Clin Endosc.  2015 Jul;48(4):285-290. 10.5946/ce.2015.48.4.285.

Diagnostic and Treatment Approaches for Refractory Peptic Ulcers

• Kim HU

• KMID: 1964269
• DOI: http://doi.org/10.5946/ce.2015.48.4.285

Abstract

Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.

Keyword

Peptic ulcer; Ulcer, refractory; Helicobacter pylori; Anti-inflammatory agent, non-steroidal; Gastrins

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Blood Platelets
Fasting
Gastrins
Helicobacter pylori
Humans
Peptic Ulcer*
Plasma
Prostaglandin-Endoperoxide Synthases
Proton Pump Inhibitors
Serologic Tests
Smoke
Smoking
Ulcer
Zollinger-Ellison Syndrome
Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Gastrins
Prostaglandin-Endoperoxide Synthases
Proton Pump Inhibitors
Smoke

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