No abstract available.
Esophagitis* ; Nitric Oxide ; Sucralfate*

BACKGROUND/AIMS: Albis(R) is a newly developed drug comprised of ranitidine, bismuth and sucralfate. The aim of the study was to demonstrate the efficacy and safety superiority of Albis(R) compared to Stillen(R) for treating erosive gastritis. METHODS: This study was a randomized, double-blind, multi-center trial. The primary endpoint was 2 weeks of treatment. RESULTS: Of the 229 patients in the intention-to-treat (ITT) population, 87 from the Albis(R), and 96 from the Stillen(R) group were included in the per protocol (PP) analysis. The endoscopic improvement rate was not different between the Albis(R)(R) group and the control in both the PP (42.5%, 39.6%) and ITT (35.3%, 34.5%) populations. The endoscopic cure of erosion was also not different in the Albis(R) group than that in the control group in both the PP (32.3%, 31.3%) and ITT (27.6%, 27.4%) populations. The endoscopic improvement rate for hemorrhage, edema, and erythema were also not different between the two groups in both the PP and ITT populations. No statistically significant differences were observed for adverse events between the two groups. CONCLUSIONS: Half of the approved dose of Albis(R) for peptic ulcers was superior to Stillen(R). A low dosage of Albis(R) is more cost efficient and safe than that of Stillen(R).
Bismuth ; Edema ; Erythema ; Hemorrhage ; Humans ; Peptic Ulcer ; Ranitidine ; Sucralfate

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are frequently used to treat non-erosive reflux disease (NERD), but their effect is limited. It is not known whether a potential alternative, AlbisD, containing ranitidine hydrochloride, sucralfate hydrate, and tripotassium dicitrato bismuthate, is effective and safe in treating NERD. The aim of the study is to evaluate the efficacy and safety of AlbisD compared with omperazole in patients with NERD. METHODS: This was a multicenter, randomized, open-label, parallel-group, non-inferiority comparative study. A total of 126 patients with NERD were randomly allocated to either AlbisD twice daily or omeprazole 20 mg once daily for 4 weeks from February 2016 to August 2016. The study patients had histories of heartburn or regurgitation of moderate severity (> score 2) and a frequency of at least 2 episodes per week, and had no mucosal breaks of the esophagus on endoscopy. The primary efficacy variable was complete cure of heartburn at week 4. Secondary efficacy variables evaluating symptoms of heartburn and acid reflux as well as safety profiles were compared in the 2 groups at week 2 and 4 after treatment. RESULTS: A total of 113 patients completed the study (57 and 56 in AlbisD and omeprazole groups, respectively). The proportion of patients with complete cure of heartburn at week 4 was not significantly different between the AlbisD and omeprazole groups (35.1% vs 32.1% respectively, P = 0.740). There were no significant differences between the 2 groups in the any secondary variables including proportions of days without heartburn or acid reflux over 4 weeks (including daytime and nighttime). Adverse events were similarly reported in the 2 groups (7 [12.3%] vs 6 [10.7%]), and there were no serious adverse events. CONCLUSIONS: The efficacy and safety of AlibsD in treating NERD patients are not inferior to those of omeprazole. Therefore, AlbisD can be an alternative to PPIs for NERD.
Bismuth ; Endoscopy ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Humans ; Omeprazole ; Pilot Projects ; Proton Pump Inhibitors ; Ranitidine ; Sucralfate

No abstract availble.
Aged ; Chronic Disease ; Colonoscopy ; *Enema ; Female ; Humans ; Proctitis/*drug therapy/pathology ; Radiation Injuries/*drug therapy/pathology ; Sucralfate/*administration & dosage

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.
Biopsy ; Coffee ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Endoscopy, Digestive System ; Esophagus ; Humans ; Mucous Membrane ; Necrosis ; Proton Pumps ; Sucralfate ; Vomiting

The impression that oral mucositis is a brief 14–28 day-consequence of chemoradiation is misguided. Clinically significant patient-reported oral mucositis may last 46 to 102 days depending on the treatment schedule and the modality used. The process of mucositis can occur in the epithelium throughout the entire GI tract and may possibly be avoided with the prescribed use of high potency polymerized cross-linked sucralfate (HPPCLS). Literature review of patient-reported mucositis occuring in the three common schedules of cancer treatment administration: daily radiation therapy, induction-based hematopoietic stem cell transplantation (HSCT), and multi-cycle chemo/immunotherapy (CT-IT). Review articles published in last 15 years focused on treatment-induced oral mucositis. The author reviewed 56 articles published in 15 years from 1999–2014 that focused primarily on treatment-induced oral mucositis. Only 6 were found to meet the criteria of providing patient-reported data from the beginning, throughout and following cancer treatment. For HSCT, radiation therapy, and CT-IT, despite active anti-mucositis treatment, patient-reported oral mucositis lasted 46–60 days, 70–84 days, and 68–102 days, respectively. Mucositis caused by cancer treatment, regardless of modality, lasts far longer than the oft quoted 2–4 weeks (range, 14–28 days). Patient reported mucositis persists from 46 to 102 days. This patient-based experience is the primary cause of treatment interruptions, delays or cancellations. It may be avoidable with HPPCLS that both prevents and rapidly reverses mucositis anywhere it occurs within the gastrointestinal tract.
Appointments and Schedules ; Drug Therapy ; Epithelium ; Gastrointestinal Tract ; Hematopoietic Stem Cell Transplantation ; Humans ; Mucositis ; Polymerization ; Polymers ; Stomatitis ; Sucralfate

No abstract available.
Endoscopy, Digestive System ; Esophagitis, Peptic/diagnosis/*drug therapy ; Humans ; Male ; Middle Aged ; Proton Pump Inhibitors/*therapeutic use ; Severity of Illness Index ; Sucralfate/therapeutic use

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

PURPOSE: Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. MATERIALS AND METHODS: A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gyx7, or 5 Gyx6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12~86 months). RESULTS: The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding : an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was performed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. CONCLUSION: Moderate and severe rectal bleeding occurred in 8.5% of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.
Appointments and Schedules ; Barium ; Brachytherapy ; Cervix Uteri* ; Enema ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Multivariate Analysis ; Radiotherapy ; Rectal Fistula ; Rectum ; Risk Factors ; Sucralfate ; Uterine Cervical Neoplasms*

Black esophagus is a rare condition of the esophagus that manifests as endoscopic findings of black-colored esophageal mucosa, which is usually caused by acute esophageal necrosis. We report a case of alcoholic patient who developed black esophagus. The 85-year-old man was admitted to Severance Hospital due to copious hematemesis over 2 days. Upper gastrointestinal endoscopy showed black-colored mucosa in the distal esophagus. Endoscopic biopsies of the esophagus revealed necrotic tissue, without any viable cells. Follow-up upper gastrointestinal endoscopy performed after supportive care with a proton-pump inhibitor, sucralfate, and total parenteral nutrition resulted in the remarkable healing of the esophageal wall with no complications.
Aged, 80 and over ; Alcoholics ; Alcoholism ; Biopsy ; Endoscopy, Gastrointestinal ; Esophagus ; Follow-Up Studies ; Hematemesis ; Humans ; Mucous Membrane ; Necrosis ; Parenteral Nutrition, Total ; Sucralfate