heart block in patients with bifascicular heart block, but competing diagnoses coexist. Whether empiric permanent pacing or acting on investigative results provides best care is unknown. METHODS: This was a multinational, randomized, pragmatic clinical trial of patients ≥50 years of age with bifascicular block, preserved left ventricular function, and ≥1 syncope in the preceding year. The primary composite outcome measure comprised cardiovascular death, syncope, bradycardia resulting in pacemaker insertion, and device complications. RESULTS: There were 57 and 58 subjects randomized to receive a pacemaker or ICM. A total of 41 patients had left bundle branch block and 74 had right bundle branch block and a left fascicular block. Patients were followed for a median 33 months. There were fewer composite primary outcomes in patients randomized to pacemaker compared with ICM, respectively (20 [35%] vs 44 [76%]; chi square P < 0.0001), with lower actuarial probabilities of a primary outcome (0.45 and 1.00; P < 0.001). Syncope was as likely in the groups randomized to receive a pacemaker or ICM (29% vs 26%, chi-square P = 0.95). CONCLUSIONS: Empiric permanent pacing compared with ICM reduced major adverse events but not syncope in older patients with bifascicular block and recent syncope. There remains a substantial likelihood of syncope recurrence in patients who receive a permanent pacemaker likely caused by vasodepressor syncope. (Syncope: Pacing or Recording in the Later Years [SPRITELY]; NCT01423994).

Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT).

BACKGROUND: The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. METHODS: This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. RESULTS: Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). CONCLUSIONS: Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. TRIAL REGISTRATION: NCT01002911.

A case report of primary cardiac intimal sarcoma presenting with atrial fibrillation and a left atrial mass.

BACKGROUND: Intimal sarcoma is an exceedingly rare type of primary cardiac tumour. It is characterized by poorly differentiated spindle-shaped cells that can mimic smooth muscle and is strongly associated with MDM2 genetic amplification. Owing to its rarity and non-distinctive histological features, diagnosis remains a significant challenge. CASE SUMMARY: In this case report, we describe a case of primary cardiac intimal sarcoma in a 37-year-old woman who presented with atrial fibrillation (AF) and a left atrial mass. Despite having a histological sample from an excised left atrial mass, the diagnosis was not made until she presented with back pain secondary to metastatic disease to the spine. DISCUSSION: Primary cardiac intimal sarcoma is an extremely rare diagnosis. The mainstay management of intimal cardiac sarcoma is aggressive surgical resection. Unfortunately, the prognosis of cardiac sarcomas remains very poor, with a mean survival between 3 months and 1 year. This case of cardiac intimal sarcoma highlights the difficulty in establishing a diagnosis, particularly given the unusual presentation of AF.

Canadian national electrophysiology ablation registry report 2011-2016.

BACKGROUND/PURPOSE: Interventional cardiac electrophysiology (EP) is a rapidly evolving field in Canada; a nationwide registry was established in 2011 to conduct a periodic review of resource allocation. METHODS: The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, success rates, and wait times. Leading physicians from each EP lab were contacted electronically; participation was voluntary. RESULTS: All Canadian EP centres were identified (n = 30); 50 and 45 % of active centres participated in the last 2 instalments of the registry. A mean of 508 ± 270 standard and complex catheter ablation procedures were reported annually for 2015-2016 by all responding centres. The most frequently performed ablation targets atrial fibrillation (PVI) arrhythmia accounting for 36 % of all procedures (mean = 164 ± 85). The number of full time physicians ranges between 1 and 7 per centre, (mean = 4). The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1-4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85 % centres; 38 % of the respondents use circular ablation techniques. CONCLUSIONS: This initiative provides contemporary data on invasive electrophysiology lab practices. The EP registry provides activity benchmarks on national trends and practices.

Intra-articular Synovial Hemangioma: A Rare Cause of Knee Pain and Swelling.

Synovial hemangioma is a rare intra articular lesion and it has several more common differentials. Therefore, our main objective is to consider the possibility of hemangioma in any intra-articular mass to prevent diagnostic delay of unnoticed or untreated hemangioma occurring within the knee joint. Ultrasound can be useful method in assessing the lesions. Surgical excision is the definitive treatment for such lesions.

Association of uterine and urinary bladder lipomas.

Lipomas of the uterus and of the urinary bladder are rare. Their coexistence is even rarer Ultrasound can play a key role in their diagnosis. We report a case of coexisting of the uterus and the urinary bladder in a 61-year-old woman.

Comparison of plantar loading patterns on natural grass and artificial turf during various athletic activities.

BACKGROUND: This study aimed to investigate the differences in plantar pressure during various athletic activities on natural grass and artificial turf. METHODS: Twenty-one athletes were fitted with properly sized soccer shoes and corresponding F-Scan system insoles and performed walking, running, vertical jumping and cutting activities to the right and left sides on both natural and artificial turf. RESULTS: There were no statistically significant differences between natural grass and artificial turf in peak pressure, maximum force and force-time integral during all the athletic activities (P˃0.05). On both turfs, the highest peak pressure and maximum force values occurred during running and cutting to the right, and the highest force-time integral value occurred during cutting to the right. There were no statistically significant differences between the two turfs in peak pressure in the various anatomical regions during any of the athletic activities (P˃0.05). The peak pressure was the highest on the first metatarsal and the hallux during all five activities. A clinically meaningful difference between the surfaces in peak pressure on the second to fifth metatarsals was found during walking, indicating more loading on artificial turf than on natural grass. There was more loading on artificial turf than on natural grass during cutting left and at hallux and third toe on natural grass during cutting right. However, these differences were not statistically significant (P˃0.05). CONCLUSIONS: The results of this study suggest that it is important to limit or prevent athletes from undertaking certain activities that increase the risk of re-injury during rehabilitation.

Pattern and Age Distribution of COVID-19 on Pulmonary Computed Tomography.

BACKGROUND: COVID-19 has emerged recently and has become a global concern. Computed tomography (CT) plays a vital role in the diagnosis. OBJECTIVES: To characterize the pulmonary CT findings and distributions of COVID-19 infection in regard to different age groups. METHODS: Chest CT scan of 104 symptomatic patients with COVID-19 infection from 7 Iraqi isolation centers were retrospectively analyzed between March 10th to April 5th, 2020. Patients were sub-classified according to their ages into three groups (young adult:20-39 years, middle age:40-59 years, and old age:60-90 years). RESULTS: The most common findings were ground-glass opacities (GGO) (92.3%, followed by consolidation (27.9%), bronchovascular thickening (15.4%), and crazy-paving (12.5%). Less commonly, there were tree-in-bud (6.7%), pulmonary nodules (5.8%), bronchiectasis (3.8%), pleural effusion (1.9%), and cavitation (1%). There were no hallo signs, reversed hallo signs, and mediastinal lymphadenopathy. Pulmonary changes were unilateral in 16.7% and bilateral in 83.3%, central in 14.6%, peripheral in 57.3%, and diffuse (central and peripheral) in 28.1%. Most cases showed multi- lobar changes (70.8%), while the lower lobe was more commonly involved (17.7%) than the middle lobe/lingula (8.3%) and upper lobe (3.1%). In unilateral involvement, changes were more on the right (68.8%) than the left (31.2%) side. Compared with middle and old age groups, young adult patients showed significantly lesser frequency of consolidation (17% vs. 13.3% and 37%), diffuse changes 28.1% (14.2% vs. 35.3% and 40.5%), bilateral disease (71.4% vs. 94.1% and 85.2%), and multi-lobar involvement (51.4% vs. 82.4% and 81.4%) respectively. CONCLUSION: Bilateral and peripheral GGO were the most frequent findings with the right and lower lobar predilection. The pattern and the distribution of CT changes seem to be age-specific.

Risk Factors for Infections Involving Cardiac Implanted Electronic Devices.

BACKGROUND: Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. OBJECTIVES: This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. METHODS: In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. RESULTS: Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. CONCLUSIONS: This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).

Challenge and Impact of Quinidine Access in Sudden Death Syndromes: A National Experience.

OBJECTIVES: This study sought to determine the nature of quinidine use and accessibility in a national network of inherited arrhythmia clinics. BACKGROUND: Quinidine is an antiarrhythmic medication that has been shown to be beneficial in select patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation. Because of the low prevalence of these conditions and restricted access to quinidine through a single regulatory process, quinidine use is rare in Canada. METHODS: Subjects prescribed quinidine were identified through the Hearts in Rhythm Organization that connects the network of inherited arrhythmia clinics across Canada. Cases were retrospectively reviewed for patient characteristics, indications for quinidine use, rate of recurrent ventricular arrhythmia, and issues with quinidine accessibility. RESULTS: In a population of 36 million, 46 patients are currently prescribed quinidine (0.0000013%, age 48.1 ± 16.1 years, 25 are male). Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation constituted a diagnosis in 13 subjects (28%), 6 (13%), and 21 (46%), respectively. Overall, 37 subjects (81%) had cardiac arrest as an index event. After initial presentation, subjects experienced 7.47 ± 12.3 implantable cardioverter-defibrillator shocks prior to quinidine use over 34.3 ± 45.9 months, versus 0.86 ± 1.69 implantable cardioverter-defibrillator shocks in 43.8 ± 41.8 months while on quinidine (risk ratio: 8.7, p < 0.001). Twenty-two patients access quinidine through routes external to Health Canada's Special Access Program. CONCLUSIONS: Quinidine use is rare in Canada, but it is associated with a reduction in recurrent ventricular arrhythmias in patients with Brugada syndrome, early repolarization syndrome, and idiopathic ventricular fibrillation, with minimal toxicity necessitating discontinuation. Drug interruption is associated with frequent breakthrough events. Access to quinidine is important to deliver this potentially lifesaving therapy.

Prevention of Arrhythmia Device Infection Trial: The PADIT Trial.

BACKGROUND: Infection of implanted medical devices has catastrophic consequences. For cardiac rhythm devices, pre-procedural cefazolin is standard prophylaxis but does not protect against methicillin-resistant gram-positive organisms, which are common pathogens in device infections. OBJECTIVE: This study tested the clinical effectiveness of incremental perioperative antibiotics to reduce device infection. METHODS: The authors performed a cluster randomized crossover trial with 4 randomly assigned 6-month periods, during which centers used either conventional or incremental periprocedural antibiotics for all cardiac implantable electronic device procedures as standard procedure. Conventional treatment was pre-procedural cefazolin infusion. Incremental treatment was pre-procedural cefazolin plus vancomycin, intraprocedural bacitracin pocket wash, and 2-day post-procedural oral cephalexin. The primary outcome was 1-year hospitalization for device infection in the high-risk group, analyzed by hierarchical logistic regression modeling, adjusting for random cluster and cluster-period effects. RESULTS: Device procedures were performed in 28 centers in 19,603 patients, of whom 12,842 were high risk. Infection occurred in 99 patients (1.03%) receiving conventional treatment, and in 78 (0.78%) receiving incremental treatment (odds ratio: 0.77; 95% confidence interval: 0.56 to 1.05; p = 0.10). In high-risk patients, hospitalization for infection occurred in 77 patients (1.23%) receiving conventional antibiotics and in 66 (1.01%) receiving incremental antibiotics (odds ratio: 0.82; 95% confidence interval: 0.59 to 1.15; p = 0.26). Subgroup analysis did not identify relevant patient or site characteristics with significant benefit from incremental therapy. CONCLUSIONS: The cluster crossover design efficiently tested clinical effectiveness of incremental antibiotics to reduce device infection. Device infection rates were low. The observed difference in infection rates was not statistically significant. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot] [PADIT]; NCT01002911).

Renal anomalies in patients with turner syndrome: Is scintigraphy superior to ultrasound?

Renal anomalies are present in up to 30% of patients with Turner syndrome (TS). Renal ultrasound (U/S) detects anatomical renal anomalies only while renal scintigraphy detects anomalies, detects early renal malfunction, and estimates glomerular filtration rate (GFR). Thus, we aimed to assess frequency of renal abnormalities detected by scintigraphy in comparison to renal U/S in TS patients. Ninety TS patients were subjected to auxological assessment, measurement of serum creatinine; and renal U/S and scintigraphy. Renal U/S detected renal anomalies in 22.22% of patients versus 17.78 % detected by scintigraphy (P = 0.035). Scintigraphy detected renal functional abnormalities in 44.44% of patients in the form of subnormal total GFR, abnormal renogram curve pattern, improper tracer handling and perfusion; and difference in split renal function >10% between both kidneys. Patients with a 45,X karyotype had more renal functional abnormalities (56%) than those with mosaic karyotype (33.33%), P = 0.04. In conclusion, renal scintigraphy is not superior to U/S in detection of renal anomalies but is a reliable method for early detection of renal malfunction in TS patients especially those with 45,X to ensure early management to offer a better quality of life.

Conjoined twins-thoraco-omphalopagus (type A).

A case of conjoined twins discovered by routine transabdominal ultrasound examination at 16 weeks gestation in a 19-year-old multigravid female. They were joined at the chest and the abdomen and had one functional heart. The pregnancy was terminated by caesarean section at 19 weeks gestation with approval from the family.

Gender-specific differences in depression and anxiety symptoms and help-seeking behavior among gastroenterology patients in Riyadh, Saudi Arabia.

OBJECTIVE: To evaluate the gender-specific difference in the prevalence of depression and anxiety and the help-seeking behavior among gastroenterology outpatients. METHODS: A cross-sectional study was carried out in gastroenterology clinics in 4 hospitals in Riyadh, Saudi Arabia between February and September 2013. A self-administrated questionnaire was developed and administered to patients. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to identify depression and anxiety. RESULTS: A total of 438 patients completed the study questionnaire; 135 (31%) females, and 303 (69%) males. Compared with males, females had more depression symptoms (44% versus 32%, p=0.012), anxiety symptoms (34% versus 24%, p=0.036), anxiety-associated difficulty (65% versus 52%, p=0.012), but similar suicidal thoughts (14% versus 11%, p=0.347). Females had similar gastrointestinal complaints but longer duration of symptoms. In both females and males, the most common first interventions were using medications (63% versus 69%), and undergoing endoscopy (19% versus 15%), while very few patients initially used herbs or Islamic incantation `Roquia` (7% versus 8%). Compared with males, females were more likely to subsequently seek help at private clinics (23% versus 14%, p=0.014), or with a Quran therapist (11% versus 5%, p=0.012). CONCLUSION: There are clear gender-specific differences in depression and anxiety symptoms and associated perceived difficulty, but modest differences in help-seeking behavior. Female patients at the gastroenterology clinic may deserve more psychological attention to diagnose depression and anxiety and to alleviate their impact.

Association of help-seeking behavior with depression and anxiety disorders among gastroenterological patients in Saudi Arabia.

BACKGROUND/AIMS: There is a high prevalence of depression and anxiety disorders among gastroenterological outpatients. Relatively few studies have been done on the help-seeking behavior among those who suffer from gastrointestinal symptoms with or without psychiatric disorders. We aimed to characterize the help-seeking behavior of gastroenterological outpatients and to evaluate if this behavior is linked to the presence of depression and anxiety. PATIENTS AND METHODS: A cross-sectional study was carried out in gastroenterology clinics in four hospitals in Riyadh between February and September 2013. A self-administrated questionnaire was developed and administered to patients. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to diagnose depression and anxiety, respectively. RESULTS: A total of 440 patients completed the study questionnaire. The average age was 36.0 ± 12.8 years and 69% of the patients were males. Complaints included abdominal pain (58%), heartburn (29%), diarrhea or constipation (25%), appetite or weight changes (22%), and nausea or vomiting (16%). Depression was diagnosed in 36%, while anxiety was diagnosed in 28% of the patients. The first intervention was use of medications (68%) and undergoing endoscopy (16%), while few patients initially used herbs or Islamic incantation (7.5%). This first intervention was done primarily (59%) in private sector hospitals rather than government sector hospitals (36%). The rates of depression and anxiety in our patients were higher among those who suffered from multiple complaints for longer durations and with less satisfaction with the offered services. CONCLUSION: Depression and anxiety are common comorbidities in gastroenterological outpatient population, especially those who have a chronic course of multiple gastrointestinal complaints.