Refractory Peptic Ulcer Disease
Korean J Helicobacter Up Gastrointest Res 2019;19(1):5-9
Published online March 10, 2019
© 2019 Korean College of Helicobacter and Upper Gastrointestinal Research.

Hyun Lim

Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
Correspondence to: Hyun Lim
Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea
Tel: +82-31-380-3704, Fax: +82-31-386-2269, E-mail: lh10004ok@hanmail.net
Received May 29, 2018; Revised June 25, 2018; Accepted June 28, 2018.
The Korean Journal of Helicobacter and Upper Gastrointestinal Research is an Open-Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Anti-inflammatory agents, non-steroidal; Helicobacter pylori; Peptic ulcer; Ulcer, refractory


March 2019, 19 (1)
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