Introduction:
An 82-year-old woman presented to the hospital complaining of upper abdominal pain, particularly in the stomach area.
Complaints:
The patient described dull pain that intensified during the day after meals, becoming shooting at night and radiating to the back. She also experienced belching with air and something acidic, sometimes with recently consumed food.
Pain was relieved by taking baking soda and Gastal initially, but recently these measures were ineffective. The painful sensations became unbearable.
History:
The painful syndrome appeared suddenly a week ago. Initially, the pain was brief and lasted for about an hour, but then it worsened.
The patient underwent an esophagogastroduodenoscopy (EGD) independently before seeing a gastroenterologist.
She has been suffering from rheumatoid arthritis for over 20 years and has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (CS) for treatment. She hasn’t visited a rheumatologist for the last 2-3 years and self-medicates with drugs like Diclofenac, Ibuprofen, Ketorol, and others when experiencing joint pain.
Examination:
During the examination, the woman felt normal. She weighed 52 kg and was 156 cm tall. Blood pressure was 135/80 mmHg, pulse rate was 82 beats per minute. Heart sounds were moderately muted and rhythmic.
Her skin was of normal color. The tongue was moist, coated with a thick white deposit showing tooth marks.
Her abdomen was of normal shape, actively participated in respiration, soft, moderately painful upon palpation of the stomach. There were no signs of peritoneal irritation. The liver and spleen were not enlarged.
Stool was formed, of normal color and odor, without admixtures of mucus, greenery, or blood.
Investigations:
According to the results of the EGD:
- The gastric mucosa was reddened (hyperemic).
- An ulcer in the antral part of the stomach on the anterior wall up to 0.7 cm in size, with a light-gray fibrin on the bottom.
- An ulcer on the posterior wall up to 1 cm in diameter, with a dark-gray fibrin on the bottom.
- Multiple erosions with dark-brown fibrin in the antral part and body of the stomach.
Diagnosis:
NSAID-induced gastropathy.
Treatment:
The woman was prescribed a diet:
- Frequent meals, not less than 5-6 times a day, in small portions of approximately 200 g each.
- Room temperature dishes (neither hot nor cold).
- Oatmeal, buckwheat, or rice porridge in water (liquid form).
- Lean meat (beef, chicken, turkey, rabbit).
- Lean fish (pikeperch, trout, cod, pollock).
- Boiled and stewed vegetables.
- Fermented milk products (sour milk, buttermilk, natural yogurts without berries, fruits, or cereals).
She was also prescribed medications:
- Rabeprazole 20 mg – one tablet 50 minutes before breakfast for a month.
- Rebegit 100 mg – one tablet three times a day 40 minutes before meals for a month.
- De-nol 120 mg – two tablets twice a day 30 minutes before meals (for breakfast and dinner) for a month.
- Pepsan-R – one sachet three times a day before meals for a month.
- Almagel – three times an hour after meals and at night for two weeks, then as needed.
A month after the treatment, the patient’s condition improved, and the pain ceased. Follow-up EGD showed healing of erosions and ulcers.
Conclusion:
This clinical case illustrates the danger of self-medication. Some medications, in addition to their pronounced anti-inflammatory and analgesic effects, can damage the mucous membrane and cause erosion and ulcers in the stomach and intestines.
Only a specialist doctor, in this case, a rheumatologist, can correctly select a medication with the least risk of side effects, prescribe the necessary dose, and determine the optimal regimen and method of administration.