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INTRODUCTION: Gastric adenocarcinoma of intestinal type is preceded by inflammation, which produces mucosal atrophy and intestinal metaplasia, progressing eventually to dysplasia and invasive cancer. Recently an international group, the Operative Link on Gastritis Assessment (OLGA) proponed a staging system for gastric biopsies. OBJECTIVE: To recognize the distribution of advanced stages of gastric mucosal atrophy in Mexican patients with dyspepsia according to the OLGA system. METHODS: We apply the OLGA system for cancer risk (Stages 0 to IV) to 322 gastric biopsies from consecutive patients with dyspepsia. Using the Sydney protocol, we recorded the presence of atrophy, dysplasia and the relationship with ulcer disease. We report the stage of atrophy for each region and the Helicobacter pylori infection status. RESULTS: We documented 72 (22.4%) cases with atrophy, 50 of them (69.4%) were metaplastic-type. Overall, nine biopsies (2.78%) were stage III (all of them with metaplastic-type atrophy) and there was not stage IV cases. We did not find high-grade dysplasia or intramucosal carcinoma. In 8 of subjects with stage III, we observed low-grade dysplasia. We documented gastric ulcer in 5 patients with stage II, 60% of them with associated low-grade dysplasia. Five patients with duodenal ulcer were found in stages 0 and I. CONCLUSIONS: We found low prevalence of advanced stages of mucosal gastric atrophy among patients with dyspepsia. However we recognized 9 patients with stage III according to OLGA system worthy of follow-up because the high risk for developing gastric cancer.
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Gastrite Atrófica/epidemiologia , Gastrite Atrófica/patologia , Adolescente , Adulto , Atrofia/epidemiologia , Biópsia , Progressão da Doença , Feminino , Mucosa Gástrica/patologia , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
BACKGROUND: Patient satisfaction is a cognitive and emotional evaluation of the patient on the performance of health staff and is based on relevant aspects of their experience in health care. AIM: To determine the satisfaction level of patients after an endoscopic procedure in the gastrointestinal endoscopy service Specialty Hospital National Medical Center La Raza and to evaluate associated factors. MATERIAL AND METHODS: A modified and validated questionnaire was applied to assess patient satisfaction after an endoscopic procedure (mGHAA-9) in patients who underwent a gastroscopy or colonoscopy. Factors that influenced patient satisfaction were assessed. RESULTS: Two-hundred questionnaires were applied (response rate: 89.5%), in 62 men (34.6%) and 117 women (65.4%). Mean patient age was 51.3 years. The average score for the overall group was 30.9 (maximum score of 35). In the overall assessment of satisfaction patients reported 60.9% excellent, very good 29.6%, good 8.9% and 0.6% regular. Factors that influenced patient satisfaction were: waiting time for appointment (OR 3.104), explaining and answering questions (OR 2.961) and waiting time for performing the procedure (OR 2.408) Some factors did not influence on patient satisfaction: Sex: Male 58.1%, female 62.4% (p = 0.63), age 52 vs. 50 years (p = 0.48) and sedation 64.7% vs. 60.5% (p = 0.8) CONCLUSIONS: The level of satisfaction of patients undergoing a gastroscopy or colonoscopy is good. The factors that influence the satisfaction of these patients are related to communication between doctor and patient, and waiting time for the study.
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Endoscopia Gastrointestinal , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: There is a need to evaluate the process of quality improvement in health care services. AIMS: To determine quality indicators, frequencies into the registry of upper gastrointestinal endoscopies in a tertiary academic hospital in Mexico City. MATERIAL AND METHODS: A retrospective, observational and transversal study was performed in the Specialty Hospital Dr. Antonio Fraga Mouret IMSS between July 2007 and June 2008. Registry of several quality indicators for upper gastrointestinal endoscopy was sought. RESULTS: A total of 485 endoscopic reports were included. The reason for upper endoscopy was as follows: Barrett's esophagus 161, esophageal dilation 133, gastric ulcer 82, peptic ulcer 120, and upper gastrointestinal bleeding 130. The indicators evaluated were: Informed consent 91.3%, complete examination 97.7%, Barrett's esophagus measured and biopsy specimens taken 85.7% y 96.2% respectively. Biopsy specimens were taken in gastric ulcer 87.8%. Description and localization of upper gastrointestinal lesion 99.2%, ulcer haemostatic treatment 98.2%, and haemostasis documented 94.6%, proton pump inhibitors were recommended to patients undergone esophageal dilation and peptic ulcer 80.3% y 29.2% respectively. CONCLUSIONS: Registry frequencies of quality indicators were high for upper gastrointestinal bleeding, completeness of examination and Barrett's oesophagus. Pharmacological treatment recommendation in peptic disease is an area that has to be improved. It was not possible to establish either the indicator or only its register was omitted. Key words: Quality indicators, endoscopy, registries, gastroscopy, consent forms, Mexico.