Kok Khoon-Sheng, Loke Yoon, Southgate Jo
Norfolk and Norwich University Hospital, Norwich, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
BMJ Case Rep. 2015 Sep 29;2015:bcr2015211859. doi: 10.1136/bcr-2015-211859.
An 86-year-old man was admitted with a 3-day history of melaena and syncope. He was haemodynamically compromised and anaemic on presentation. His only medical history was mild Alzheimer's disease diagnosed 6 months prior. For this, he was on donepezil, a cholinesterase inhibitor (ChEI), with a recent dose increase 3 months earlier. After fluid resuscitation with packed red cells, an endoscopy was performed, which showed an acute duodenal ulcer. This was treated with a high-dose proton pump inhibitor. The patient recovered well and was discharged on donepezil with the addition of a gastro-protective proton pump inhibitor. In view of other absent risk factors of upper gastrointestinal haemorrhage, donepezil was the likely causative agent. ChEIs are associated with frequent side effects and increased hospitalisation due to central and peripheral increase in acetylcholine. With this case report, we review the literature of side effects related to ChEIs, where the mechanisms of action, complications and appropriate management are discussed.
一名86岁男性因黑便和晕厥3天入院。入院时他存在血流动力学不稳定和贫血的情况。他唯一的病史是6个月前被诊断出患有轻度阿尔茨海默病。为此，他正在服用胆碱酯酶抑制剂（ChEI）多奈哌齐，且在3个月前刚增加了剂量。在输注浓缩红细胞进行液体复苏后，进行了内镜检查，结果显示为急性十二指肠溃疡。给予高剂量质子泵抑制剂进行治疗。患者恢复良好，出院时继续服用多奈哌齐，并加用了一种具有胃保护作用的质子泵抑制剂。鉴于不存在其他上消化道出血的危险因素，多奈哌齐可能是致病因素。ChEIs常伴有副作用，且由于中枢和外周乙酰胆碱增加导致住院率上升。通过本病例报告，我们回顾了与ChEIs相关副作用的文献，并讨论了其作用机制、并发症及适当的管理方法。
