caa a22 4500 475802454 CHVBK 20180406123741.0 cr unu---uuuuu 170329e20000301xx s 000 0 eng 10.1007/s002689910040 doi (NATIONALLICENCE)springer-10.1007/s002689910040 Freston James W. Office of Clinical Research, University of Connecticut Health Center, 263 Farmington Avenue, MC 2806, Farmington, Connecticut 06030, USA, US aut Management of Peptic Ulcers: Emerging Issues [Elektronische Daten] [James W. Freston] Most peptic ulcers are caused by Helicobacter pylori infection. The infection is best diagnosed by a radiolabeled carbon urea breath test, which also can prove that eradication therapy was successful. Serologic testing is useful for establishing prior or present infection but not to determine if the infection has been eradicated. Endoscopic tests usually are not needed to establish a diagnosis. Modern ulcer treatment consists of H. pylori eradication in infected patients. A combination of a proton pump inhibitor plus clarithromycin and amoxicillin or a proton pump inhibitor plus bismuth, metronidazole, and tetracycline are the most effective regimens. Reinfection is less than 2% per year in developed countries. Evidence suggests that H. pylori eradication may foster the development of erosive esophagitis, but confirmatory studies are needed. Studies also suggest an interaction between H. pylori infection and peptic ulcers related to the use of nonsteroidal antiinflammatory drugs (NSAIDs). However, the studies are conflicting: One shows that H. pylori eradication protects against NSAID-related ulcers; another suggests protection afforded by the infection. Non-H. pylori peptic ulcers remain a challenge, especially in the United States, where one study showed that 42% of peptic ulcers were not due to the infection. Some non-H. pylori ulcers are refractory to usual doses of antisecretory drugs. by the Société Internationale de Chirurgie, 2000 World Journal of Surgery Springer-Verlag 24/3(2000-03-01), 250-255 0364-2313 24:3<250 2000 24 268 https://doi.org/10.1007/s002689910040 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910040 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Freston James W. Office of Clinical Research, University of Connecticut Health Center, 263 Farmington Avenue, MC 2806, Farmington, Connecticut 06030, USA, US aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/3(2000-03-01), 250-255 0364-2313 24:3<250 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer