Diagnostic and Treatment Approaches for Refractory Peptic Ulcers

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.

Efficacy of Ayarij Faiqura in Qarah-e-Hazmiya - Randomized controlled Clinical study

“…Patients were divided into two groups of 20 in test and 8 in control group. The median VAS Score of burning sensation in abdomen in control group was 8 [8,8] on base line (0 day) and 3 [2,5] on 45th day, whereas in test group the median score was 8 [7,8] on baseline (0 day) and 0[0,3] on 45th day. When the median VAS Score of two groups were compared statistically using Friedman test with Dunn pair comparison test for intra-group comparison and Krushkall Wallis for inter group comparison, it was found that the median VAS Score at 30th and 45th day in control group was reduced significantly (P<0.01) when compared with median VAS Score0th day of control group.…”

“…The median VAS score of abdominal pain in control group was 8 [5,8] on base line (0 day) and 3 [1,5] on 45th day, whereas in test group the median VAS score was 8 [7,8] …”

“…4,5 Symptoms of PUD include abdominal pain, upper abdominal discomfort, bloatedness, feeling of fullness, vomiting, weight loss.…”

Management of non variceal upper gastrointestinal bleeding: Position paper statement of the Catalan Society of Gastroenterology

“…67 They should then continue to take a PPI for four weeks for a duodenal ulcer or for eight weeks in the case of a gastric ulcer (SR: strong; QE: high). 70 Differentiating between benign and malignant gastric ulcers is more difficult in UGIB, and biopsies should always be taken in the baseline endoscopy whenever possible. A double PPI dose is recommended for ulcers not infected by Hp in patients with no prior history of NSAIDs or antiplatelet drugs, or for refractory ulcers (SR: moderate; QE: strong).…”

Insights to Indications and Harm of Proton Pump Inhibitors Usage in Patients with Liver Cirrhosis

“…Currently, PPIs are the mainstay treatment option of peptic ulcers in the general population [13]. Helicobacter pylori infection contributes to the development of hyperammonemia [14] and subsequent episodes of hepatic encephalopathy in cirrhosis [15].…”