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Refractory duodenal ulcer.
1Department of Medicine, Gastroenterology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Summary
Refractory ulcers fail to heal despite treatment. Thorough re-evaluation and aggressive medical management can effectively heal these persistent peptic ulcers.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Refractory ulcers are defined as peptic ulcers failing to heal after 8-12 weeks of standard antiulcer therapy.
- Up to 25% of patients with refractory ulcers may be asymptomatic, complicating diagnosis.
- Factors like NSAID use, noncompliance, and acid hypersecretion contribute to refractory ulcers.
Purpose of the Study:
- To define refractory ulcers and outline diagnostic and management strategies.
- To differentiate refractory peptic ulcers from nonpeptic conditions and H. pylori-related ulcers.
- To emphasize the efficacy of aggressive medical management for refractory ulcers.
Main Methods:
- Review of clinical definitions and associated factors for refractory ulcers.
- Discussion of diagnostic approaches including endoscopy, biopsies, and serum gastrin levels.
- Outline of treatment strategies, including medical management and surgical indications.
Main Results:
- Nonpeptic ulcers (tuberculosis, malignancy) and H. pylori colonization require specific consideration.
- Thorough re-evaluation is crucial for identifying underlying causes.
- Aggressive medical management, often with multiple antiulcer drugs, achieves high healing rates.
Conclusions:
- Refractory ulcers necessitate a comprehensive diagnostic workup to exclude other pathologies.
- Optimal medical therapy is highly effective in healing refractory ulcers.
- Surgery is reserved for refractory cases unresponsive to medical treatment or with complications.
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