A case of gastrointestinal injury associated with nonsteroidal anti-inflammatory drug use

Abstract

A 47-year-old female with a history of bipolar disorder was admitted to our hospital with diarrhea. Several hours after admission, she presented hematemesis. Upper endoscopy revealed hemorrhagic mucosal injury in the upper gastrointestinal tract. Furthermore, capsule endoscopy showed multiple ulcers in the small intestine. She reported being prescribed loxoprofen 360mg daily for the 4 months prior for headache. The nonsteroidal anti-inflammatory drug therapy was discontinued, and she was treated with an intravenous proton-pump inhibitor (PPI). She had also disseminated intravascular coagulation (DIC) associated with sepsis. The improvement of DIC was obtained with intravenous broad spectrum antibiotics. The mucosal injury in the upper gastrointestinal tract promptly improved, but it took more time for the multiple ulcers in the small intestine to improve.