Korean J Helicobacter Up Gastrointest Res.  2019 Mar;19(1):5-9. 10.7704/kjhugr.2019.19.1.5.

Refractory Peptic Ulcer Disease

• Lim H

• KMID: 2440649
• DOI: http://doi.org/10.7704/kjhugr.2019.19.1.5

Abstract

The eradication of Helicobacter pylori and the widespread use of effective antisecretory therapies, including proton pump inhibitors, have improved the management of peptic ulcer disease. However, in some patients, peptic ulcer disease is refractory to 8 to 12 weeks of standard antisecretory drug treatment. For refractory peptic ulcer disease, further evaluation of the risk factors and causes of refractory peptic ulcer disease, including patient risk factors and noncompliance (smoking, nonsteroidal anti-inflammatory drug use, and noncompliance with medical treatment), persistent H. pylori infection, and non-H. pylori-related factors (giant ulcer, gastrinoma, infections other than H. pylori, and malignancy), is essential. The treatment should focus on the cause of the refractory peptic ulcer disease, avoiding smoking and nonsteroidal anti-inflammatory drug, the treatment of persistent H. pylori, use of high-dose proton pump inhibitors, or surgical excision of gastrinomas. Surgery should be considered in patients who are at high risk for complications and recurrent peptic ulcer disease despite medical treatment. In this review, I describe the diagnosis and treatment of refractory peptic ulcer disease.

Keyword

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

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Diagnosis
Gastrinoma
Helicobacter pylori
Humans
Peptic Ulcer*
Proton Pump Inhibitors
Risk Factors
Smoke
Smoking
Ulcer
Anti-Inflammatory Agents, Non-Steroidal
Proton Pump Inhibitors
Smoke