130203 20241125101146.0 doi 10.1080/14656566.2023.2199922 sideral 133558 ART-2023-133558 eng Borao Laguna, Cristina Advances in the pharmacotherapeutic management of refractory peptic ulcers 2023 Access copy available to the general public Unrestricted Introduction: Refractory peptic ulcer is now a rare disease since most peptic ulcers heal with appropriate treatment with proton pump inhibitors (PPIs) and/or Helicobacter pylori eradication. Areas covered: The most frequent cause of apparent refractoriness is lack of adherence to treatment. Persistence of H. pylori infection, use or abuse (often surreptitious) of high dose non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin (ASA) are the two major causes of true refractory ulcers. There is a growing number of peptic ulcers which are not linked to either NSAIDs or H. pylori infection. Refractoriness in these ulcers can be linked to gastric acid hypersecretion, rapid PPI metabolization, ischemia, chemo-radiotherapy, immune diseases, more rarely to other drugs or be fully idiopathic. Treatment of the cause of the ulcer, if known, is essential. This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to refractory peptic ulcer. Expert opinion: High-dose PPI or the new potassium competitive acid blocker or the combination of PPIs with misoprostol can be recommended in these cases. Other more experimental treatments such the topical application of platelet-rich plasma or mesenchymal stem cells have also been suggested. Surgery is the last option, but there is no guarantee of success, especially in NSAID or ASA abusers. info:eu-repo/semantics/openAccess by-nc-nd http://creativecommons.org/licenses/by-nc-nd/3.0/es/ 2.5 2023 PHARMACOLOGY & PHARMACY 180 / 354 = 0.508 2023 Q3 T2 0.687 2023 Medicine (miscellaneous) 2023 Q2 Pharmacology (medical) 2023 Q2 Pharmacology 2023 Q2 5.6 2023 info:eu-repo/semantics/review info:eu-repo/semantics/acceptedVersion Lanas, Ángel Universidad de Zaragoza (orcid)0000-0001-5932-2889 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 24, 7 (2023), 825-833 Expert opin. pharmacother. EXPERT OPINION ON PHARMACOTHERAPY 1465-6566 445802 http://zaguan.unizar.es/record/130203/files/texto_completo.pdf Postprint info:eu-repo/date/embargoEnd/2024-04-11 842185 http://zaguan.unizar.es/record/130203/files/texto_completo.jpg?subformat=icon icon Postprint info:eu-repo/date/embargoEnd/2024-04-11 oai:zaguan.unizar.es:130203 articulos driver 2024-11-22-12:04:34 ARTICLE