Medical and surgical treatment of peptic ulcer disease

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Peptic ulcer therapy directed against Helicobacter pylori has become increasingly accepted, but traditional and alternative therapies are still valid and valuable. Reinfection rates after H. pylori eradication seem low enough (in industrialized countries) to expect continued remission for most subjects. Eradication has been achieved with a myriad of regimens; regimens with success rates less than 90% probably should not be chosen as first-line therapy. Courses of antibiotics that are too short may be detrimental. Anti-acid treatment is beneficial to maintain remission and patients may be able to control their own doses. A novel study has used oxygen-derived free radical scavengers to treat acute duodenal ulcer and maintain remission. Some patient groups, notably cirrhotics, are especially resistant to therapy. A wide variety of efficacious treatment and maintenance options currently exist and are responsible for the continued decline in surgery as definitive therapy for all but complicated ulcers.

Current Opinion in Gastroenterology 1993, 9:909-916

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