Gastric and colonic ulcers induced by a nonsteroidal anti-inflammatory drug

Abstract

A 70-year-old man was admitted to our hospital with weight loss, appetite loss and anemia (Hb 6.7 g/dl) . He had been prescribed diclofenac sodium and methylprednisolone by another clinic to treat rheumatoid arthritis for the previous eight years. Esophagogastroduodenoscopy (EGD) revealed multiple gastric ulcers in the midbody and antrum. Colonoscopy revealed an ulcer in the transverse colon. Both gastric and colonic ulcers were suspected to be induced by the nonsteroidal anti-inflammatory drug (NSAID) . Capsule endoscopy revealed there were several red areas in the small intestine. Diclofenac sodium administration was ceased; the dose of methylprednisolone reduced and a proton pump inhibitor administered. EGD repeated one month later demonstrated healing of the gastric ulcers. The anemia and appetite improved and the patient was discharged. Four months later, a second colonoscopy showed scarring of the colonic ulcer. We report here a case showing simultaneous gastric and colonic ulcers induced by NSAID. Only one previous case with concurrent gastric and colonic ulcers induced by NSAIDs has been reported in Japan. In anemic patients receiving NSAIDs, both upper and lower gastrointestinal tracts should be examined.