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Delay of endoscopic submucosal dissection-induced gastric ulcer healing by methotrexate

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Abstract

We report a case of methotrexate (MTX) delaying the healing of an endoscopic submucosal dissection (ESD)-induced gastric ulcer. The patient, who had been taking MTX for rheumatoid arthritis, underwent ESD for early gastric carcinoma. Despite taking vonoprazan after ESD, abdominal pain and anorexia continued, and the gastric ulcer did not heal after the ESD. After discontinuing MTX, the patient’s symptoms improved and the ulcer healed. Patients taking MTX require careful follow-up after ESD, considering that ulcers can be difficult to heal. Discontinuation of MTX should be considered if delayed healing of an ulcer is observed.

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Abbreviations

ESD:

Endoscopic submucosal dissection

PPI:

Proton pump inhibitor

P-CAB:

Potassium-competitive acid blocker

MTX:

Methotrexate

EGD:

Esophagogastroduodenoscopy

PSL:

Prednisolone

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Authors and Affiliations

  1. Department of Gastroenterology, Shuto General Hospital, Kogaisaku 1000-1, Yanai, 742-0032, Japan

    Shu Kiyotoki, Ryo Kawasato, Takao Nakashima, Takakazu Furutani, Hirokazu Ozawa & Mitsuru Yasunaga

  2. Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Minamikogushi 1-1-1, Ube, 755-8505, Japan

    Jun Nishikawa

  3. Department of Oral and Maxillofacial Surgery, Shuto General Hospital, Kogaisaku 1000-1, Yanai, 742-0032, Japan

    Jutaro Miyamoto

  4. Department of Gastroenterology, Hikari Municipal Hikari General Hospital, 6-1 Hikarigaoka, Hikari, 743-8561, Japan

    Koji Tanigawa

  5. Department of Orthopedics, Hikari Municipal Hikari General Hospital, 6-1 Hikarigaoka, Hikari, 743-8561, Japan

    Seiji Tsuchida

  6. Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minamikogushi 1-1-1, Ube, 755-8505, Japan

    Isao Sakaida

Authors
  1. Shu Kiyotoki
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  2. Jun Nishikawa
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  3. Jutaro Miyamoto
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  4. Koji Tanigawa
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  5. Seiji Tsuchida
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  6. Ryo Kawasato
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  7. Takao Nakashima
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  8. Takakazu Furutani
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  9. Hirokazu Ozawa
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  10. Mitsuru Yasunaga
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  11. Isao Sakaida
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Corresponding author

Correspondence to Shu Kiyotoki.

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Conflict of interest

Shu Kiyotoki, Jun Nishikawa, Jutaro Miyamoto, Koji Tanigawa, Seiji Tsuchida, Ryo Kawasato, Takao Nakashima, Takakazu Furutani, Hirokazu Ozawa, Mitsuru Yasunaga and Isao Sakaida declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from this patient to be included in the case report.

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Kiyotoki, S., Nishikawa, J., Miyamoto, J. et al. Delay of endoscopic submucosal dissection-induced gastric ulcer healing by methotrexate. Clin J Gastroenterol 14, 754–758 (2021). https://doi.org/10.1007/s12328-021-01370-1

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  • DOI: https://doi.org/10.1007/s12328-021-01370-1

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