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This was our AUGUST
Newsletter:
This Month's Newsletter Includes:
1: Chronic Heartburn/GERD Often Masquerades as Asthma International Organization
Emphasizes the Need for Proper Medical
Diagnosis, Treatment
2: FDA Issues Heartburn Drug Warning for Propulsid
3: PHYSICIAN ALERT--Consider side-effect profile when prescribing metoclopramide
(Reglan)
4: Gastroesophageal reflux in children and its relationship to erosion of primary
and permanent teeth
5: Management of peptic esophagitis in children. A review of forty-six cases
1: Chronic Heartburn/GERD Often Masquerades as Asthma International
Organization Emphasizes the Need for Proper Medical Diagnosis, Treatment
MILWAUKEE, Wis., June 29 /PRNewswire/ -- For millions of Americans who suffer from
asthma, breathing can be difficult, even painful. The symptoms of the condition coupled
with the anxiety they generate can make an asthma attack a frightening experience. Could
this breathing-related problem be related to a gastrointestinal problem such as
gastroesophageal reflux, a problem usually associated with heartburn?
Studies have noted that as many as 89% of asthmatic patients may have gastroesophageal
reflux disease (GERD), the most common symptom of which is chronic heartburn(1). Over 21
million Americans currently suffer from GERD, usually characterized by chronic heartburn
occurring more than two times a week(2). Unfortunately, most sufferers do not know that
GERD can lead to other more serious conditions such as asthma.
GERD occurs when stomach acid repeatedly spills back into the esophagus. Doctors believe
that for many GERD patients, the acid that spills into the esophagus may find its way into
the lungs, causing irritation and asthma-like symptoms.
"It is very important that the public be aware of this condition. GERD is a chronic
problem and it can significantly impact a person's lifestyle. If left untreated, it can
cause more severe problems. The bottom line is that people need to see their doctor to get
examined if they suffer from chronic heartburn symptoms. There are prescription
medications that can successfully manage this problem," commented Nancy Norton,
President of the International Foundation for Functional Gastrointestinal Disorders
(IFFGD).
"Asthmatics whose condition is associated with GERD tend to be those whose breathing
problems began as adults, who have no family history of asthma, who do not smoke and whose
asthma symptoms are worse after eating or exercising," said Philip Katz, M.D., of the
Allegheny University Hospital, Graduate Division, in Philadelphia, PA.
Experts worry that many patients are mistakenly self-medicating themselves with
over-the-counter heartburn medications which claim to be the solution for heartburn, but
really only offer temporary relief. These types of medications may allow the condition to
persist, putting the patient at an increased risk for developing long-term complications.
Dr. Katz cautions patients, "People need to recognize that it's time to see a doctor
if they have heartburn more than two times a week to determine if they have GERD, and
receive proper medical treatment to avoid more serious complications."
(1) Allergy and Asthma Foundation of America
(2) GERD in America 1997: A Two Year Follow-up Study: Louis Harris and Associates,
1997.
SOURCE International Foundation For Functional Gastrointestinal Disorders
2: FDA Issues Heartburn Drug Warning for Propulsid.(See
PROPULSID Warning Letter
WASHINGTON (AP) - The government urged doctors Monday to prescribe heartburn
patients every reasonable alternative before trying the drug Propulsid, issuing new
warnings that it may cause serious heart problems.
The Food and Drug Administration strengthened warnings on Propulsid's label after reports
of hearth rhythm abnormalities, including 38 deaths, since the pill hit the market in
1993.
The FDA noted that it cannot prove the drug caused any deaths, but said Propulsid -
approved specifically for nighttime heartburn - already was known to cause heart
arrhythmias when taken together with certain other medicines. Monday's action strengthens
those warnings, adding newly discovered drug interactions and a list of other illnesses
that increase the risk.
Manufacturer Janssen Pharmaceutica wrote thousands of doctors and pharmacists Monday to
alert them to the strengthened warnings.
The warnings say:
Never prescribe Propulsid, known chemically as cisapride, to patients taking a list of
other drugs, including such antibiotics as erythromycin, antifungals such as ketoconazole,
certain antidepressants or any AIDS drugs known as protease inhibitors.
Never prescribe Propulsid to patients with congestive heart failure, chronic obstructive
pulmonary disease, advanced cancer or electrolyte disorders, including dehydration and
vomiting. Also do not give it to patients needing acute-care diuretic or insulin
treatment.
There are some people who still could benefit from Propulsid, said FDA drug chief Dr.
Murray Lumpkin. But ``this really ought to be the drug for after you've tried everything
else,'' he stressed.
AP-NY-06-29-98 1811EDT
3: PHYSICIAN ALERT
Consider side-effect profile when prescribing metoclopramide (Reglan)
Physicians should consider, and discuss with patient families, the CNS side effects
of metoclopramide (Reglan) when prescribing this drug. Metoclopramide crosses the
blood-brain barrier and frequently affects the Central Nervous System.
"Side effects occur in 20% -30% of patients treated with effective doses. Side
effects include somnolence, restlessness, and insomnia, but the most troubling are
dystonic and extrapyramidal movements. Tremors, trismus, facial spasms, and oculogyric
crises improve after withdrawal of the drug or administration of intravenous
diphenhydramine 1mg/kg. Tardive dyskinesias may not respond to drug withdrawal."
Pediatric Gastrointestinal Motility Disorders, (Hyman, Di Lorenzo, eds), Chapter 25
(Pharmacotherapy), p. 379.
Incidence of side effects of metoclopramide is 20%.1 Neurological symptoms such as
oculogyric crisis and involuntary contractions of the eye muscles leading to upward
conjugate gaze occur in about 1% of patients.2 Children and young adults are more prone to
develop these symptoms, even after a single dose.3,4 Despite the fact that these effects
disappear spontaneously and completely after discontinuation of this treatment, they
create unnecessary anxiety for the patient, parents and health care personnel. This
problem would not have emerged without the uncontrolled, and most of the time unnecessary,
prescription of metoclopramide to young children. In this study, over a one-year period,
we analyzed the clinical data of 24 children who presented with these manifestations after
being prescribed metoclopramide for an acute illness.
For More Information on Reglan and this article, click here: Children's Motility
Foundation
4: Gastroesophageal reflux in children and its relationship to erosion
of primary and permanent teeth
Abstract of article.
Gastroesophageal reflux (GER) is often a self-limiting condition bur nevertheless is a
common cause of morbidity in childhood. Studies of adult patients with hiatus hernias and
GOR have suggested that there is an increased incidence of dental erosion in these
individuals. The aim of this study was to investigate the relationship between dental
erosion and GER in children. Fifty-three children aged 2 to 16 yr (mean 4.9 yr) with
moderate to severe GOR, defined by pH monitoring, were examined for dental erosion. A
questionnaire investigating dietary habits, other relevant medical conditions, and erosion
risk factors was also completed. Results showed that the prevalence of dental erosion was
low, when compared with the UK National Survey, with only 9 (17%) children showing any
signs of erosion, and of these only one had erosion involving dentine. These results
suggest that dental erosion may not be as great a problem in children with GOR as it is in
adults. It map be that refluxing is limited to the oesophagus, and further work is needed
to investigate those children that positively reflux into the mouth.
Journal
EUROPEAN JOURNAL OF ORAL SCIENCES 106 765 -769
Authors
O'Sullivan,E.A. ; Curzon,M.E.J. ; Roberts,G.J. ; Milla,P.J. ; Stringer,M.D.
Date: 1998/06//
5: Management of peptic esophagitis in children. A
review of forty-six cases
Abstract
Forty-six pediatric cases of peptic esophagitis seen over a seven- year period were
reviewed retrospectively with special attention to endoscopic findings and to outcomes
under conservative therapy. Infants contributed 85% of the study group. Common symptoms
included blood-tinged vomiting (n = 14), chronic vomiting with episodes of hematemesis (n
= 10), and isolated hematemesis (n = 8), The severity of esophagitis as assessed by
endoscopy was stage I in 14 cases, stage II in 12 cases, and stage III in 16 cases.
Evidence of peptic stenosis was seen in the remaining four cases. Management consisted of
positional therapy and an H2-receptor antagonist, which was subsequently replaced by a
proton pump inhibitor (PPI) in four cases, The outcome was favorable in 93% of patients
with stage I or II esophagitis versus only 50% (n = 8) of those with. stage III
esophagitis, Of these eight patients, four were seen before the introduction of PPIs and
were treated surgically, and four had a favorable outcome under PPI therapy. In
conclusion, in this series containing a substantial proportion of cases of severe
esophagitis, H2-receptor antagonists were often effective. IPPs should be used in patients
who fail to respond to an H2-receptor antagonist. Surgery is needed if conservative
therapy fails. Surgery is warranted immediately if adequate endoscopic follow-up is not
available or if compliance with conservative therapy is poor.
Journal
ANNALES DE PEDIATRIE, Volume 45 Pages, 389 -393
Authors: Abkari,A. ; Sbihi,M. ; Chafai,S. ; Mikou,N. ; Khalifa,H.H.
Date: 1998/06//
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