Most peptic ulcers respond to life style changes and appropriate medications. However, a number of ulcers are refractory to standard therapy. Often one or more underlying explanations can be found.


Risk factors for a refractory peptic ulcer:

(1) noncompliance in taking medications

(2) noncompliance with lifestyle changes (cigarette smoking, liquor, other)

(3) continued physiologic or psychological stress

(4) infection with Helicobacter pylori resistant to antibiotic therapy

(5) use of NSAIDS or other medications associated with peptic ulceration

(6) gastrinoma with Zollinger-Ellison syndrome

(7) history of abdominal radiation therapy

(8) malignant tumor

(9) outflow obstruction or stenosis


A patient who continues to be refractory to optimum medical management may require a more extensive diagnostic evaluation and eventual surgical management.


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