MEDizzy - An 88-year-old white woman with osteoarthritis has noticed

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Gastroenterology

An 88-year-old white woman with osteoarthritis has noticed mild epigastric discomfort for several weeks. Naproxen has helped her joint symptoms. She suddenly develops hematemesis and hypotension. For each case scenario, select the most likely diagnosis.

ExplanationNonsteroidal anti-inflammatory drugs, even over-the-counter brands, are common causes of GI bleeding. Preceding symptoms may be mild before the bleeding occurs. Cotreatment with misoprostol decreases GI bleeding but is quite expensive. Selective COX-2 inhibitors decrease the incidence of GI bleeding, but have recently been shown to increase cardiovascular events and to carry the same risk of renal dysfunction, edema, and blood pressure elevation as nonselective NSAIDs.