CASE 32
A 63-year-old female presents to the clinic with recurrent midepigastric pain
over the last 3 months. She reports some relief shortly after eating, but then the
discomfort returns. She has tried various over-the-counter medications without
relief. She also reports feeling tired and has had to increase the amount of
ibuprofen needed for relief of her arthritis. She denies nausea, vomiting, and
diarrhea. On exam she is found to have mild midepigastric tenderness and
guaiac positive stool. A CBC revealed a microcytic anemia and normal white
blood cell count, consistent with iron deficiency. The patient was referred to a
gastroenterologist who performed an upper GI endoscopy that identified gas-
tric ulcers. He stated that he suspected that the ibuprofen, a nonsteroidal anti-
inflammatory drug (NSAID) was the causative agent and suggested switching
from ibuprofen to a coxib, such as celecoxib.
What is the likely biochemical etiology of the disorder?
Why do coxibs generally have a lower incidence of upper GI
problems than other NSAIDs?
What is the major difference between aspirin and other NSAIDs
with regard to platelet function?
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