{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:37:38Z","timestamp":1759937858679,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,9,18]]},"abstract":"<jats:p>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\u2005months prior. For this, he was on donepezil, a cholinesterase inhibitor (ChEI), with a recent dose increase 3\u2005months 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.<\/jats:p>","DOI":"10.1136\/bcr-2015-211859","type":"journal-article","created":{"date-parts":[[2015,9,29]],"date-time":"2015-09-29T07:32:46Z","timestamp":1443511966000},"page":"bcr2015211859","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Upper gastrointestinal bleed associated with cholinesterase inhibitor use"],"prefix":"10.1136","volume":"2015","author":[{"given":"Khoon-Sheng","family":"Kok","sequence":"first","affiliation":[{"name":"Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoon","family":"Loke","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo","family":"Southgate","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,9,29]]},"reference":[{"unstructured":"National Institute for Health and Clinical Excellence. 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NSAIDS\u2014prescribing issues. http:\/\/cks.nice.org.uk\/nsaids-prescribing-issues (accessed 1 Aug 2015).","key":"2025082804104204000_2015.sep29_1.bcr2015211859.12"},{"doi-asserted-by":"publisher","key":"2025082804104204000_2015.sep29_1.bcr2015211859.13","DOI":"10.1097\/MOG.0b013e328358d5b9"},{"doi-asserted-by":"publisher","key":"2025082804104204000_2015.sep29_1.bcr2015211859.14","DOI":"10.1001\/archinte.165.7.808"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2015-211859","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:51Z","timestamp":1756379451000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2015-211859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,29]]},"references-count":14,"alternative-id":["10.1136\/bcr-2015-211859"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2015-211859","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2015,9,29]]}}}