title: Successful treatment of severe reflux esophagitis with erythromycin in a patient with progressive systemic sclerosis and proximal gastrectomy.
abstract: A case of severe reflux esophagitis related to progressive systemic sclerosis (PSS) and proximal gastrectomy was successfully treated with oral erythromycin (EM). A 53-year-old woman was troubled with severe heartburn related to PSS for a long period and had undergone proximal gastrectomy for a gastric cancer a few months before. She was not readily made free from heartburn by any anti-ulcer drugs and she could barely eat. Therefore she underwent continuous intravenous hyperalimentation (IVH). She was referred to our hospital for IVH. Nine months after the proximal gastrectomy, we gave oral erythromycin to her in expectation of improvement of the heartburn. Gradually she recovered from the heartburn and became able to eat small amounts. EM is an agonist of motilin which is a gastrointestinal hormone. EM acts on the stomach and intestine not through the autonomic nervous system but through the circulation system of the blood. This is the reason why EM is effective in the residual stomach and intestine. In the case of severe esophagitis which is related to PSS and/or proximal gastrectomy and which resists anti-ulcer drugs, oral EM should be considered as a second therapy.
authors.affiliation: Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan. harashou@tea.ocn.ne.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hara
authors.forename: Kyouji
authors.initials: K
authors.lastname: Ogoshi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kameya
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kenmochi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kise
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nishi
authors.forename: Osamu
authors.initials: O
authors.lastname: Chino
authors.forename: Hideo
authors.initials: H
authors.lastname: Shimada
authors.forename: Toshihide
authors.initials: T
authors.lastname: Imaizumi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Makuuchi
mesh_terms: D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004942:Esophagitis, Peptic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010528:Peristalsis / Q000187:drug effects; D045743:Scleroderma, Diffuse / Q000150:complications*; D012720:Severity of Illness Index
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin