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Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma

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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.

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Authors and Affiliations

  1. Departments of Surgery, University of Maryland, Baltimore, Maryland

    James L. Guzzo MD, Mona Duncan MD, Barbara L. Bass MD & Grant V. Bochicchio MD, MPH,

  2. University of Michigan, Room 1C421 University Hospital, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109-0033, USA

    Lena M. Napolitano MD

Authors
  1. James L. Guzzo MD
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  2. Mona Duncan MD
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  3. Barbara L. Bass MD
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  4. Grant V. Bochicchio MD, MPH,
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  5. Lena M. Napolitano MD
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Correspondence to Lena M. Napolitano MD.

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Guzzo, J.L., Duncan, M., Bass, B.L. et al. Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma. Dig Dis Sci 50, 1999–2008 (2005). https://doi.org/10.1007/s10620-005-2999-5

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  • DOI: https://doi.org/10.1007/s10620-005-2999-5

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