Refractory Peptic Ulcer Disease: Listen for the Cause

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Refractory Peptic Ulcer Disease: Listen for the Cause Prangthip Charoenpong, MD, Nilubon Methachittiphan, MD, Thoetchai Peeraphatdit, MD, Niyada Naksuk, MD The American Journal of Medicine Volume 127, Issue 2, Pages e5-e6 (February 2014) DOI: 10.1016/j.amjmed.2013.08.032 Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure (A) Esophagoduodenoscopy revealed multiple nonbleeding, irregular, and superficial ulcers in the gastric fundus and body. (B) Gastric ulcer biopsy revealed debris and nonulcerated mucosa with lamina propria fibrosis and glandular atrophy. Although rarely seen in the stomach, these histologic findings are suggestive of an ischemic process. (C) Abdominal computed tomography (CT) angiography showed severe stenosis at the origin of the celiac artery (arrow). (D) CT image reconstruction demonstrated severe stenosis at the origins of the celiac and superior mesenteric arteries (arrows). The American Journal of Medicine 2014 127, e5-e6DOI: (10.1016/j.amjmed.2013.08.032) Copyright © 2014 Elsevier Inc. Terms and Conditions