A 71-year old man was admitted to the hospital after getting very dizzy upon rising from the toilet seat. At that time his pulse was racing and he remembers that his stool looked very different than usual. Over the last 4 or 5 weeks before the incident, the patient self-medicated with highdose ibuprofen 3 times a day to control some pain in his hips. What is the mechanism of action for nonsteroidal anti-inflammatory drugs (NSAIDs) to cause gastrointestinal bleeding?

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NSAIDs, like ibuprofen, inhibit the cyclooxygenase (COX) enzymes, which are crucial for the synthesis of prostaglandins. Prostaglandins help protect the gastric mucosa, so their inhibition can lead to gastrointestinal bleeding.  Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase and consequently inhibit synthesis of prostaglandins. In the stomach, prostaglandins have a cytoprotective effect through inhibition of acid secretion, enhancement of mucosal blood flow, and stimulation of bicarbonate and mucus secretion. Inhibiting these processes can cause stomach ulcers and bleeding such as described in the case

A 71-Year Old Man Was Admitted to the Hospital After