Case Study of a Refractory Idiopathic Peptic Ulcer in Which 24-h Intragastric pH Monitoring Contributed to Its Pathophysiological Analysis.

IF 0.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Case Reports in Gastroenterology Pub Date : 2024-07-31 eCollection Date: 2024-01-01 DOI:10.1159/000540185

Tomoyo Iwano, Tsutomu Takeda, Shotaro Oki, Yasuko Uemura, Momoko Yamamoto, Ryota Uchida, Hisanori Utsunomiya, Daiki Abe, Nobuyuki Suzuki, Atsushi Ikeda, Yoichi Akazawa, Kumiko Ueda, Hiroya Ueyama, Mariko Hojo, Akihito Nagahara

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Abstract

Introduction: In recent years, the frequency of idiopathic peptic ulcers (IPUs) has increased. However, the clinicopathological characteristics of IPU have not been fully elucidated and treatment methods for recurrent and refractory cases have not yet been established.

Case presentation: A man in his forties complained of epigastric discomfort. Esophagogastroduodenoscopy revealed a gastric ulcer in the lesser curvature of the gastric angle. After Helicobacter pylori was eradicated, the gastric ulcer recurred despite the administration of a potassium competitive acid blocker (PCAB), and a diagnosis of IPU was made. Twenty-four-hour intragastric pH monitoring revealed insufficient gastric acid suppression. Misoprostol was added to the patient's treatment. Subsequently, the ulcer healed and recurrence was not observed.

Conclusion: For refractory IPU, the evaluation of pathophysiological function through 24-h gastric pH monitoring may lead to the selection of an appropriate treatment. If a proton pump inhibitor and PCAB do not improve the IPU, combination treatment with misoprostol may be considered as an option.

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难治性特发性消化性溃疡病例研究，其中 24 小时胃内 pH 值监测有助于病理生理学分析。

简介近年来，特发性消化性溃疡（IPU）的发病率越来越高。然而，特发性消化性溃疡的临床病理特征尚未完全阐明，针对复发性和难治性病例的治疗方法也尚未确立：病例介绍：一名四十多岁的男子主诉上腹不适。食管胃十二指肠镜检查发现胃小弯处有一个胃溃疡。幽门螺杆菌被根除后，尽管服用了竞争性钾酸阻滞剂（PCAB），胃溃疡还是复发了，因此被诊断为 IPU。24 小时胃内 pH 监测显示胃酸抑制不足。患者的治疗中增加了米索前列醇。随后，溃疡愈合，未见复发：结论：对于难治性 IPU，通过 24 小时胃酸 pH 值监测评估病理生理功能，可以选择适当的治疗方法。如果质子泵抑制剂和 PCAB 不能改善 IPU，可以考虑选择米索前列醇联合治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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