BLEEDING ESOPHAGEAL ULCERS CAUSED BY NSAIDS

This report describes four patients with NSAID-induced esophageal ulce rs documented by endoscopy. The cause of injury was ibuprofen alone in two patients, aspirin in one patient, and a combination of aspirin an d ibuprofen in one patient. The most common findings were anemia, retr osternal pain, and dysphagia. Three patients had bleeding esophageal u lcers requiring blood transfusions. One patient had massive bleeding w hich was controlled by endoscopic hemostasis. Three patients were foll owed up by endoscopy, which showed healing in 3-4 weeks. These NSAID-i nduced ulcers had characteristic endoscopic features, namely, a large, shallow, discrete ulcer in the midesophagus near the aortic arch with normal surrounding mucosa. These findings suggest that the injury res ulted from mucosal contact with NSAIDs. A precise history and immediat e endoscopic examination were most important in establishing the diagn osis of esophageal ulcer. Healing occurs if drug-induced injury is rec ognized early and treatment is appropriately started with antacids and H-2 blockade. Offending medication should be discontinued and patient s should be counseled to take pills in an upright posture with liberal amounts of fluids well before retiring for the night.