ABSTRACT
The objective of the study was to document practice pattern of gastroenterologists for the management of gastroesophageal reflux disease (GERD) under the minimal influence of the insurance reimbursement guideline. Data on management for 1,197 consecutive patients with typical GERD symptoms were prospectively collected during 16 weeks. In order to minimize the influence of reimbursement guideline on the use of proton pump inhibitors (PPIs), rabeprazole was used for the PPI treatment. A total of 861 patients (72%) underwent endoscopy before the start of treatment. PPIs were most commonly prescribed (87%). At the start of treatment, rabeprazole 20 mg daily was prescribed to 94% of the patients who received PPI treatment and 10 mg daily to the remaining 6%. At the third visits, rabeprazole 20 mg daily was prescribed to 70% of those who were followed and 10 mg daily for the remaining 30%. Continuous PPI treatment during the 16-week period was performed in 63% of the study patients. In conclusion, a full-dose PPI is preferred for the initial and maintenance treatment of GERD under the minimal influence of the insurance reimbursement guideline, which may reflect a high proportion of GERD patients requiring a long-term treatment of a full-dose PPI.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use , Enzyme Inhibitors , Gastroenterology , Gastroesophageal Reflux/diagnosis , Guideline Adherence , Insurance, Health, Reimbursement , Practice Patterns, Physicians' , Proton Pump Inhibitors/therapeutic use , Republic of Korea , Treatment OutcomeABSTRACT
Acromegaly is an uncommon disease characterized clinically by enlargement of the acral parts, coarse facial features and visceralomegaly. In most patients, the disorder arises from a tumor of the anterior pituitary gland that secretes excessive amounts of growth hormone. A few cases have been reported, associated with the development of leukemia due to increased growth hormone. But, chronic myelogenous leukemia has not been reported in patients with acromegaly. We report a case of chronic myelogenous leukemia in patients with situs inversus and acromegaly. A 70-year old male patient who was admitted to endocrinology department because of acromegalic features was referred to the hematology department for the abnormal hematologic findings. LAP score was decreased. Bone marrow aspiration and biopsy revealed chronic myelogenous leukemia. Chest radiographs showed a dextrocardia. Abdominal sonography showed a splenomegaly and transposition of liver and spleen. Growth hormone level was elevated and pituitary tumor was detected on brain MRI.