Obscure Gastrointestinal Bleeding Due to Non-steroidal Anti-inflammatory Drug-Induced Colopathy

Abstract

Obscure gastrointestinal (GI) bleeding poses a diagnostic challenge and is associated with high mortality. We report a case of life-threatening obscure GI bleeding precipitated by the ingestion of a non-steroidal anti-inflammatory drug (NSAID). The source of bleeding could not be identified preoperatively, and hence exploratory laparotomy was performed. An ileocaecal resection was undertaken based on the findings of the intraoperative enteroscopy. However, the bleeding recurred and repeated endoscopy examination identified the source to be multiple NSAID-induced ulcers that were scattered in the colo-rectum. The bleeding stopped spontaneously after a period of intensive supportive therapy and sulphasalazine enemas. This case highlights the diagnostic challenge of obscure GI bleeding. It also highlights the potentially life-threatening danger of GI bleeding secondary to NSAID-induced colopathy, even after a short course of treatment.

Salicylic Acid: Synthetic Strategies and Their Biological Activities

“…Shchegolkov et al have synthesised polyfluorinated derivatives of salicylic acid of the type 13 a-d and 14 a-e (Scheme 4). [24] The reaction involved the treatment of penta- [12] 2 Anti-inflammatory Park et al [13] 3 Anti-inflammatory Meshikhes et al [14] 4 Anti-inflammatory Li et al [15] 5 Antipyretic Mamatha et al [16] 6 Antithrombotic Schmidt et al [17] 7 Antineoplastic Li et al [18] 8 Anti-inflammatory Maturana et al [19] 9 Antidiarrheal Svensson et al [20] 10 Antitubercular Arumugam et al [21] ChemistrySelect fluorobenzoic acid 11 a-d with magnesium methoxide and toluene to yield an intermediate 12 a which further reacted with phosphorous pentachloride and hydrogen bromide to obtain tetrafluorosalicylic acid 13 a which on reaction with acetic anhydride and sulfuric acid yielded 2-acetoxy-3,4,5,6tetrafluorobenzoic acid 14 a-e. The synthesised compounds were screened for their permeability, COX-1 inhibitory action (in vitro), acute toxicity, anti-inflammatory and analgesic activities (in vivo).…”