Study of outcome after targeted intervention for peptic ulcer resistant toacid suppression therapy

OBJECTIVE: Different factors might affect outcome in ulcers resistant to an tisecretory therapy. The aim of the study was to define the odds of resista nt ulcers being associated with NSAID use, and/or Helicobacter pylori (H. p ylori) infection, or neither. METHODS: A total of 80 patients with resistant peptic ulcers were prospecti vely followed after targeted intervention for a mean follow-up of 39.5 +/- 6.9 months. RESULTS: NSAID use was involved in 24 cases (14 with and 10 without concomi tant H, pylori infection), H. pylori alone was involved in 44, and 12 patie nts had neither factor present. Of the NSAID group, resistant ulcers healed in patients who stopped taking NSAIDs. Those continuing to use NSAIDs (10 of 24; 41.6%) had either persistent ulceration or ulcer complications despi te H. pylori eradication and omeprazole therapy. Of the H. pylori group, in fection eradication induced ulcer remission in most patients, but those wit h persistent infection and a small subset of H. pylori eradicated patients (16.6%) had persistent/recurrent ulceration. Of the 12 refractory patients with neither NSAID use nor H. pylori infection, three had persistent ulcera tion but nine were controlled with antisecretory agents. Other factors (e.g ., smoking or acid hypersecretion) were not associated with final outcome a fter targeted intervention of H. pylori infection and NSAID use. CONCLUSIONS: With current antiulcer therapies, NSAID use is the main, but n ot the exclusive, factor leading to intractability and complications in ref ractory ulcers. In a subset of resistant ulcers, neither the presence of H. pylori nor use of NSAIDs are involved. In this study, despite specific the rapeutic intervention, 22.5% of patients with resistant ulcers had continui ng ulcer problems. (C) 2000 by Am. Cell. of Gastroenterology.