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*

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*

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

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*

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*

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

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

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.
Antacids ; Biopsy ; Bismuth ; Calcinosis* ; Calcium ; Eating ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastric Mucosa ; Gastritis ; Gastroesophageal Reflux ; Humans ; Hyperparathyroidism ; Renal Insufficiency ; Salts ; Stomach Neoplasms ; Sucralfate ; Transplants

In recent years, there has been renewed interest in preoperative methods to reduce gastric acidity, thus lessening the risk of a serious pulmonary reactions following aspiration of gastric contents. Emergency obstetrical patients frequently have large volumes of gastric fluid. It is less commonly appreciated that patients fasting prior to elective surgery afterive in operating room with large gastric fluid volumes with a low pH. Prophylactic preoperative oral administration of antacids has been shown to reduce preoperative gastric acidity in significant percentage of patients, but aspiration of antacids can be associated with pulmonary complications, and there use may be associated with increased gastric volume. Preoperative adrpinistration of glycopyrrolate may decrease the frequency of surgical patients with a low gastric pH, and it appears that the volume of gastric fluid may be reduced by medication that relax the pylorus. However, none of these pharmacologic manuevers completely abolisbes the possibility of serious pulmonary damage with aspiration. Mendelson and Teabeat demonstrated the importance of pH in the etiology of acid aspiration and it is generally accepted that the critical pH is 2. 5 or less, i.e. the risk of aerious pulmonary reaction increases progressively as the pH of the aspirate falls below 2.5. A critical volume of acid aspirate is also necessary for widespread pulmonary damage to occur irrespective of a low gastric pH. The critical volume is rhesus monkeys has been shown to be 0.4 ml/kg, but the critical volume in man is less well difined. Several investigators have determined the patient to be at risk of serious pulmonary complications with aspiration if at least 25 ml of gastric fluid with a pH of 2.5 or less is aspirated. The present study was undertaken to investigate the effects on the volume and pH of gastric juice under general anesthesia. The 35 patients were studied, and were divided. into 4 group account to the kind of premedicants, N.P.O. time, weight, and obstetric patients Gastric juice, aspirated through a Levine tube, was examined for pH and. volume under general anesthesia.
Accidental Falls ; Administration, Oral ; Anesthesia, General* ; Antacids ; Emergencies ; Fasting ; Gastric Acid ; Gastric Juice ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration* ; Macaca mulatta ; Operating Rooms ; Pylorus ; Research Personnel

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