Etiology and Therapeutic Strategies for Refractory Peptic Ulcers: A Comprehensive Review

Author: Su Bee PARK ¹
Author Information

1. Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
Publication Type:Review
From:The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2025;25(1):17-22
CountryRepublic of Korea
Language:Korean
Abstract: The leading causes of refractory peptic ulcers are Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs. Additionally, insufficient treatment for the suppression of gastric acid, smoking, alcohol consumption, and concomitant diseases can hinder recovery. Treatment includes the eradication of H. pylori, discontinuation of the causative agent, and appropriate suppression of gastric acid. Even after improvement of symptoms, sufficient proton pump inhibitor maintenance is necessary for 8 to 12 weeks. To increase the success rate of H. pylori eradication, it is essential to accurately determine the initial infection and for patients where treatment has failed due to antibiotic resistance, the success rate of treatment can be increased through sensitivity testing. Sometimes, evaluation for rare causes, such as Zollinger–Ellison syndrome, may be necessary, and follow-up gastroscopy must be performed to exclude the possibility of malignancy.