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Daily Medical Update
Peptic ulcer disease
Tuesday, June 09, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Langenbeck's archives of surgery (2025) - Network Meta-Analysis
Key Findings
- Laparoscopic repair reduced mortality versus open surgery, with an odds ratio of 0.36 (95% CI 0.17-0.75).
- Laparoscopic management reduced postoperative complications and improved length of stay versus open surgery.
- Network ranking showed improved overall performance for laparoscopic repair versus other surgical strategies for perforated peptic ulcers.
📋 Practice Implication: For perforated peptic ulcer, surgeons should preferentially use a laparoscopic approach when expertise and patient stability allow because it appears to improve survival and postoperative recovery.
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Gut and liver (2025) - Randomized Controlled Trial
Key Findings
- Fexuprazan achieved ulcer prevention outcomes comparable to lansoprazole over 24 weeks without reducing efficacy.
- Fexuprazan did not increase gastroduodenal bleeding rates compared with lansoprazole.
- Fexuprazan did not increase adverse event rates compared with lansoprazole.
📋 Practice Implication: In patients who need chronic NSAID therapy, fexuprazan is a reasonable prophylactic alternative to lansoprazole when a potassium-competitive acid blocker is preferred or already in use.
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Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2025) - Network Meta-Analysis
Key Findings
- Proton pump inhibitors improved prevention of recurrent NSAID-induced ulcers more than other single-drug strategies in high-risk patients.
- Cyclooxygenase-2 inhibitors showed less ulcer-prevention benefit and increased cardiovascular risk concerns.
- Combination regimens improved protection versus monotherapy in patients with prior ulcer history.
📋 Practice Implication: For patients at highest ulcer risk from NSAIDs, clinicians should keep PPIs as the preventive backbone and escalate to combination protection only when prior ulcer burden justifies the added complexity.
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The American journal of gastroenterology (2025) - Systematic Review
Key Findings
- Rebamipide significantly lowered the incidence of NSAID-induced gastrointestinal mucosal breaks versus placebo.
- Rebamipide did not reduce mucosal protection compared with standard proton pump inhibitors.
- Long-term rebamipide use did not significantly increase adverse events.
📋 Practice Implication: Rebamipide can be considered when standard PPI prophylaxis is undesirable, unavailable, or poorly tolerated, especially for patients needing ongoing NSAID exposure.
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Scientific reports (2025) - Randomized Controlled Trial
Key Findings
- Rebamipide plus tegoprazan produced a higher week-4 ulcer healing rate than tegoprazan alone (96.4% vs 93.6%).
- Combination therapy was associated with greater ulcer size reduction and better healing quality by week 8.
- Combination therapy did not increase adverse events versus tegoprazan monotherapy.
📋 Practice Implication: After endoscopic submucosal dissection, adding rebamipide to tegoprazan may be useful when faster healing quality is clinically important, such as in larger post-ESD ulcers.
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Summary
Recent peptic ulcer disease evidence is dominated by prevention and procedural management rather than new eradication strategies. Higher-significance studies support laparoscopic repair for perforated ulcers, confirm strong acid suppression for NSAID-related ulcer prevention, and suggest selected adjunctive mucosal protection can improve healing or reduce injury. The 2025 evidence base therefore reinforces risk-stratified prophylaxis and minimally invasive management for complicated ulcer presentations.
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