Korean J Intern Med.  2015 Sep;30(5):559-570. 10.3904/kjim.2015.30.5.559.

A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers

• Chung CS
• Chiang TH
• Lee YC

• KMID: 2381553
• DOI: http://doi.org/10.3904/kjim.2015.30.5.559

Abstract

An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. The first step in treatment is to exclude common possible causes, including Helicobacter pylori infection, infection with other pathogens, ulcerogenic drugs, and uncommon diseases with upper gastrointestinal manifestations. When all known causes are excluded, a diagnosis of idiopathic peptic ulcer can be made. A patient whose peptic ulcer is idiopathic may have a higher risk for complicated ulcer disease, a poorer response to gastric acid suppressants, and a higher recurrence rate after treatment. Risk factors associated with this disease may include genetic predisposition, older age, chronic mesenteric ischemia, smoking, concomitant diseases, a higher American Society of Anesthesiologists score, and higher stress. Therefore, the diagnosis and management of emerging disease should systematically explore all known causes and treat underlying disease, while including regular endoscopic surveillance to confirm ulcer healing and the use of proton-pump inhibitors on a case-by-case basis.

Keyword

Idiopathic peptic ulcer; Helicobacter pylori infection; Endoscopy

MeSH Terms

Endoscopy, Gastrointestinal
Humans
Patient Selection
Peptic Ulcer/*diagnosis/etiology/*therapy
Predictive Value of Tests
Proton Pump Inhibitors/therapeutic use
Risk Assessment
Risk Factors
Treatment Outcome
Wound Healing/drug effects
Proton Pump Inhibitors