Refractory peptic ulcer disease - UpToDate
A peptic ulcer is an excavated defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper layers of the wall. Most peptic ulcers respond to treatment with antimicrobial therapy for Helicobacter pylori, withdrawal of nonsteroidal antiinflammatory drugs, or treatment with antisecretory drugs. However, in some individuals, the ulcer is either refractory to conventional therapy or recurs following successful initial treatment. This topic will review the factors associated with refractory ulcer disease, and their diagnosis and management. The clinical manifestations, diagnosis, and initial management of peptic ulcer disease are discussed in detail, separately. (See "Peptic ulcer disease: Clinical manifestations and diagnosis" and "Peptic ulcer disease: Treatment and secondary prevention".) TERMINOLOGY Refractory peptic ulcer — A refractory peptic ulcer is defined as an endoscopically proven ulcer greater than 5 mm in diameter that does not heal after
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