This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is the ascending colon of a 76-year-old woman with rheumatoid arthritis who has been on diclofenac and hydroxychloroquine for years and this lesion was identified and the question is what is the diagnosis? The key teaching point here is that this ulcer has the endoscopic appearance of a benign ulcer. There's nothing about the edge or lip, lack of lip at the margin of the ulcer or about the mucosa surrounding the ulcer that suggests neoplasia. This kind of non-specific benign ulceration is seen fairly commonly during colonoscopy even in patients who don't have Crohn's disease, don't have inflammatory bowel disease. Most commonly in the ascending colon and around the ileocecal valve. One of the most common causes of this is chronic NSAID or aspirin use. This in fact is an NSAID related ulcer. In this patient we would relate it to the chronic use of diclofenac. When you see this kind of thing it probably makes sense to take biopsy samples to document the ulceration with photography and use the biopsy samples to document that the histology is benign, but in fact the endoscopic appearance is remarkably specific for benign ulceration without neoplasia.

ASG video tip

benign ulcer

rheumatoid arthritis

diclofenac

hydroxychloroquine