Recurrence of upper gastrointestinal bleeding after donepezil administration.

摘要

A 86-year-old woman was admitted to our Department with epigastric pain, hematemesis, and melena of 2 days duration. Her medical history was unremarkable except for Alzheimer disease (AD) (Mini-Mental State Examination score: 19) treated with donepezil (Aricept) 5mg per day for the last month. She had initiated donepezil 6 months before her admission, but it was discontinued after an episode of melena. After donepezil discontinuation, she took a proton pump inhibitor for 10 days and then was asymptomatic until her present episode of gastrointestinal bleeding. Admission laboratory findings included: Ht: 27%, Hb: 7.7 g/dL, and urea: 92mg/dL. Emergency endoscopy of the upper gastrointestinal tract revealed a gastric ulcer, whereas rapid urease (CLO) test for Helicobacter pylori was negative. Other potential risk factors for ulcer expression, such as agitation or changes in dietary habits, also were negative. Donepezil was discontinued once more and the patient was transfused with 2 units of red blood cells; omeprazole was administered intravenously. The patient had an uncomplicated recovery and was discharged in good condition. Twelve months after discharge, the patient remains without any sign of ulcer recurrence.