A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers
Journal
Korean Journal of Internal Medicine
Journal Volume
30
Journal Issue
5
Pages
559-570
Date Issued
2015
Author(s)
Abstract
An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. The first step in treatment is to exclude common possible causes, including Helicobacter pylori infection, infection with other pathogens, ulcerogenic drugs, and uncommon diseases with upper gastrointestinal manifestations. When all known causes are excluded, a diagnosis of idiopathic peptic ulcer can be made. A patient whose peptic ulcer is idiopathic may have a higher risk for complicated ulcer disease, a poorer response to gastric acid suppressants, and a higher recurrence rate after treatment. Risk factors associated with this disease may include genetic predisposition, older age, chronic mesenteric ischemia, smoking, concomitant diseases, a higher American Society of Anesthesiologists score, and higher stress. Therefore, the diagnosis and management of emerging disease should systematically explore all known causes and treat underlying disease, while including regular endoscopic surveillance to confirm ulcer healing and the use of proton-pump inhibitors on a case-by-case basis. ? 2015 The Korean Association of Internal Medicine.
SDGs
Other Subjects
acetylsalicylic acid; alendronic acid; antibiotic agent; bisphosphonic acid derivative; histamine H2 receptor antagonist; immunosuppressive agent; nonsteroid antiinflammatory agent; placebo; potassium chloride; prostaglandin; proton pump inhibitor; steroid; age; comorbidity; Crohn disease; diagnostic error; duodenum ulcer; endoscopy; false negative result; genetic predisposition; Helicobacter infection; human; idiopathic disease; idiopathic peptic ulcer; incidence; mental stress; mesenteric ischemia; peptic ulcer; peptic ulcer bleeding; prevalence; rapid urease test; recurrence risk; Review; smoking; stomach mucosa lesion; stomach ulcer; urea breath test; Zollinger Ellison syndrome; drug effects; gastrointestinal endoscopy; patient selection; peptic ulcer; predictive value; risk assessment; risk factor; treatment outcome; wound healing; Endoscopy, Gastrointestinal; Humans; Patient Selection; Peptic Ulcer; Predictive Value of Tests; Proton Pump Inhibitors; Risk Assessment; Risk Factors; Treatment Outcome; Wound Healing
Publisher
Korean Association of Internal Medicine
Type
review