Management of peptic ulcer disease not related to Helicobacter pylori or NSAIDs.

摘要: Helicobacter pylori (H. pylori) infection is widely accepted as the most important factor in pathogenesis of duodenal ulcer. However, parallel with more effective eradication H. pylori, prevalence changing, and pylori-negative peptic ulcer disease appears to be increasing. When making a diagnosis disease, it essential avoid misclassification because inaccurate diagnosis. In addition, secondary causes may need excluded appropriate investigations. absence nonsteroidal anti-inflammatory drug usage common cause ulcer; surreptitious unexplained up 60% patients. Hypersecretory syndromes such Zollinger-Ellison syndrome, although rare, excluded. Once all known etiological factors are excluded, there remains group patients so-called "idiopathic ulcers." The interplay idiopathic poorly defined but include genetic predisposition, altered acid secretion, rapid gastric emptying, defective mucosal defense mechanisms, psychological stress, smoking. management ulcers not defined; they appear resistant standard therapy, can associated frequent complications, those that relapse require long-term maintenance therapy.