Recurrent duodenal ulcer due to nonsteroidal anti-inflammatories following the suspension of antiulcer medication.
The patient was a 62-year-old woman with a personal history of chronic alcoholism and a medical history of duodenal ulcer, congestive heart failure, atrial fibrillation, dilated cardiomyopathy, and recurring urinary tract infections. She had osteoporosis, cirrhosis of the liver and portal hypertension. She had undergone surgery for multiple arm fractures after an accidental fall in the previous year and had received NSAIDs without concomitant gastric protection. On the fourth day of hospitalization she had an episode of haematemesis. The patient continued to take NSAIDs as required, as well as habitual medication of propranolol 40 mg/day, spironolactone 25 mg/day, furosemide 40 mg/day, pantoprazole 40 mg/day and strontium 2 g/day. Upper digestive endoscopy (UDE) revealed level I/II (Baveno) oesophageal varicose veins with no signs of haemorrhage and portal hypertensive gastropathy. The duodenal bulbous was deformed by an extensive ulcer with blood clots and one vessel was visible along the antero-superior portion (Forrest IIa classification). Numerous superficial ulcers with haemosiderin pigment at D2 were observed. Endoscopic haemostasis was achieved with epinephrine and bipolar probe. Food was suspended and the patient received continuous intravenous treatment with pantoprazole 8 mg/h. UDE repeated after 48 hours showed no signs of haemorrhaging from the ulcer. After 72 hours, the pantoprazole dose was changed to 40 mg every 12 hours and food was allowed. After 12 days with no recurrence of the haemorrhagic incident, the patient was prescribed oral pantoprazole 40 mg once daily and released from hospital.
Silva
Ana Paula
AP
Centro Hospitalar de Vila Nova de Gaia Vila Nova de Gaia, Portugal.
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000517:prevention & control*; D055502:Secondary Prevention
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D000077402:Pantoprazole