Question

What should be suspected if Mid-epigastric pain/ulcers don't improve with eradication of H.pylori, large, multiple or atypically located ulcers?

Answer 1

Possible causes of persistent ulcers that do not improve with H. pylori eradication include drug-induced ulcers, gastrinoma, malignancy, or Zollinger-Ellison syndrome.

Step-by-step explanation:

If mid-epigastric pain/ulcers do not improve with eradication of H. pylori or if they are large, multiple, or atypically located, there are a few possible causes that should be suspected:

1. Drug-induced ulcers: Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can cause ulcers that may not respond to H. pylori treatment.
2. Gastrinoma: This is a rare tumor that produces excessive gastrin, leading to multiple ulcers.
3. Malignancy: In some cases, ulcers that do not heal may be an indication of stomach cancer.
4. Zollinger-Ellison syndrome: This is a condition characterized by overproduction of gastrin, resulting in excessive acid secretion and multiple ulcers.

If the initial treatment for H. pylori and acid reduction does not lead to improvement, further investigation should be done to determine the underlying cause of the persistent ulcers.