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Napolitano L - Refractory peptic ulcer disease (PUD) manifests as either hemorrhagic complications (persistent or recurrent bleeding) or gastrointestinal (GI) complications (perforation, stricture, obstruction). Treatment strategies for hemorrhagic complications include Endoscopic therapy, surgery, and transcatheter angiographic embolization. Treatment strategies for GI complications include endoscopic dilation for stricture and surgery for perforation and obstruction.

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