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Peptic ulcer disease (PUD) develops in approximately 25% of chronic users of non-steroidal anti-inflammatory drugs (NSAIDs). The incidence of uncomplicated PUD has been declining over the past 3 decades unlike that of complicated PUD in the elderly. An expert consensus document published jointly in 2008 by the American College of Gastroenterology (ACG), the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA) provided recommendations on prevention of PUD among users of antiplatelets and anticoagulants. This work aimed to evaluate physicians’ compliance with these guidelines in a tertiary academic setting. We examined our medical record database for the 9 month period extending from April 2018 until December 2018. Using this database, we identified elderly patients (> 64 years old) who were chronic (> 3 months) users of low dose aspirin (81 mg once daily) and had an indication for PUD prophylaxis as per the ACG–ACCF–AHA guideline document. We performed a retrospective chart review of patients included in this study. Descriptive statistics were compared using χ2 and independent sample t tests. A total of 852 patients were included in this study. The mean age was 75 years old, and 43% of patients were females. In addition to aspirin, patients were prescribed P2Y12 inhibitors (45.5%), direct oral anticoagulants (DOACs) (23%), warfarin (12%), steroids (9%) or enoxaparin (1%). Users of DOACs were most commonly prescribed apixaban (16%), followed by rivaroxaban (6%) and dabigatran (1%). Overall, only 40% of patients with an indication for PUD prophylaxis received a proton pump inhibitor. PUD prophylaxis may be underutilized in elderly patients. This finding, along with increasing rates of NSAID use and an aging population, may help explain the increased incidence of complicated PUD in the elderly. Efforts are needed to raise physician awareness of PUD prophylaxis guidelines.

Background Autoimmune hepatitis (AIH) is an extremely rare complication of anastrozole therapy. It presents with elevated liver function tests. The diagnosis is established by detecting high titers of autoantibodies such as antinuclear antibodies, anti-smooth muscle antibodies, and elevated immunoglobulins. It is confirmed with a liver biopsy showing interface rosetting and an increased number of plasma cells. Early diagnosis of anastrozole-induced AIH is important because it allows anastrozole to be discontinued and immunomodulatory treatment to be promptly initiated. Case report We present the case of a 71-year-old female patient diagnosed with early-stage breast cancer. The patient developed AIH as a result of treatment with anastrozole. Its clinicopathological presentation, diagnosis, and treatment are reviewed. Conclusion This case report intends to make clinicians aware of this rare complication of anastrozole therapy. AIH should be suspected in any patient on anastrozole (and possibly, other aromatase inhibitors) who develops elevated liver function tests.