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Abstract
Refractory PUD is a diagnostic and therapeutic challenge. Optimal management of severe
or refractory PUD requires a multidisciplinary team approach, using primary care providers,
gastroenterologists, and general surgeons. Medical management has become the cornerstone
of therapy. Identification and eradication of H pylori infection combined with acid
reduction regimens can heal ulceration and also prevent recurrence. Severe, intractable
or recurrent PUD and associated complications mandates a careful and methodical evaluation
and management strategy to determine the potential etiologies and necessary treatment
(medical or surgical) required.