Nicorandil-induced terminal ileal ulceration—a probable link

Nicorandil, a commonly prescribed anti-anginal agent, has been reported to be associated with ulceration in various parts of the gastrointestinal tract. A 68-year-old general practitioner presented with severe rectal bleeding and abdominal pain associated with terminal ileal ulceration diagnosed by...

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Bibliographic Details
Published in:BMJ case reports 2010-05, Vol.2010 (may31 1), p.bcr0920092303-bcr0920092303
Main Authors: Swinscoe, Mark Thomas, Savani, Ramesh, Lobo, Alan J, Stephenson, Timothy J, Shorthouse, Andrew J
Format: Article
Language:English
Subjects:
Abdomen
Anti-Arrhythmia Agents - adverse effects
Aspirin
Capsule Endoscopy
Cardiovascular disease
Colonoscopy
Endoscopy
Europe (West)
Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect
Gastrointestinal Hemorrhage - chemically induced
Hogs
Humans
Ileal Diseases - chemically induced
Indian Sub-Continent
Male
Medical imaging
Middle Aged
Nicorandil - adverse effects
Pain
Patients
Ulcer - chemically induced
Ulcers
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Summary:Nicorandil, a commonly prescribed anti-anginal agent, has been reported to be associated with ulceration in various parts of the gastrointestinal tract. A 68-year-old general practitioner presented with severe rectal bleeding and abdominal pain associated with terminal ileal ulceration diagnosed by colonoscopy. Capsule endoscopy revealed no other source of bleeding and CT was normal. Diclofenac and/or aspirin were assumed to be causative factors and discontinued. Aspirin was temporarily resumed then discontinued after a second massive, but self-limiting, haemorrhage and persistent abdominal pain. Repeat colonoscopy 5 weeks later confirmed that the previously documented terminal ileal ulceration had worsened. Histopathology was consistent with localised mucosal ischaemia. Nicorandil was withdrawn, after which no further episode of bleeding occurred and his pain settled. Repeat colonoscopy 3 months later confirmed complete healing. This report implicates nicorandil as a cause of terminal ileal ulceration leading to life-threatening rectal bleeding and abdominal pain.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.09.2009.2303