Published On: 12 Sep, 2024 12:31 PM | Updated On: 24 Jan, 2025 12:02 PM

Postpartum Peptic Ulcer Disease Secondary to NSAID use

A report describes a case of a 27-year-old woman with G1P0 who underwent primary low transverse cesarean section without any intraoperative and postoperative complications. She received 1 g acetaminophen and 600 mg ibuprofen every six hours, with 5 mg oxycodone every four hours (if needed) for breakthrough pain, and was discharged home on postoperative Day 3. 

On postoperative Day 6, the patient reported three episodes of black stools along with lightheadedness, weakness, fatigue, and dyspnea on exertion. Postpartum bleeding and healing were normal. 

Laboratory work-up revealed severe anemia with hemoglobin of 5.4 g/dL, blood urea nitrogen of 29 mg/dL, and blood urea nitrogen: creatinine ratio of 50. Rectal exam revealed guaiac positive. An esophagogastroduodenoscopy (EGD) revealed a 5-mm gastric body ulcer with a flat pigmented spot without active bleeding and a 3-mm duodenal ulcer with a clean, white base without active bleeding. Biopsies came back negative for H. pylori.

The patient received three units of packed RBCs for her profound anemia and Intravenous pantoprazole for her presumed diagnosis of Upper gastrointestinal bleeding (UGIB). She responded well to transfusion and showed hemodynamic stability; hence, she was discharged home on hospital Day 3 of readmission.

The patient was instructed to discontinue using all NSAIDs, continue using 40 mg oral pantoprazole BD for eight weeks, and receive once daily 200 mg iron infusions for three days.

Surveillance endoscopy ten weeks post-hospital discharge ensured ulcer healing without bleeding and normal EGD.

Tallmadge M, MacBeth M, Palatnik A. New Onset of Symptomatic Peptic Ulcer Disease Postpartum Secondary to Nonsteroidal Anti-Inflammatory Drug Use. Case Rep Obstet Gynecol. 2024 Jun 11;2024:6422824. Doi: 10.1155/2024/6422824. PMID: 38962291; PMCID: PMC11221993.

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