title: A Case of Refractory Gastric Cardia Ulcer in Which Marked Elevation of the Surrounding Mucosa was Observed During the Clinical Course.
abstract: A 55-year-old man visited our department because of epigastric pain. Upper gastrointestinal endoscopy revealed a small, undermined ulcer in the gastric cardia. He had no history of taking NSAIDs, and was positive forHelicobacter pylori(Hp) infection. After Hp eradication therapy followed by 8 weeks of proton pump inhibitor (PPI) administration, re-endoscopy showed that the ulcer had slightly shrunk without scarring, and the surrounding mucosa was markedly elevated, like in a submucosal tumor. Endoscopic ultrasonography, performed at the same time, showed thickening of the submucosal and muscular layers around the ulcer. After continuous PPI administration, the mucosal elevation disappeared, and the ulcer shrunk and later scarred. However, when the dose of PPI was reduced with the aim of discontinuing it after the confirmation of successful Hp eradication, the ulcer recurred. We report this case of gastric ulcer because of its peculiar clinical presentation.
authors: Division of Gastroenterology, Department of Internal Medicine, The International University of Health and Welfare, Shioya Hospital, Japan.
authors: Tateki
authors: T
authors: Yamane
authors: Division of Pulmonology, Department Of Internal Medicine, The International University of Health and Welfare, Shioya Hospital, Japan.
authors: Akira
authors: A
authors: Umeda
authors: Department of Surgery, The International University of Health and Welfare, Shioya Hospital, Japan.
authors: Hitoshi
authors: H
authors: Shimao
authors: Sanikukai Family Clinic, Japan.
authors: Takayuki
authors: T
authors: Ishii
keywords: High located gastric ulcer; Recurrence after Hp eradication; Refractory peptic ulcer