Esophageal ulcers induced by doxycycline is a rare complication. These patients usually complain of sudden onset of symptoms, ie acute substernal or chest pain and odynophagia without prior hietory of esophageal syraptoms. On esophagoscopic examination, there are upper or midesophageal ulcers, which heal after diseontinuation of the drug within 2 weeks. A history of ingestion of the doxycycline,with liquid jost before bedtime can be elicited. The exact eause of the xaucosal ulceration is not clear, but a direct irritant effeet on esophageal mucosa seems most likely. We report 5 cases of esophageal uleeration secondary to the ingestion of doxycydine. Esophagoscopy revealed esophageal ulcers in all patients and the patients hecame asymptomatic following stopping of tbe drugs and taking antacids.
Antacids ; Chest Pain ; Doxycycline* ; Eating ; Esophagoscopy ; Humans ; Mucous Membrane ; Ulcer*

OBJECTIVES: In Korea, pharmacists can dispense medicines without doctor's prescription. This causes the high proportion of pharmaceutical expenditures. The study shows the prescribing behaviors of practicing pharmacists with the simulated patient of arthritis. We select the arthritis as a subject of simulation, because the arthritis is one of the major health problems and the abuse of cortico-steroids is usual in treatment of arthritis patients. METHODS: Twenty drug stores among the 320 drug stores in a district, Seoul, Korea were randomly selected. One of the researchers visited the drug stores and received the medicines from the pharmacists after explaining standardized scenario of arthritis. The simulated patient recorded the practice behaviors of pharmacists. RESULTS: The mean number of prescribed drugs are four and half. Among the twenty pharmacists, the nineteen prescribed non-steroidal anti-inflammatory drugs and the seven(35%) prescribed the cortico-steroids. The antacids were prescribed by the fourteen(70%) pharmacists. The five(25%) pharmacists only recommended the simulated patients to visit the medical doctors, and the three(15%) performed physical examination to the simulated patients. The three pharmacists(15%) asked the past history of the drug adverse effects and no pharmacist explained the adverse effects of prescribed medicines. CONCLUSIONS: The research shows that the cortico-steroids are frequently prescribed and the pharmacists commonly do not give the explanations of the prescribed medicines to the arthritis patients.
Antacids ; Arthritis* ; Health Expenditures ; Humans ; Korea ; Patient Simulation ; Pharmacists* ; Physical Examination ; Prescriptions* ; Seoul

BACKGROUND: In Korea, doctors are tend to prescribe digestive system drugs to the patients who have no digestive symptoms. The purpose of this study was to describe the prescription tendency toward digestive system drugs among residents of family practice. METHODS: Among outpatients who were consulted by residents of family practice in S hospital from Jan. 1995 to Jul. 1996, the patients without digestive symptoms were selected and their medical records were reviewed about prescribed drugs. RESULTS: The total number of eligible patients were 308. The number of residents who examined the eligible patients were 25 and they consulted average 12.3(S.D 5.1, range 521) patients. The proportion of patints who were given digestive system drugs was 43.2%. The proportions were 48.3%, 35.4% and 54.8% in patients who were examined by 1st, 2nd and 3rd grade reridents, respectively. There were no differences in the proportions between patients sex groups, among patients age groups, and also among groups of number of major drugs. The proportion was 58.6% in patients with common cold, 39.4% in patients with respiratory diseases other than common cold, 70.2% in patients with musculoskeletal diseases, 50.0% in patients with headache, 45.0% in patients with neurosis. The three most common categories of digestive system drugs were enzyme digestives, motility regulators and antacids. The proportion of total prices of digestive system drugs to total price of prescribed drugs was 19.8 % in all patients and 36.3% in patients who were given digestive system drugs. CONCLUSIONS: Residents of family practice in S hospital were tend to prescribe digestive system drugs to the patients who have no digestive symptoms and therefore there need more efforts to improve prescription behavior.
Antacids ; Common Cold ; Digestive System* ; Family Practice ; Headache ; Humans ; Korea ; Medical Records ; Musculoskeletal Diseases ; Outpatients ; Prescriptions*

Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey.
Anesthesia, General ; Antacids ; Esophagogastric Junction ; Fundoplication* ; Gastroesophageal Reflux* ; Hand ; Hernia, Hiatal ; Humans ; Proton Pump Inhibitors ; Proton Pumps ; Recurrence

Helicobacter pylori(H. pylori) is thought to play an important role in the pathogenesis of peptic ulcer. Because peptic ulcer is one of serious complications during renal transplantation, we evaluated the inci- dence and clinical impact of H. pylori infection in pre-KT and post-KT recipients. Gastrofiberscopy was performed in 179 kidney transplant recipients(M: F=124: 55) at Kangnam St. Mary's Hospital from Aug. 1994 to Mar. 1998 preoperatively and was followed up postoperatively 14 days. Diagnosis of H. pylori infection was made by Warthin Starry stain on biopsy specimen. H2 blocker, antacids and misoprostol were prescribed to all patients from preoperative 7 days. Preoperative eradication of H. pylori infection was not performed. In pre-KT patietns, gastrofiberscopy showed normal(0.6M), gastritis(82.79%), gastric ulcer(6.7%), duodenitis(5.6%), esophagitis(3.9%) and duodenal ulcer(0.6%). In post-KT recipients, gastrofiberscopic findings were normal(1.7%), gastritis(83.8%), gastric ulcer(7.3%), duodenal ulcer(2.8%), esophagitis(2.2%) and duodenitis(2.2%). The incidence of H. pylori infection in pre-KT patients and post-KT recipients was 27.9% and 13.4 96, respectively(p<0.001). In pre-KT patients, peptic ulcer has occurred more often in patients with H. pylori infection(p<0.01). In post-KT recipients, peptic ulcer was not correlated with H. pylori infection. H. pylori infection did not affect renal function and the incidence of acute rejection and was not affected by cyclosporine blood level, accumulated doses of prednisolone or use of methylprednisoloe in renal transplant recipients. In conclusion, the incidence of H. pylori infection is higher in pre-KT recipients than that in post-KT recipients. This may be due to drugs such as antibiotics used during renal transplantation. And H. pylori infection does not seem to be a major cause of peptic ulcer in renal transplantation. We think other causes including drugs and stress may develop peptic ulcer in renal transplantation but further evaluation will be necessary.
Antacids ; Anti-Bacterial Agents ; Biopsy ; Cyclosporine ; Diagnosis ; Helicobacter ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Misoprostol ; Peptic Ulcer ; Prednisolone ; Transplantation*

No abstract available.
Alcohol Drinking ; Antacids/therapeutic use ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/complications/*diagnosis ; Gastroesophageal Reflux/complications/*diagnosis ; Humans ; Risk Factors ; Sex Factors

Menetrier' disease is a rare disease characterized, histologically, by epithelial hyperplasia involving the surface and foveolar mucous cells, accompanied by atrophic or normal oxyntic glands of the stomach. The 48 year-old man with epigastric discomfort and peripheral edema was admitted to St. Paul Hospital. Gastrofiberscopic examination revealed extremely thickened mucosal fold in fundus and body especially greater curvature of stomach, and microscopically there was marked hyperplasia of foveolae and cystic dilatation. Serum albumin concentration was decreased and clearance of a1-antitrypsin was markedly increased in the stool, suggesting the protein-losing enteropathy. He was diagnosed to Menetrier's disease and treated with H2 blocker, antacids, diuretics and albumin replacement.
Antacids ; Dilatation ; Diuretics ; Edema ; Esophagus* ; Gastritis, Hypertrophic* ; Humans ; Hyperplasia ; Intestines* ; Middle Aged ; Protein-Losing Enteropathies ; Rare Diseases ; Serum Albumin ; Stomach*

Chronic heavy use of phosphate-binding antacids has been known to cause osteomalacia. However, in spite of widespread use of antacids without prescription, there was no case report of osteomalacia associated with antacids in Korea. We report a case of osteomalacia diagnosed in a 36-year-old woman who had ingested large amounts of aluminum-containing antacids due to epigastric soreness. She had consumed about 4.2 kg of aluminum hydroxide over 10 years until she had withdrawn antacids 3 months before she was admitted with non-traumatic fractures of bilateral femur necks. Biochemical tests revealed normal levels of serum calcium and iPTH, increased level of serum alkaline phosphatase, and normal renal function. Bone mineral density (BMD) values of lumbar spines were decreased (T-score=-3.99~-3.11). Bone biopsy showed abundant unmineralized osteoid indicating osteomalacia. She was treated with bilateral total hip replacement arthroplasty and recommended not to restart the ingestion of antacids. After thirty months' withdrawal of antacids, BMD values of lumbar spines were found to be improved (T-score=-2.3~-1.4).
Adult ; Alkaline Phosphatase ; Aluminum ; Aluminum Hydroxide ; Antacids ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Biopsy ; Bone Density ; Calcium ; Eating ; Female ; Femur Neck ; Humans ; Korea ; Osteomalacia* ; Prescriptions ; Spine

OBJECTIVETo explore the diagnostic values of 24-hour pH monitoring in patients with laryngopharyngeal reflux disease (LPRD).

METHODSFifty patients with suspected laryngopharyngeal reflux were enrolled into this study. Twenty five patients had 24-hour pH monitoring, antacid treatment with omeprazole was given in study group with pathologic reflux. The remaining 25 patients as control group only had the same antacid treatment. All the patients had 3 months follow up, and treatment effect was evaluated according to clinical manifestation improvement. After 3 month treatment followed up, it was defined as inefficacy treatment if the clinical manifestation score decrease was equal or less than 4, defined as efficacy if the score decrease was more than 4.

RESULTSSeventeen of 25 patients had pathologic reflux, positive rate was 68.0%. The mean times of total acid reflux was 35.71 +/- 41.70 (x +/- s), the mean total reflux time was (35.71 +/- 33.19) min, the mean total reflux index (reflux times per hour) was (1.53 +/- 1.73)/h, the mean reflux time was (1.12 +/- 0.91) min. Before antacid treatment, the mean clinical manifestation score was 14. 88 +/- 4.11 in study group and 13.00 +/- 4.17 in control group. There was no significant difference between the two groups (t = 1.444, P > 0.05). The validity of study group was 82.4% (14/17), Among the control group, two cases were out of followed, and the validity of remained patients was 52. 2% (12/23). The mean decreased score of clinical manifestation in study group was 7.47 +/- 3.18 and 3.96 +/- 4.25 in control group. There was significant difference between the two groups (t = 2. 864, P = 0.007).

CONCLUSIONSThe dual-probe 24-hour pH monitoring is considered the gold standard for diagnosis of LPRD and it is essential in patients who have laryngopharyngeal complaints and is capable to improve the effect of antacid treatment significantly. It's worthy of clinical application.

Adult ; Aged ; Antacids ; therapeutic use ; Esophageal pH Monitoring ; Female ; Humans ; Laryngopharyngeal Reflux ; diagnosis ; drug therapy ; physiopathology ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Pharynx ; physiopathology ; Young Adult

No abstract available.
Alginates/*therapeutic use ; Aluminum Hydroxide/*therapeutic use ; Antacids/*therapeutic use ; Female ; Gastroesophageal Reflux/*drug therapy ; Humans ; Male ; Silicic Acid/*therapeutic use ; Sodium Bicarbonate/*therapeutic use