This report offers descriptive data about the drugs utilized in outpatient department (OPD) of Yeungnam University Hospital (YUH) in the period of March to August in 1985. The data in this report were produced by the computerized totalization of the number of mentions of individual drugs included in the prescriptions. The 100 drug entries that were most frequently recorded are listed in rank order. The listing is arbiturarily restricted to the drugs that were prescribed as single preparations, the drugs of basis of compound preparations and the drugs of adjuvant or corrective of compound preparations that have significant therapeutic effects either by generic names. And in addition, the listing also involves the compound preparations used in relatively large frequency, and the individual components of which have the unique pharmacological actions each other by proprietary names. And all routes of administrations were allowed. The 10 drugs most frequently named are diazepam, aluminum compounds, acetaminophen, isoniazid, metoclopramide, polaramine®, carboxymethylcystein, ephedrine, codeine and caroverine in order. The 521, 855 drug mentions listed as above are described by the chief therapeutic usage that each is intended to apply generally. The drugs which account the largest proportion of total mentions were those acting on the central nervous system (20.57%), including tranquillizers and sedative hypnotics (11.71%), analgesic antipyretics (5.55%), antidepressants (2.15%) etc. Gastrointestinal drugs and smooth muscle preparations (18.64%) included antacids and antiulcer drugs (9.24%), antiemetics (3.57%), spasmolytics (3.14%) and others. Respiratory drugs (16.11%) included expectorants and cough preparations (10.99%) and bronchodilators (5.12%). Chemotherapeutic agents (15.12%) included the antiTbc drugs (7.09%) most frequently, and the penicillins (3.33%) accounted the largest proportion among the antibiotics. Cardiovascular drugs (5.64%) included cardiac drugs and coronary vasodilator (4.12%) and antihypertensives and vasodilators (1.06%). And antiinflammatory drugs (4.33%), vitamins of single preparations (3.76%), hormones and their antagonists (3.29%), common cold preparations (3.12%), diuretics (2.81%), drugs supporting liver function (2.02%), drugs affecting autonomic nervous system (1.89%) including antiglaucomas, atropine and cerebral vasodilators, antihistamine drug (1.02%) and disinfectants (0.74%) were following in order. The data in the report were compared to those reported by H. Koch, et al. in United States (US), 1981 as “Drugs Most Frequently Used in Office Practice : National Ambulatory Medical Case Survey, 1981.” Cardiovascular drugs prescribed in YUH were much less in proportion than in US (10.56%), but gastrointestinal drugs accounted the larger proportion than in US (3.72%). Expectorants and preparations in YUH also accounted the larger proportion than in US (2.74%). In conclusion, in the period of March to August, 1985, OPD of YUH prescribed the CNS drugs including diazepam most frequently, and gastrointestinal, respiratory and chemotherapeutic drugs in next orders. It is supposed that the eating habits of Koreans and a unique atmospheric condition in Taegu as a basin were some important factors that affected the proportions of drugs acting on gastrointestinal and respiratory tracts.
Acetaminophen ; Aluminum Compounds ; Antacids ; Anti-Bacterial Agents ; Antidepressive Agents ; Antiemetics ; Antihypertensive Agents ; Antipyretics ; Atropine ; Autonomic Nervous System ; Bronchodilator Agents ; Cardiovascular Agents ; Central Nervous System ; Codeine ; Common Cold ; Cough ; Daegu ; Diazepam ; Disinfectants ; Diuretics ; Eating ; Ephedrine ; Expectorants ; Gastrointestinal Agents ; Humans ; Hypnotics and Sedatives ; Isoniazid ; Liver ; Metoclopramide ; Muscle, Smooth ; Outpatients ; Parasympatholytics ; Penicillins ; Prescriptions ; Respiratory System ; Therapeutic Uses ; United States ; Vasodilator Agents ; Vitamins

Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a case of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Drainage ; Duodenal Ulcer ; Endoscopy, Gastrointestinal ; Enterocolitis ; Foreign Bodies ; Stomach Neoplasms ; Stomach Ulcer ; Weight Loss

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.
Anti-Inflammatory Agents, Non-Steroidal ; Capsule Endoscopy ; Diagnosis ; Endoscopy ; Epidemiology ; Hemorrhage ; Peptic Ulcer ; Purpura ; Ulcer ; Upper Gastrointestinal Tract

Clinically, we often encounter patients who have symptoms of loose stool or diarrhea due to the use of antibiotics. Psuedomembranous colitis is the most frequent, but hemorrhagic colitis is rare. Penicillin-like-antibiotics-induced hemorrhagic colitis was infrequently reported in abroad, but in Korea, quinolone-induced colitis was reported. We found a case that the patient had the hematochezia after use of amoxicillin for eradication of H. pylori. Colonoscopic abnormalities showed superficial ulceration and mucosal edematous change without pseudomembrane on the ascending and transverse colon. We diagnosed the amoxicillin-induced hemorrhagic colitis by clinical course, colonoscopic findings, histologic findings and other laboratory results for differential diagnosis. This disease is rare but rapidly recovered after the withdrawal of the antibiotics and has a good prognosis. Therefore, we should differentiate this disease from hemorrhagic colitis of other causes by history taking.
Amoxicillin ; Anti-Bacterial Agents ; Colitis* ; Colon, Transverse ; Diagnosis, Differential ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Humans ; Korea ; Prognosis ; Ulcer

Clinically, we often encounter patients who have symptoms of loose stool or diarrhea due to the use of antibiotics. Psuedomembranous colitis is the most frequent, but hemorrhagic colitis is rare. Penicillin-like-antibiotics-induced hemorrhagic colitis was infrequently reported in abroad, but in Korea, quinolone-induced colitis was reported. We found a case that the patient had the hematochezia after use of amoxicillin for eradication of H. pylori. Colonoscopic abnormalities showed superficial ulceration and mucosal edematous change without pseudomembrane on the ascending and transverse colon. We diagnosed the amoxicillin-induced hemorrhagic colitis by clinical course, colonoscopic findings, histologic findings and other laboratory results for differential diagnosis. This disease is rare but rapidly recovered after the withdrawal of the antibiotics and has a good prognosis. Therefore, we should differentiate this disease from hemorrhagic colitis of other causes by history taking.
Amoxicillin ; Anti-Bacterial Agents ; Colitis* ; Colon, Transverse ; Diagnosis, Differential ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Humans ; Korea ; Prognosis ; Ulcer

Ischemic colitis, the most common form of acute mesenteric ischemia, is encountered primarily in elderly patients, and frequently presents with abdominal cramping pain and hematochezia. Both occlusive and nonocclusive underlying mechanisms have been proposed, but the precise pathophysiology remains unknown. On colonoscopy, the earlier signs of ischemic colitis are mucosal hyperemia, edema, and hemorrhagic nodules representing submucosal bleeding. It is followed by well-demarcated elongated ulcerations covered with exudate. In most cases, the clinical course is transient and self-limiting. After conservative treatment with hydration, cessation of food, and broad-spectrum antibiotics, clinical symptoms improve within several days. Recently, we have experienced a case of ischemic colitis following falling down and report this case with a review of the literature.
Accidental Falls ; Aged ; Anti-Bacterial Agents ; Colic ; Colitis, Ischemic* ; Colonoscopy ; Edema ; Exudates and Transudates ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hyperemia ; Ischemia ; Ulcer

INTRODUCTIONThe use of an additional biopsy from the gastric body may help improve the detection of Helicobacter pylori during endoscopy. This study aimed to determine whether such an additional biopsy is necessary in routine rapid urease test (RUT), and whether acid suppression and antibiotic therapy affect RUT results.

METHODSPatients recruited had two gastric mucosal biopsies taken - one from the gastric antrum and the other from the gastric body. Each biopsy was placed into separate RUT kits. Information on previous or current use of proton-pump inhibitors, H2 receptor antagonist, bismuth and antibiotics was obtained. Patients on any of those drugs one week prior to endoscopy were considered to have a positive drug history (PDH).

RESULTSOf the 400 patients recruited, 311 had negative RUTs and 89 had at least one positive RUT. Between the PDH and negative drug history (NDH) groups, there was a significant difference in the distribution of the location of the biopsies that yielded positive RUTs (p = 0.023). The NDH group had a higher proportion of patients who had positive RUTs for both locations, whereas the PDH group had a higher proportion of patients who had positive RUTs for only one location.

CONCLUSIONAs RUT results are significantly affected by the use of acid suppression and antibiotic therapies, biopsies for RUT should be taken from both the gastric antrum and body to minimise false negative results.

Adult ; Aged ; Antacids ; pharmacology ; Anti-Bacterial Agents ; pharmacology ; Endoscopy ; Endoscopy, Gastrointestinal ; Female ; Gastric Mucosa ; microbiology ; pathology ; Gastrointestinal Diseases ; diagnosis ; epidemiology ; microbiology ; Helicobacter Infections ; diagnosis ; Helicobacter pylori ; drug effects ; isolation & purification ; History, Ancient ; Humans ; Middle Aged ; Singapore ; epidemiology ; Urease ; analysis

Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pyori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pyori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pyori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.
Anti-Ulcer Agents/therapeutic use ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/diagnosis ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Hemostasis, Endoscopic ; Humans ; Misoprostol/therapeutic use ; Peptic Ulcer/surgery/*therapy ; Peptic Ulcer Hemorrhage/surgery/*therapy ; Proton Pump Inhibitors/therapeutic use

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.
Adolescent ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Child ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Male ; Mesalamine/therapeutic use ; Rectal Diseases/*diagnosis/drug therapy ; Steroids/therapeutic use ; Sucralfate/therapeutic use ; Syndrome ; Ulcer/*diagnosis/drug therapy

Dieulafoy ulcer is an unusual cause of massive, recurrent and frequently fatal gastrointestinal hemorrhage that results from erosion of abnormally large submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Diagnosis depends on the observation of protruding and eroded artery with pulsatile bleeding or adherent thrombus by endoscopy. Even during active bleeding, the endoseopic examination can be negative if intraluminal blood or clots obscure the source of bleeding. If the bleeding has stopped, the small mucosal lesion can be easily overlooked. Unlike peptic ulceration, there is no excavation of the mucosa. A 76-year-old man presented with massive hematemesis and melena. The patient had no previous history of peptic ulcer disease. He did not drink alcohol and use aspirin or NSAIDs. Physical examination revealed a pale, severely diaphoretic male with hypotension and melenic stools. He was found to have hemoglobin 4.0 g/dL and hematocrit 12.7%. We performed emergency endoscopy which showed a pulsatile and bleeding exposed artery without evidence of surrounding ulcerative lesion on the posterior wall of upper body of stomach. Endoscopic ligation using O ring of Stiegman-Goff endoscopic ligator kit was done successfully and the bleeding stopped immediately after ligation. Ten days after treatment, endoscopy showed artificial ulcerative lesion on previous ligated site and no evidence of bleeding. Another endoscopy four days later revealed healing ulcerative lesion. After improvement, the patient was discharged and rebleeding has not occurred to date.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Arteries ; Aspirin ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hematemesis ; Hematocrit ; Hemorrhage ; Humans ; Hypotension ; Ligation* ; Male ; Melena ; Mucous Membrane ; Peptic Ulcer ; Physical Examination ; Stomach ; Thrombosis ; Ulcer*