Rowan SOM/Jefferson Health NJ Franklinville, NJ, United States
Matthew Everwine, DO1, David Truscello, DO2, Sindhu Maramupdi, DO3, Sangam Shivaprasad, 4, Maulik Shah, DO5, Charles Snyder, MD6 1Rowan SOM/Jefferson Health NJ, Franklinville, NJ; 2Rowan University School of Osteopathic Medicine, Sewell, NJ; 3Rowan University School of Osteopathic Medicine, Stratford, NJ; 4Rowan University, Stratford, NJ; 5Rowan University School of Osteopathic Medicine, Cherry Hill, NJ; 6Virtua Health, Cherry Hill, NJ
Introduction: Alka-Seltzer ® is an over the counter medication that contains acetylsalicylic acid (aspirin) and is advertised to treat heartburn, acid indigestion, sour stomach and pain. We describe a case of peptic ulcers and decompensated heart failure possibly induced by excessive use of Alka-Seltzer ®.
Case Description/Methods: A 69 year old man presented to the hospital for dyspnea and lower extremity edema over one week. He was seen by cardiology and initiated on diuretics for newly diagnosed decompensated heart failure. While undergoing cardiac evaluation, he reported melena. After further questioning, the patient endorsed indigestion and heartburn for which he used 10-20 tablets of Alka-Seltzer® daily for relief. He was placed on pantoprazole and subsequently underwent upper endoscopy which revealed large clean based (Forrest III) ulcers in the antrum with negative immunohistochemical staining for H.pylori. His volume status improved and he was discharged on pantoprazole with interval follow up and instructions to avoid Alka-Seltzer ®.
Discussion: Alka-Seltzer ® contains sodium bicarbonate, acetylsalicylic acid (aspirin), and anhydrous citric acid. Acetylsalicylic acid (aspirin) inhibits cyclooxygenase-1 (COX-1) which in turn impairs gastric and duodenal cytoprotection. Due to the aspirin content, Alka-Seltzer ® tablets likely increase the risk of PUD. Additionally, each tablet contains 567 mg of sodium, rendering cardiac patients at risk of acute heart failure. Based on the amount of tablets ingested, our patient consumed at least 3,250 mg aspirin and 5,000 mg sodium daily. A low sodium diet is recommended to prevent heart failure exacerbations, typically less than 3 grams daily. The sodium intake received from the Alka-seltzer ® tablets likely precipitated our patient’s heart failure. Although we are unable to determine if the patient had underlying PUD, it is highly plausible that he developed PUD from his Alka-Seltzer ® use or at least worsened his ulcers. It's imperative that patients and physicians are educated regarding supplement contents and their potential effects and interactions.
Figure: Endoscopic visualization of pre-pyloric ulcers.
Matthew Everwine indicated no relevant financial relationships.
David Truscello indicated no relevant financial relationships.
Sindhu Maramupdi indicated no relevant financial relationships.
Sangam Shivaprasad indicated no relevant financial relationships.
Maulik Shah indicated no relevant financial relationships.
Charles Snyder indicated no relevant financial relationships.
Matthew Everwine, DO1, David Truscello, DO2, Sindhu Maramupdi, DO3, Sangam Shivaprasad, 4, Maulik Shah, DO5, Charles Snyder, MD6. P2057 - Peptic Ulcers and Decompensated Heart Failure Induced by Excessive Alka-Seltzer® Use, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.