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Treating nonhealing ulcers
Gastric ulcers that have not healed after eight weeks of conventional medical therapy should be re-evaluated by multiple endoscopic biopsies to rule out gastric carcinoma. If no malignancy is seen in the biopsies, aggressive treatment should be instituted for six more weeks to eradicate H. pylori and to suppress acid with full doses of a proton pump inhibitor medication. A gastric ulcer that does not heal after this second aggressive course of medical therapy may suggest underlying malignancy, even with negative repeat biopsies. At this point, nonhealing gastric ulcers should undergo further evaluation with endoscopic ultrasound and deeper biopsies.
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