Images in Clinical Medicine

An Aspirin Tablet and a Gastric Ulcer

David J. Levy, M.D.

N Engl J Med 2000; 343:863September 21, 2000

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Figure 1 A 76-year-old woman had iron-deficiency anemia, a hematocrit of 24 percent, and a positive test for occult blood in stool. For several years, she had been taking 400 mg of etodolac twice a day for rheumatoid arthritis; one tablet of enteric-coated, regular-strength aspirin a day; and 1 mg of warfarin sodium a day for severe peripheral vascular disease. Her international normalized ratio was 1.15. After receiving a transfusion, she underwent upper gastrointestinal endoscopy, which revealed an aspirin tablet, with the enteric coating still intact, within an ulcer of the gastric antrum. The tablet was removed with a forceps. Treatment with etodolac and aspirin was stopped, and the patient was given 30 mg of lansoprazole twice a day. Two months later, a second endoscopic examination showed complete healing of the ulcer.

David J. Levy, M.D.
Hamot Medical Center, Erie, PA 16550

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