Acta gastro-enterologica Belgica
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Acta Gastroenterol. Belg. · Oct 1999
NSAID use and abuse in gastroenterology: refractory peptic ulcers.
With current antiulcer therapies to eliminate H. pylori infection, non-steroidal antiinflammatory drug use is the main factor involved in resistant peptic ulcers which must be defined as those ulcers that do not heal after 6 (duodenal ulcers) or 8 (gastric ulcers) weeks of treatment with proton pump inhibitors, despite H. pylori eradication. NSAID use (especially aspirin abuse) in patients with resistant ulcers is often surreptitious. Ulcers tend to complicate with stenosis and bleeding, commonly change site, are multicentric and have poorly defined margins. ⋯ Refractory ulcers with no evidence of NSAID use and no evidence of H. pylori infection are rare but not exceptional. Smoking and genetic background seem important factors in patients with this type of ulcers. Idiopathic basal gastric acid hypersecretion might be important in a few patients, but the Zollinguer-Ellison syndrome must be ruled out.