title: Treatment of gastric hemorrhage by pulverized omeprazole and antacid--concomitant administration via a nasogastric tube.
abstract: Gastroesophageal reflux (GER) is a common episode in pediatric patients with severe motor and intellectual disabilities (SMID) and occasionally leads to a severe clinical state accompanied with nausea, hematemesis, melena, wheezing, pneumonia, anemia and/or failure to thrive. We report here a case of a 14-year-old male with Lennox syndrome who had been treated with a histamine H2 blocker intravenously or via a nasogastric tube for repeated gastric hemorrhage due to severe GER. Since his gastric hemorrhage became resistant to the H2 blocker, we decided to replace it with a proton pump inhibitor (PPI). Although lansoprazole can be decapsulated for administration via a nasogastric tube, it tends to block fine tubes. The acid-sensitive drug omeprazole, another oral PPI, is commercially available as enteric-coated tablets. Therefore, we pulverized the tablets and administered omeprazole, mixed with a small amount of antacid, via a nasogastric tube. The patient's gastric hemorrhage was dramatically improved. Thus, administration of pulverized omeprazole concomitantly with antacid via a fine nasogastric tube may provide a novel approach for the treatment of chronic GER in pediatric patients with SMID.
authors.affiliation: Department of Hospital Pharmacy, Isahaya Ryoiku Center, Nagasaki, Japan. gzw05275@nifty.com
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Mukai
authors.forename: E
authors.initials: E
authors.lastname: Kinoshita
authors.forename: H
authors.initials: H
authors.lastname: Ohtani
authors.forename: Y
authors.initials: Y
authors.lastname: Sawada
mesh_terms: D000293:Adolescent; D000863:Antacids / Q000008:administration & dosage / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002927:Cimetidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005764:Gastroesophageal Reflux / Q000150:complications; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D013272:Stomach Diseases / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000863:Antacids; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D002927:Cimetidine; D009853:Omeprazole