MRCP2-2101

MRCP2-2101

A 65-year-old man presents with severe upper abdominal pain, nausea, and dizziness that has been ongoing for the past day. Upon further questioning, he reveals that he has been experiencing intermittent mild upper abdominal pain for the past month, usually after meals. He has a medical history of hypertension, type 2 diabetes, osteoarthritis, and a heart attack five years ago, for which he received a stent. He is currently taking aspirin, ramipril, amlodipine, metformin, naproxen, and paracetamol.

During his time in the department, he develops diarrhea, and a stool examination reveals melaena. His blood pressure is 110/55 mmHg, and his heart rate is 95 beats per minute. Upon examination, he is tender in the epigastrium with no peritonism and normal bowel sounds. Examination of other systems is normal.

Blood tests show that his Hb is 95 g/l, platelets are 200 * 109/l, WBC is 8 * 109/l, Neuts are 3 * 109/l, Na+ is 145 mmol/l, K+ is 4.5 mmol/l, urea is 12 mmol/l, and creatinine is 102 µmol/l. He is given intravenous fluids and analgesia, and all his regular analgesia except for paracetamol is withheld. Later that day, he is taken to endoscopy, where a 1 cm ulcer is seen in the gastric antrum with an adherent clot. This is clipped and injected with adrenalin. He recovers well from sedation, and upon returning to the ward, his blood pressure is 135/70 mmHg, and his heart rate is 80 beats per minute. He has no further diarrhea or vomiting, and a repeat haemoglobin test shows a level of 121 g/l.

Upon discharge, what advice should he be given regarding his use of non-steroidal anti-inflammatory drugs?