Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.
Aged ; Dihydroergotamine ; Emergency Treatment ; Famotidine ; Fever ; Histamine ; Histamine H2 Antagonists ; Humans ; Hypertension ; Male ; Meperidine ; Myoclonus ; Nausea ; Pneumonia, Aspiration ; Reflex ; Serotonin Syndrome* ; Serotonin* ; Tachycardia ; Tachypnea ; Ureteroscopy

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.
Aged ; Dihydroergotamine ; Emergency Treatment ; Famotidine ; Fever ; Histamine ; Histamine H2 Antagonists ; Humans ; Hypertension ; Male ; Meperidine ; Myoclonus ; Nausea ; Pneumonia, Aspiration ; Reflex ; Serotonin Syndrome* ; Serotonin* ; Tachycardia ; Tachypnea ; Ureteroscopy

To investigate the effects of neuronal histamine on spatial memory acquisition impairment in rats with pentylenetetrazole-kindling epilepsy, and to explore its mechanisms.A subconvulsive dose of pentylenetetrazole (35 mg/kg) was intraperitoneally injected in rats every 48 h to induce chemical kindling until fully kindled. Morris water maze was used to measure the spatial memory acquisition of the rats one week after fully pentylenetetrazole-kindled, and the histamine contents in different brain areas were measured spectrofluorometrically. Different dosages of hitidine (the precursor of histamine), pyrilamine (H1 receptor antagonist), and zolantidine (H2 receptor antagonist) were intraperitoneally injected, and their effects on spatial memory acquisition of the rats were observed.Compared with control group, escape latencies were significantly prolonged on Morris water maze training day 2 and day 3 in pentylenetetrazole-kindling epilepsy rats (all<0.05); and the histamine contents in hippocampus, thalamus and hypothalamus were decreased significantly (all<0.05). Escape latencies were markedly shortened on day 3 by intraperitoneally injected with histidine 500 mg/kg, and on day 2 and day 3 by intraperitoneally injected with histidine 1000 mg/kg in pentylenetetrazole-kindling epilepsy rats (all<0.05). The protection of histidine was reversed by zolantidine (10 and 20 mg/kg), but not by pyrilamine.Neuronal histamine can improve the spatial memory acquisition impairment in rats with pentylenetetrazole-kindling epilepsy, and the activation of H2 receptors is possibly involved in the protective effects of histamine.
Animals ; Benzothiazoles ; pharmacology ; Brain Chemistry ; drug effects ; Epilepsy ; chemically induced ; complications ; Hippocampus ; chemistry ; Histamine H1 Antagonists ; pharmacology ; Histamine H2 Antagonists ; pharmacology ; Histidine ; pharmacology ; Hypothalamus ; chemistry ; Kindling, Neurologic ; physiology ; Memory Disorders ; drug therapy ; etiology ; Pentylenetetrazole ; Phenoxypropanolamines ; pharmacology ; Piperidines ; pharmacology ; Pyrilamine ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Histamine H2 ; drug effects ; physiology ; Spatial Memory ; drug effects ; Spectrometry, Fluorescence ; Thalamus ; chemistry

BACKGROUND/AIMS: In pediatrics, endoscopic examination has become a common procedure for evaluation of gastrointestinal presentations. However, there are limited data on pediatric endoscopy in Korea. The aim of this study was to analyze the current status and clinical impacts of endoscopic examination in children and adolescents. METHODS: We retrospectively reviewed the medical records of outpatients who visited the tertiary hospital. Patients under 18 years of age who underwent endoscopy were included. Endoscopic findings were classified as specific and normal based on gross findings. Specific endoscopic findings were reflux esophagitis, peptic ulcers, and Mallory-Weiss tear. Other findings included acute gastritis classified according to the updated Sydney system. RESULTS: In 722 of 330,350 patients (0.2%), endoscopic examination (554 esophagogastroduodenoscopies [EGDs], 121 colonoscopies, 47 sigmoidoscopies) was performed between January 2008 and January 2013. In EGD, abdominal pain was the most frequent presentation (64.1%). The most common diagnosis was gastritis (53.2%), followed by reflux esophagitis. The frequency of peptic ulcer disease was 12.8%. Frequent symptoms leading to colonoscopic examination were abdominal pain, diarrhea, and hematochezia. In colonoscopy, a negative result was more likely in children younger than 7 years old. After the procedure, the diagnostic yield of EGD and colonoscopy was 88.1% and 45.8%, respectively, and the rate of change in management was 67.1%. CONCLUSIONS: In pediatrics, endoscopic examination was useful for the choice of therapeutic strategy and it would be a standard method for evaluation of gastrointestinal presentation.
Abdominal Pain ; Adolescent ; Child ; Child, Preschool ; *Endoscopy, Digestive System ; Esophagitis, Peptic/diagnosis/drug therapy ; Female ; Gastritis/diagnosis/drug therapy ; Gastrointestinal Hemorrhage/diagnosis ; Histamine H2 Antagonists/therapeutic use ; Humans ; Infant ; Infant, Newborn ; Inflammatory Bowel Diseases/diagnosis ; Male ; Peptic Ulcer/diagnosis/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers

BACKGROUND/AIMS: Anxiety and depression are associated with reflux symptoms in patients with gastroesophageal reflux disease (GERD). The purpose of this study is to investigate whether the anxiety and depression in patients with GERD will improve with anti-secretory treatment. MATERIALS AND METHODS: Participants who had taken upper endoscopic evaluation and who had symptoms of heartburn or acid regurgitation more than once a week were included through questionnaires. The hospital anxiety and depression scale was used to compare the scores before and after anti-secretory drug (proton pump inhibitor [PPI] or histamine-2 receptor blocker [H2 blocker]) treatment for four weeks. RESULTS: Eighty-four out of a total 94 patients were randomly assigned to a four week treatment, in which, 46 and 38 patients were each assigned to PPI and H2 blocker, respectively. Regardless of the type of treatment, anxiety scores decreased significantly from 5.8+/-3.8 to 5.2+/-3.9 after treatment (P=0.033). Depression scores of 6.3+/-3.4 before treatment reduced to 5.5+/-3.4 after treatment (P=0.011). Anxiety scores and depression scores decreased significantly after treatment in the H2 blocker group. In the response group, anxiety and depression showed significant improvement (P=0.008, P=0.011). CONCLUSIONS: Regardless of the type of drugs, anti-secretory therapy is helpful in treating symptomatic GERD patients, not only in relieving symptoms, but also in relieving anxiety and depression accompanied with GERD.
Anxiety ; Depression ; Gastroesophageal Reflux ; Heartburn ; Histamine H2 Antagonists ; Humans ; Proton Pump Inhibitors ; Surveys and Questionnaires

BACKGROUND/AIMS: Anxiety and depression are associated with reflux symptoms in patients with gastroesophageal reflux disease (GERD). The purpose of this study is to investigate whether the anxiety and depression in patients with GERD will improve with anti-secretory treatment. MATERIALS AND METHODS: Participants who had taken upper endoscopic evaluation and who had symptoms of heartburn or acid regurgitation more than once a week were included through questionnaires. The hospital anxiety and depression scale was used to compare the scores before and after anti-secretory drug (proton pump inhibitor [PPI] or histamine-2 receptor blocker [H2 blocker]) treatment for four weeks. RESULTS: Eighty-four out of a total 94 patients were randomly assigned to a four week treatment, in which, 46 and 38 patients were each assigned to PPI and H2 blocker, respectively. Regardless of the type of treatment, anxiety scores decreased significantly from 5.8+/-3.8 to 5.2+/-3.9 after treatment (P=0.033). Depression scores of 6.3+/-3.4 before treatment reduced to 5.5+/-3.4 after treatment (P=0.011). Anxiety scores and depression scores decreased significantly after treatment in the H2 blocker group. In the response group, anxiety and depression showed significant improvement (P=0.008, P=0.011). CONCLUSIONS: Regardless of the type of drugs, anti-secretory therapy is helpful in treating symptomatic GERD patients, not only in relieving symptoms, but also in relieving anxiety and depression accompanied with GERD.
Anxiety ; Depression ; Gastroesophageal Reflux ; Heartburn ; Histamine H2 Antagonists ; Humans ; Proton Pump Inhibitors ; Surveys and Questionnaires

The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.
Adolescent ; Bile Reflux/diagnosis ; Child ; Child, Preschool ; Demography ; Domperidone/therapeutic use ; Dopamine Antagonists/therapeutic use ; Drug Administration Schedule ; Female ; Histamine H2 Antagonists/therapeutic use ; Humans ; Infant ; Male ; Parenteral Nutrition ; Retrospective Studies ; Superior Mesenteric Artery Syndrome/*diagnosis/drug therapy ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Weight Loss

H2-receptor antagonists, such as cimetidine, ranitidine and famotidine, are some of the most commonly prescribed medications for gastric acid-related disorders. These compounds are generally well-tolerated and anaphylactic reactions to them are rare. Here, we report two cases of H2-receptor antagonist-induced anaphylactic reactions: the first presented with sudden dyspnea, sneezing, urticaria, and swelling of the eyelids after ranitidine intake. The second presented with sudden severe urticaria, facial swelling, chest discomfort, dizziness, and hypotension. Possible cross-reactivity with other H2-receptor antagonists was assessed by oral challenge and skin tests. To date, only a few reports addressing cross-reactivity among H2-receptor antagonists have been published. We review the literature and summarize the data available on drug cross-reactivity in H2-receptor antagonist hypersensitivity.
Anaphylaxis ; Cimetidine ; Cross Reactions ; Dizziness ; Drug Hypersensitivity ; Dyspnea ; Eyelids ; Famotidine ; Histamine H2 Antagonists ; Hypersensitivity ; Hypotension ; Ranitidine ; Skin Tests ; Sneezing ; Thorax ; Urticaria

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Dyspepsia/diet therapy/*therapy ; Gastroscopy ; Helicobacter Infections/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Proton Pump Inhibitors/therapeutic use ; Psychotherapy ; Serotonin 5-HT3 Receptor Antagonists/therapeutic use ; Vasoconstrictor Agents/therapeutic use

BACKGROUND/AIMS: Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. METHODS: From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. RESULTS: Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD. CONCLUSIONS: For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Endoscopy, Gastrointestinal ; Female ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/*etiology ; Proton Pump Inhibitors/therapeutic use ; Questionnaires ; Recurrence ; Risk Factors ; Sex Factors ; Smoking ; Stomach Ulcer/etiology