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Answer 6
  1. High-dose PPI therapy. The patient has developed gastric outlet obstruction as a consequence of peptic ulcers. This is a rare but serious complication. First-line therapy is high-dose PPI therapy, preferably administered intravenously, to treat the gastric inflammation and the ulcers themselves. H2 blockers would not provide adequate acid suppression. Dilation could be considered as a second-line approach if the patient does not respond to PPI therapy. Dilation in the acute phase may precipitate bleeding of the ulcers. Surgical evaluation could be considered if both medical and endoscopic therapy fail to relieve the patient’s gastric outlet obstruction. Gastroduodenal stenting is generally contraindicated for benign disease and is reserved for malignant obstruction and should thus be avoided.3

    3. Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci 1999;44:1883–6.

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