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Identifier

000350396

Title

Μελέτη των λειτουργικών διαταραχών του πεπτικού συστήματος στην πρωτοβάθμια φροντίδα υγείας

Alternative Title

Study of the functional gastrointestinal disorders in primary health care

Author

Αναστασίου, Φωτεινή

Thesis advisor

Λιονής, Χρήστος

Reviewer

Κουρούμαλης, Ηλίας
Μουζάς, Ιωάννης
Κογεβίνας, Εμμανουήλ
Μπούμπας, Δημήτριος
Τσιφτσής, Δημήτριος
Μοσχανδρέα, Ιωάννα

Abstract

Background Functional gastrointestinal disorders (FGIDs) constitute an enigmatic disease’s group of unknown organic explanation. They are characterized as psychological disturbances and many doctors do not accept their existence or are negative toward patients with such symptoms. The FGIDs are presented with high frequency in the general population and in surgeries of general medicine. The absence of a known organic mechanism makes the use of diagnostic criteria and questionnaires inevitable. These illnesses have not been studied extensively in Greece and more specifically in the Primary Health Care (PHC). Aim The aim of this thesis was to investigate FGIDs in PHC centres of rural regions of Crete. Main objective of this thesis was to investigate Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD) in PHC units. The study also sought to explore issues of applicability of international diagnostic criteria in the Greek patients and to reveal whether the diseases are influencing the quality of life of patients. Subjects and methods In this study 4 Health Care Centers and one surgery participated, 3 in rural regions: Anogeia, Perama, Spili and two in a semi-urban regions: Neapolis and Archanes surgery. The population of responsibility of the PHC units was 40081 individuals according to the national consensus of 1991. The first part of the thesis consisted of a retrospective study of all files electronic and printed of the years 1996 to 2000 (4 years). All patients over 15, with the diagnosis of IBS, dyspepsia, Inflammatory Bowel Diseases, acute gastroenteritis and celiac disease were recorded. All patients that had been diagnosed as IBS were invited to a home structured interview. The diagnostic criteria of Manning’s and Rome II, a tool of diagnosis for dyspepsia that was translated and validated into Greek, for the purposes of this study, and existing Greek questionnaire for the diagnosis of IBS, were used for the interview. The general questionnaire of the quality of life, SF-36 was also applied. The quality of life of IBS patients from this group was compared with patients and no patients of IBS from Sweden. Results IBS and dyspepsia were found to be presented in smaller frequencies than the reported in international studies (1/1000 patients-years and 2.7/1000 patients-years respectively). One hundred and forty six patients were identified with the diagnosis of IBS. Sixty-Seven out of them participated in the structured interview. The criteria of Manning were fulfilled by 69% of patients while the criteria Rome II by 32% and questions matching the Rome III by 16% of the patients. The agreement of criteria Rome III with the criteria of Manning was poor (k=0.25) while with Rome II was moderate (k=0.51). Symptoms from upper gastrointestinal tract without known ulcer or other gastric problem, were found in 394 patients, only 48 (12.2%) of them had been recorded as dyspepsia by the primary care doctors. The questionnaire for the identification of dyspepsia in the general population (IDGP) was reliably translated and validated into Greek. The quality of life of Greek patients with IBS was found to be more influenced when compared to patients and controls from Sweden. Conclusion The FGIDs are frequent in PHC in Greece but in smaller degree than that reported in the international bibliography. Doctors in PHC do not appear to use internationaly accepted diagnostic criteria and the agreement between the various criteria and questionnaires of diagnosis, was found low, marking in this way the need for less complex criteria and questionnaires in PHC. The questionnaire that was translated and validated into Greek for the purposes of this study and the difficulties that were recognized in the registration of FGIDs are expected to contribute in the research that ought to follow this dissertation.

Physical description

116 σ. : πιν. ; 30 εκ.

Language

Greek

Subject

Gastrointestinal Diseaseas

Primary Health Care

Quality of Life

Γαστρεντερικά νοσήματα

Ποιότητα ζωής

Πρωτοβάθμια φροντίδα υγείας

Issue date