A patient with a history of NSAID use complains of epigastric pain and black stools. What is the likely diagnosis?

• A. Continue NSAIDs and monitor.
• B. Administer proton pump inhibitors alone without addressing NSAID use.
• C. NSAID-induced peptic ulcer disease; discontinue NSAIDs and evaluate; monitor.
• D. Ignore GI symptoms.

Answer: (C)

Recognizing that NSAID use can injure the GI lining and cause an upper GI ulcer with bleeding is the key idea. Epigastric pain paired with black stools (melena) signals a GI bleed, most often from a peptic ulcer when NSAIDs are involved. NSAIDs reduce protective prostaglandins in the stomach, weakening the mucosal barrier and making ulcers more likely and more prone to bleeding.

The best approach is to discontinue the NSAID and proceed with evaluation of the ulcer and bleeding source (often with endoscopy) and implement appropriate treatment such as acid suppression and further management as indicated. Merely continuing NSAIDs would keep damaging the mucosa, and treating with a proton pump inhibitor alone without stopping the causative agent is insufficient. Ignoring the symptoms would risk more significant blood loss and complications.