NSAID use and abuse in gastroenterology: refractory peptic ulcers

With current antiulcer therapies to eliminate H, pylori infection, non-ster oidal antiinflammatory drug use is the main factor involved in resistant pe ptic 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 erradication, NSAID use (especially aspirin abuse) in patients with resistant ulcers is often surreptitious. Ulcers ten d to complicate with stenosis and bleeding, commonly change site, are multi centric and have poorly defined margins. These patients should never underg o surgery unless they develop uncontrolled complications, since ulcer recur rence is the rule. Analgesic abuse and personality disorders might present in some of these patients. Refractory ulcers with no evidence of NSAID use and no evidence of H, pylori infection are rare but not exceptional. Smokin g 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.