Peptic ulcer disease failure

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Although the risk of GI complications is relatively small with short-term therapy, coadministration with a proton pump inhibitor should be considered in elderly patients and others at increased GI risk. NSAIDs should be used with caution in individuals with a history of peptic ulcer disease, heart failure, uncontrolled hypertension, renal insufficiency, coronary artery disease, or if they are receiving anticoagulants concurrently. 

Finally, it is universally accepted at present that Helicobacter pylori infection has a definitive ethiological role in peptic ulcer disease, and that erradication therapy is warranted in these clinical scenarios. The majority of therapeutic trials have included the application of triple therapy with proton pump inhibitors or ranitidine bismuth citrate, clarithromycin and either amoxycillin or metronidazol and is to date the treatment of choice. However, recent studies have reported antibiotic resistance which can be one reason for failure of treatment of Helicobacter pylori infection [101-103], and new treatment strategies are therefore Wellcome. Flavonoids, in addition to their gastroprotective activity previously commented, have been also shown to inhibit Helicobacter pylori growth in vitro. In this way, Beil et al. [50]... 

Patients with peptic ulcer disease who develop recurrent ulcer signs or symptoms of Cl bleeding or perforation should be referred to a specialist. Assess reasons for therapeutic failure, including noncompliance to the drug regimen, antibiotic resistance (HPeradication), heavy smoking, NSAID use, and the need for HP eradication in a patient on conventional antiulcer medications. 

Individuals with contraindications to NSAIDs (e.g., active peptic ulcer disease, renal impairment, heart failure, or history of hypersensitivity) or individuals who cannot ingest medications orally may be treated with intravenous corticosteroids or intra-articular corticosteroids. 

Because of parasympathetic predominance , contraindicated in patients with congestive heart failure, asthma, bronchitis, peptic ulcer disease. Patients with family history of depression. 

In patients with peptic ulcer disease (duodenal ulcers) on medical treatment whose ulcer fails to heal after 12 weeks of treatment. The tests may establish the reason for the failure, e.g. a missed gastrinoma, reveal the need for a higher therapeutic drug dosage, or even establish the need for a switch to a more potent antisecretory drug. 

Relative active or latent peptic ulcer disease, recent intestinal anastomoses, nonspecific ulcerative colitis (increased risk of perforation), diabetes, adrenocortical insufficiency (may persist for months after discontinuing therapy), active or latent tuberculosis, cerebral malaria, chicken pox, meades, latent amebiasis or strongyloides infection, inactivated viral or bacterial vaccines where antibody response may not be induced, cirrhosis, congestive heart failure, renal failure or hypertension (increased risk of sodium retention, edema and potassium loss), hypokalemia or hypocalcemia, emotional instability or psychotic tendencies, hypothyroidism, growth retardation in infants and children. 

Other current nonmalignant disease or disorder, for example, congestive heart failure or peptic ulcer, that may or may not be related to the malignant disease... 

Concurrent colonization by Gram-negative bacilli occurs in some patients with failure of the gastric acid barrier, suggesting additional deficiencies of host defense abnormal oral flora, malnutrition, general illness, or diseases or medication interfering with intestinal peristalsis and clearance. This type of microflora is also seen in 10-30% of patients on acid inhibitors, for which mucosal injury and functional changes related to peptic ulcer and reflux disease may be responsible. 

Glucocorticoids must be used with great caution in patients with peptic ulcer, heart disease or hypertension with heart failure, certain infectious illnesses such as varicella and tuberculosis, psychoses, diabetes, osteoporosis, or glaucoma. 

NS AID, moderate or severe heart failure, patients with active peptic ulceration, ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, inflammatory bowel disease, uncontrolled hypertension, pregnancy, breastfeeding... 

Thyroid disorders (hypothyroidism or hyperthyroidism) Cardiovascular disease (arrhythmias, congestive heart failure) Gastrointestinal disease or disorder (sprue or other malabsorption syndromes, peptic ulcer, cohtis)... 

Naproxen should be given with care to patients with asthma or bronchospasm, bleeding disorders, cardiovascular disease, peptic ulceration or a history of such ulceration, renal failure, and in those who are recieving coumarin anticoagulants. Patients who are sensitive to aspirin should generally not be given naproxen (5). 

Key contraindications include congestive heart failure (New York Heart Association class II-IV), inadequately controlled hypertension with persistent BP elevation >140/90 mmHg, established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease, active peptic ulceration or GI bleeding, creatinine clearance <30 mL/min, or severe hepatic dysfunction [4],... 

Nevertheless, there does appear to be a group of patients in whom ulcers recur even after successful eradication of H. pylori. In such instances, once other causes of therapeutic failure (noncompliance, salicylate abuse, NSAIDs, gastrinoma) have been eliminated, maintenance antisecretory therapy should be considered. Long-term antisecretory agents should thus be reserved for individuals in whom at least two attempts at H. pylori eradication have failed or in those who have H. pylori-negatiwe peptic disease, and possibly in individuals with complicated ulcers, particularly those prone to recurrent bleeding. 

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