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Giant Gastric Ulcers: An Unusual Culprit
Aamer Abbass1, Sameen Khalid2, Vaishnavi Boppana3
1Division of Gastroenterology and Hepatology, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA. aabbass@salud.unm.edu.
Digestive Diseases and Sciences
|September 3, 2020
Summary
Mycophenolate mofetil (MMF) can cause serious gastrointestinal side effects, including large gastric ulcers, in transplant patients. Discontinuing MMF and using proton pump inhibitors effectively treated a 5 cm giant gastric ulcer in a cardiac transplant recipient.
Area of Science:
- Gastroenterology
- Transplant Medicine
- Pharmacology
Background:
- Mycophenolate mofetil (MMF) is a vital immunosuppressant in solid organ transplantation.
- MMF is frequently linked to gastrointestinal (GI) adverse effects, including ulcers and bleeding.
- The combination of MMF with tacrolimus and corticosteroids may elevate the risk of GI complications.
Observation:
- A 56-year-old male cardiac transplant recipient developed severe epigastric pain, melena, and significant weight loss.
- Endoscopy revealed a large 5 cm gastric ulcer, smaller ulcers, and aphthous lesions.
- Biopsies excluded H. pylori, CMV, and malignancy.
Findings:
- Discontinuation of MMF and switching to azathioprine led to symptom resolution.
- Proton pump inhibitor therapy was crucial in healing the giant gastric ulcer.
- MMF-induced GI toxicity is hypothesized to stem from disrupted purine synthesis in enterocytes.
Implications:
- This case highlights the potential for severe GI complications, such as giant gastric ulcers, with MMF use.
- Early recognition and management, including MMF discontinuation and medical therapy, are key.
- Understanding MMF's mechanism of GI toxicity can inform preventative strategies in transplant patients.
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