Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches

Acute Med Surg. 2021 Nov 20;8(1):e710. doi: 10.1002/ams2.710. eCollection 2021 Jan-Dec.

Abstract

Background: Topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs) have been created to lessen systemic adverse effects. In general, they are believed to be well tolerated and appropriate for use as an over-the-counter (OTC) drug.

Case presentation: A 68-year-old woman visited our clinic due to tarry stool. The patient reported multiple episodes of recurrent bleeding from a gastric ulcer for 2 months and was treated with endoscopic hemostatic clipping. The patient disclosed she had been using a large number of diclofenac patches for more than 3 months. The patient was treated conservatively by discontinuation of diclofenac patches and treatment with a proton pump inhibitor and omeprazole.

Conclusion: In conclusion, inappropriate use of topical NSAID patches can be a cause of peptic ulcer bleeding. Patients reporting multiple episodes of recurrent bleeding from a gastric ulcer should be questioned, particularly about the use of OTC medications that might include topical NSAID patches.

Keywords: Gastric ulcer; topical nonsteroidal anti‐inflammatory drug.

Publication types

  • Case Reports