Proton pump inhibitors, purple gastric juice and peptic ulcer disease
<span class="paragraphSection">An 87-year-old woman has a 6-year history of chronic kidney disease with medical control and valvular heart disease status post metal valve repair in 2011. She had underwent warfarin therapy for 5 years. Passage of melena developed 6 days prior to admission and normocytic anemia (hemoglobin: 4.0 mg/dl) was observed. Pale conjunctiva and epigastric tenderness were found during physical examination. Esophagog astroduodenoscopy revealed gastric ulcer (Forrest IIa), duodenal ulcer scars with luminal deformity and delayed gastric emptying. Although endoscopic hemostasis was underwent, passage of tarry stool presented. Therefore, proton pump inhibitor injection (esomeprazole 40 mg/d) was continued. Although gastrointestinal bleeding improved gradually, intravenous esomeprazole was shifted to the enteral form (Nexium 40 mg/d). And she was allowed to take clear liquid diet (Resource Fruit Beverage) since there was no evidence of concurrent gastrointestinal tract bleeding. However, she was plagued with poor digestion and purple fluid regurgitated from nasogastric tube was observed. No occult blood in the purple fluid was found by guaiac test and this phenomenon was resolved rapidly after adding prokinetics (<a href="#hcw172-F1" class="reflinks">Figure 1</a>). Figure 1<strong>(A)</strong> Purple gastric juice filled in nasogastric tube and <strong>(B)</strong> enlarged view of the purple gastric juice.</...
Source: QJM - Category: Internal Medicine Source Type: research
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