Nonpharmacologic Therapy

© Patients with PUD should avoid exposure to factors known to worsen the disease, exacerbate symptoms, or lead to ulcer recurrence. Patients should be advised to reduce psychological stress and avoid cigarette smoking, alcohol consumption, foods or beverages that exacerbate ulcer symptoms, and NSAID or aspirin use.10,1 Patients who require chronic NSAID therapy (e.g., rheumatoid arthritis) may be given prophylaxis with misoprostol or a PPI (see Treatment of NSAID-Induced Ulcers).

The high-success rates of medical therapies have reduced the number of surgical procedures performed and relegated surgery primarily to elective situations. For this reason, surgical interventions are generally reserved for complicated or refractory PUD. Some surgical procedures include: (a) vagotomy and pyloroplasty; (b) highly selective vagotomy; or (c) vagotomy combined with antrectomy. Vagotomy is the central component of most procedures because of its targeted effects on blocking further acid secretion. These procedures have a high success rate. Complications are rare but can include dumping syndrome, bile reflux, diarrhea, malabsorption, and gastric atony.12

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