This report presents three unusual forms of resistant peptic ulcer disease, all healed completely with the use of a new class of anti-ulcer drug, a proton pump blocker, omeprazole. Each of these patients represents an unusual facet of acid-pepsin disease, namely, resistance to healing with current standard therapy, recurrence and rehealing with a second course of omcprazole, and a subsequent need for maintenance omeprazole to remain ulcer-free. The first patient had an unusual complication of a stomal ulcer after gastric bypass surgery for morbid obesity. This ulcer proved to be intractable, not healing with standard therapy, but healing with omeprazole, and subsequently recurring. A second course of therapy resulted in complete rehealing, but maintenance therapy with omeprazole was necessary to prevent ulcer recurrence. The second patient had rheumatoid arthritis and an NSAID associated chronic gastric ulcer which did not heal with standard therapy. A course of omeprazole resulted in complete healing; however, the ulcer recurred. A second course of omeprazole was necessary which led to complete healing, and subsequent maintenance therapy has kept this patient ulcer-free for the past 18 months. The third patient had recurrent circumferential esophageal ulcers following esophageal variceal sclerotherapy along with primary biliary cirrhosis. These ulcers took five months to heal on conventional therapy, but treatment with omeprazole resulted in healing within a three month time frame, and maintenance omeprazole has since kept this patient free from esophageal ulcers.
Early-TIPS Versus Current Standard Therapy for Acute Variceal Bleeding in Cirrhosis Patients: A Systemic Review With Meta-analysis
