Upper gastrointestinal bleed associated with cholinesterase inhibitor use

Area of Science:

• Geriatric Medicine
• Pharmacology
• Gastroenterology

Background:

• Alzheimer's disease is a common neurodegenerative disorder.
• Cholinesterase inhibitors (ChEIs) like donepezil are standard treatments for Alzheimer's.
• ChEIs can increase acetylcholine levels, potentially affecting various bodily systems.

Observation:

• An 86-year-old male with Alzheimer's disease presented with severe gastrointestinal bleeding (melaena and syncope).
• The patient was on donepezil, with a recent dose increase, and had no other identifiable risk factors for upper gastrointestinal hemorrhage.
• Endoscopy revealed an acute duodenal ulcer, successfully treated with proton pump inhibitors.

Findings:

• Donepezil was identified as the likely causative agent for the acute duodenal ulcer and subsequent gastrointestinal bleeding.
• Cholinesterase inhibitors are associated with a range of side effects due to increased acetylcholine activity.
• This case underscores a potential link between ChEI use and upper gastrointestinal complications.

Implications:

• Clinicians should consider gastrointestinal bleeding as a potential side effect of cholinesterase inhibitors, particularly donepezil.
• Further investigation into the mechanisms linking ChEIs to gastrointestinal ulcers is warranted.
• Gastroprotective agents may be considered in patients on ChEIs, especially those with risk factors or presenting with gastrointestinal symptoms.