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Question

Dear sir , what is the latest / updated /evidenced based management protocol for Duodenal ulcer in an adolesent child , Pl specifically highlight indications for surgery . exclude conditons like perforation or an active open bleeder caught open in cicratrised tissue due to chronicity .Is there something as failure of conservative mangemnt - necessciating surgery. what is the maximum period Rantidine and omeprazole group of drugs are to be given trial . thanks Dr ( Lt Col )Alok Dubey

Answer

Operative intervention is indicated for massive intractable bleeding or perforation. Rarely, recurrent pyloric channel ulcers or prepyloric ulcers may result in gastric outlet obstruction, which requires an acid-reducing operation combined with a gastric-emptying procedure. Proton pump inhibitors and ranitidine may be given for 6-8 weeks. Post operatively they may be needed longer.
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