Antral ulcer in lady on steroids

This lady on steroids and Naproxen for rheumatoid arthritis was admitted with septic arthritis of her left hip. She underwent total hip replacement but the antibiotics made her feel nauseated.

"Routine" gastroscopy was arranged before she was discharged from hospital. When she attended for this four months later she was assymptomatic as she was no,longer on antibiotics. At endoscopy there was an antral ulcer but no other pathology. She was commenced on a PPI and changed to a COX II selective antagonist with the aim of allowing her to continue on her anti-inflammatory therapy "because I couldn't do without them". Repeat OGD arranged to check for ulcer healing.

I include her case as gastric ulcers are so rare in hospital practice these days. It is important to note the masking of symptoms by steroids.