Mr. Hung has a history of high blood pressure, kidney disease, and chronic gout. In recent two months, he lost 4 kg and experienced increased dizziness. He sought treatment at Tam Anh General Hospital Hanoi when his symptoms worsened.

Lab results showed he had anemia, with a red blood cell count of 2,9 million/mm³, significantly below the normal male range of 4,2-5,4 million/mm³. Further tests revealed microcytic hypochromic red blood cells and significantly reduced serum iron. Digestive endoscopy revealed ulcers around the pyloric orifice and duodenal bulb that had silently progressed over a long period, causing stomach bleeding.

Mr. Hung stated that he frequently experienced joint pain and had taken non-steroidal anti-inflammatory drugs (NSAIDs) for over 10 years.

According to Master, Doctor Nguyen Quang Huy, from the Department of Nephrology - Dialysis, this group of medications often causes side effects on the stomach and duodenum with continuous use. NSAID painkillers can inhibit COX enzymes, reducing the synthesis of prostaglandins, which play a crucial role in protecting the stomach lining. When this protective layer weakens, stomach acid easily attacks, causing inflammation, ulcers, and bleeding. NSAID-induced stomach ulcers often progress silently in their early stages. Most patients are diagnosed when ulcers lead to complications such as gastrointestinal bleeding, severe anemia, or stomach perforation.

Doctor Huy examines Mr. Hung. *Photo: Tam Anh General Hospital*

Doctor Huy explained that Mr. Hung's ulcers slowly bled for several weeks, leading to chronic blood loss.

The patient received two units of packed red blood cells to increase hemoglobin. Concurrently, doctors treated him with proton pump inhibitors (PPIs), iron supplementation, and controlled his blood uric acid, while completely discontinuing NSAID medication. Following treatment, Mr. Hung's anemia improved.

Doctor Huy advises patients to change their lifestyle to manage underlying conditions and limit prolonged painkiller use. Patients should use NSAID medications strictly according to doctor's instructions. If symptoms such as fatigue, dizziness, dull abdominal pain, dark stools, blurred vision, or shortness of breath occur, patients should seek medical attention for timely diagnosis and treatment.

Thanh Ba