Appearance of a gastric ulcer during diphosphonate therapy in a woman with CRST syndrome.

A 46-year-old woman with the CRST variant of scleroderma (calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasis) was treated with a diphosphonate (disodium etidronate) in an effort to reduce her dystrophic calcifications or retard their progression. After 18 months of therapy, no improvement in her calcinosis was noted. In addition, she developed bloody diarrhea, epigastric burning, and weight loss during the last two months of Therapy. Upper gastrointestinal series revealed a gastric ulcer. Endoscopy with biopsy proved it to be benign. Gastric ulcerations has been seen in animals given disodium etidronate but only at much higher doses than are currently recommended for humans. Although a cause and effect relationship cannot be established with certainty in this patient, it is suggested since she was not receiving other ulcerogenic drugs chronically. This information may be important to other investigators of disodium etidronate.