A 58-year-old woman presented with multiple episodes of coffee ground emesis with no associated melena or hematochezia. The patient reported no prior history of GI bleeding. However, she had multiple comorbidities including, hypertension, COPD, and paroxysmal atrial fibrillation. The patient has been a heavy smoker for many years. She was taken off anticoagulant medication owing to noncompliance and history of recurrent falls.
She was consuming daily dose of 81mg aspirin when presented. Examination She looked hemodynamically stable except for irregular heart rhythm. Physical examination was remarkable except for epigastric tenderness Laboratory investigation: Hb: 11.8 g/dl Stool: Positive for occult blood Upper endoscopy showed black discoloration of mucosa of the distal esophagus (1 st image), and altered blood in the gastric fundus (2 nd image). However, her upper and mid esophagus,…
