Proton Pump Inhibitor Co-Therapy in Patients with Atrial Fibrillation Treated with Oral Anticoagulants and a Prior History of Upper Gastrointestinal Tract Bleeding

Abstract Background We report a case of a patient with iris metastasis as the initial manifestation of a systemic cancer: upper gastrointestinal tract carcinoma. Case presentation A 24-year-old Asian man presented to our hospital with complaints of red left eye, decreased visual acuity, pain, and photophobia for about 3 weeks with no prior history of cancer or any other medical abnormality. Ocular examination showed a pinkish white lesion on the superonasal part of the iris. The patient’s intraocular pressure was progressively increasing despite medications, followed by lymphadenopathy 4 weeks later. Comprehensive examination was performed along with a complete systemic workup, which detected systemic malignancy. Histopathology and immunohistochemistry revealed signet ring cells, which indicated an upper gastrointestinal tract tumor as a primary source of iris metastasis. The systemic condition of the patient deteriorated rapidly thereafter and led to his death in the 12th week of the disease. Conclusion A red eye with iris lesions in otherwise healthy individuals should be considered as a possible initial manifestation of underlying systemic malignancy. Prompt referral of such patients to an oncologist is warranted.

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Proton Pump Inhibitors for Prophylaxis of Nosocomial Upper Gastrointestinal Tract Bleeding

Archives of Internal Medicine ◽

10.1001/archinternmed.2010.51 ◽

2010 ◽

Vol 170 (9) ◽

pp. 779 ◽

Cited By ~ 21

Author(s):

Patrick S. Yachimski

Keyword(s):

Gastrointestinal Tract ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Upper Gastrointestinal Tract ◽

Gastrointestinal Tract Bleeding ◽

Upper Gastrointestinal

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The Use of Proton Pump Inhibitors in Intensive Care Units

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2017-0011 ◽

2018 ◽

Vol 0 (0) ◽

Author(s):

Aleksandar Cvetkovic ◽

Marko Spasic ◽

Mladen Pavlovic ◽

Danijela Cvetkovic ◽

Bojan Stojanovic ◽

...

Keyword(s):

Intensive Care ◽

Gastrointestinal Tract ◽

Intensive Care Units ◽

Critically Ill ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Critically Ill Patients ◽

Upper Gastrointestinal Tract ◽

Gastrointestinal Tract Bleeding ◽

Upper Gastrointestinal

AbstractThe bleeding from the upper gastrointestinal tract represent a significant medical but also socio-economic problem. A special group of patients et increased risk consists of critically ill patients in intensive care units. Particularly significant cause of bleeding in intensive care unit patients is bleeding resulting from the stress ulcers caused by damage of the mucosa of the stomach and duodenum.The purpose of this review is to present current experience in prevention of upper gastrointestinal tract bleeding using proton pump inhibitors in intensive care units.Combination of endoscopic hemostatic methods and proton pump inhibitors represents golden standard in most cases.Despite some adverse effects treatment with proton pump blockers is essential when upper gastrointestinal tract bleeding appears in critically ill patients in intensive care units. Proton pump inhibitors are more effective in acid suppression, as well as in the prevention of recurrent bleeding after endoscopic hemostasis than histamine 2 receptor blockers. The efficacy of proton pump blockers is higher in the case of a continuous intravenous infusion than in the intermittent mode of administration of the drug. The need for highly elaborate strategy for the prophylaxis of bleeding from the upper parts of gastrointestinal tract in intensive care units is essential, because when it occurs in intensive care units, mortality is high, and therapeutic options become narrow.

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