The refractory ulcer

Abstract

The termrefractoryis applied to those ulcers that fail to heal despite 3 months of active treatment, recur within 1 year despite maintenance therapy with H2‐receptor antagonists, or, in the untreated state, persist without remission. Approximately 20–30% of ulcers fulfill 1 of these 3 criteria. Factors often associated with a refractory ulcer include large ulcer size, gastric outlet obstruction, hour‐glass deformity, penetration, Candida infection, and cimetidine resistance. Incomplete healing of the ulcer and/or initial treatment with H2‐receptor antagonists may predispose to a refractory long‐term course. Successful treatment of the refractory ulcer correlates more with duration of treatment than with the drug used. The more potent antisecretory agents, such as omeprazole, may be the drug of choice. The role of smoking and other environmental factors is not clear.

Sulphydryl-Containing Agents: A New Approach to the Problem of Refractory Peptic Ulceration

“…The present investigation studied pa tients with refractory peptic ulceration which remained unhealed after treatment for 3 months with cimetidine. Although bismuth chelate is a cytoprotective agent which pro motes healing of refractory ulceration [ 1 ]. ad dition of this agent to the cimetidine regimen for 1 month did not alter the state of ulcer ation.…”

“…The term refractory peptic ulceration can be applied to those ulcers which remain un healed after 3 months of active treatment [1], Based on initial healing rates alone [2], some 10% of duodenal ulceration is refractory. Sul phydryl-containing agents, such as DL-methionine-methyl sulphonium chloride (MMSC) and DL-cysteine, have been shown in the rat [3] to convey gastric mucosal cytoprotection by sustaining the physicochemical properties of the mucosal barrier, thus affording defence against injury by ischaemia or noxious sub stances like alcohol and acetylsalicylic acid.…”