Severe and refractory peptic ulcer disease: The diagnostic dilemma. Case report and comprehensive review

James L. Guzzo, Mona Duncan, Barbara L. Bass, Grant V. Bochicchio, Lena M. Napolitano

Research output: Contribution to journalArticlepeer-review

Abstract

The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general surgeons. Surgery is reserved for complications of the disease, refractory disease, or rare causes of ulcer disease such as gastrinoma and Zollinger-Ellison syndrome. In this report, we describe a case of intractable peptic ulcer disease that progressed to gastric outlet obstruction despite maximal medical therapy. We review the diagnostic studies utilized to evaluate the potential etiologies of peptic ulcer disease and the difficulty in diagnosing gastrinoma and Zollinger-Ellison in the setting of potent medical acid suppression therapy.

Original languageEnglish (US)
Pages (from-to)1999-2008
Number of pages10
JournalDigestive Diseases and Sciences
Volume50
Issue number11
DOIs
StatePublished - Nov 2005
Externally publishedYes

Keywords

  • Gastrin
  • Helicobacter pylori
  • Hypersecretion
  • Peptic ulcer disease
  • Zollinger-Ellison syndrome

ASJC Scopus subject areas

  • Gastroenterology

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