The presentation of epigastric pain with melena in a patient taking NSAIDs most strongly suggests what diagnosis?

• A. Gastritis due to infection.
• B. Pancreatitis.
• C. GERD.
• D. Peptic ulcer disease from NSAID use.

Answer: (D)

When upper GI bleeding is suspected in someone taking NSAIDs, the most likely issue is peptic ulcer disease caused by NSAID-induced mucosal injury. NSAIDs block COX-1, which reduces protective prostaglandins in the stomach lining. That loss of protection makes the gastric mucosa more vulnerable to irritation from stomach acid, leading to erosions and ulcers. If bleeding occurs, digested blood turns into melena, which is dark, tarry stool reflecting an upper GI source.

Other possibilities can cause epigastric pain, but they don’t fit the whole picture as well. Infections causing gastritis can produce pain, but the presence of melena alongside NSAID use points more strongly to an ulcer with bleeding. Pancreatitis usually presents with severe upper abdominal pain that may radiate to the back and is not typically associated with melena. GERD involves heartburn and regurgitation rather than GI bleeding.