{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:37:54Z","timestamp":1777405074439,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:00Z","timestamp":1637366400000},"content-version":"vor","delay-in-days":323,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Topical forms of nonsteroidal anti\u2010inflammatory drugs (NSAIDs) have been created\u2009to lessen\u2009systemic adverse effects.\u2009In general, they are believed to be well tolerated\u2009and appropriate for use as an\u2009over\u2010the\u2010counter (OTC)\u2009drug.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>A 68\u2010year\u2010old woman visited our clinic due to tarry stool. The patient reported multiple episodes of recurrent bleeding from a gastric ulcer for 2\u2009months and was treated with endoscopic hemostatic clipping. The patient disclosed she had been using a large number of diclofenac patches for more than 3\u2009months. The patient was treated conservatively by discontinuation of\u2009diclofenac patches and treatment with a proton pump inhibitor\u2009and omeprazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, inappropriate use of\u2009topical NSAID patches can be a cause of peptic ulcer bleeding.\u2009Patients reporting multiple episodes of recurrent bleeding from a gastric ulcer should be questioned, particularly about the use of OTC medications that might include topical NSAID patches.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ams2.710","type":"journal-article","created":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T08:54:29Z","timestamp":1637398469000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4230-3328","authenticated-orcid":false,"given":"Yuta","family":"Oda","sequence":"first","affiliation":[{"name":"Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiromichi","family":"Naito","sequence":"additional","affiliation":[{"name":"Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0768-0179","authenticated-orcid":false,"given":"Tsuyoshi","family":"Nojima","sequence":"additional","affiliation":[{"name":"Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6818-2985","authenticated-orcid":false,"given":"Atsunori","family":"Nakao","sequence":"additional","affiliation":[{"name":"Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,11,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2017.1390602"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200060030-00004"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a117563"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199906173402407"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1134"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00126839-200506060-00003"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.53.1669"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2005.02484.x"},{"key":"e_1_2_6_10_1","first-page":"95","article-title":"Pharmacokinetics of diclofenac hydroxyethylpyrrolidine (DHEP) plasters in patients with monolateral knee joint effusion","volume":"19","author":"Gallacchi G","year":"1993","journal-title":"Drugs Exp Clin Res"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcg.0000225610.41105.7f"}],"container-title":["Acute Medicine &amp; 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