title: Nicorandil-induced terminal ileal ulceration--a probable link.
abstract: Nicorandil, a commonly prescribed anti-anginal agent, has been reported to be associated with ulceration in various parts of the gastrointestinal tract. A 68-year-old general practitioner presented with severe rectal bleeding and abdominal pain associated with terminal ileal ulceration diagnosed by colonoscopy. Capsule endoscopy revealed no other source of bleeding and CT was normal. Diclofenac and/or aspirin were assumed to be causative factors and discontinued. Aspirin was temporarily resumed then discontinued after a second massive, but self-limiting, haemorrhage and persistent abdominal pain. Repeat colonoscopy 5 weeks later confirmed that the previously documented terminal ileal ulceration had worsened. Histopathology was consistent with localised mucosal ischaemia. Nicorandil was withdrawn, after which no further episode of bleeding occurred and his pain settled. Repeat colonoscopy 3 months later confirmed complete healing. This report implicates nicorandil as a cause of terminal ileal ulceration leading to life-threatening rectal bleeding and abdominal pain.
authors: Sheffield Teaching Hospitals, Surgery, Northern General Hospital, UK.
authors: Mark Thomas
authors: MT
authors: Swinscoe
authors: Ramesh
authors: R
authors: Savani
authors: Alan J
authors: AJ
authors: Lobo
authors: Timothy J
authors: TJ
authors: Stephenson
authors: Andrew J
authors: AJ
authors: Shorthouse
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D053704:Capsule Endoscopy; D003113:Colonoscopy; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007077:Ileal Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000009:adverse effects*; D014456:Ulcer / Q000139:chemically induced*
chemical_list: D000889:Anti-Arrhythmia Agents; D020108:Nicorandil