A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers.
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.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Chen-Shuan
CS
Chung
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Tsung-Hsien
TH
Chiang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yi-Chia
YC
Lee
D016099:Endoscopy, Gastrointestinal; D006801:Humans; D018579:Patient Selection; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D054328:Proton Pump Inhibitors
Endoscopy; Helicobacter pylori infection; Idiopathic peptic ulcer