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Friday, 2 September 2016

Refractory Peptic Ulcers: Underlying Causes That Shouldn't Be Missed

Despite the fact that treatment with twice daily proton pump inhibitors (PPIs) will result in healing of all benign ulcers, there are still a minority of patients who have ulcers refractory to treatment.

Image result for peptic ulcer 

Before considering the presence of an underlying pathology other than benign peptic ulcer disease, patient compliance with therapy should be ensured, as non-compliance is the most common cause.

Next to treatment non-compliance, are the use of aspirin and Non-steroidal anti-inflammatory drugs (NSAIDs), and the presence of H Pylori infection.

Other causes that must be suspected based on the clinical data:

Gastric adenocarcinoma
Gastric lymphoma
Zollinger-Ellison syndrome
Cameron ulcers (linear ulcers in large hiatus hernias)
Treatment with bisphosphonate
Crohn's disease
Infections: Cytomegalovirus (CMV), and mucormycosis

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