Refractory gastroduodenal ulcers: investigating non-peptic etiologies.

This article presents two clinical cases of gastroduodenal peptic ulcers refractory to medical treatment. In both cases, malignancy was excluded following persistent lesions observed in repeated endoscopies, leading to the use of surgery as both a diagnostic and therapeutic approach. These refractory cases require a multidisciplinary approach with a broad differential diagnosis, including etiologies such as toxic substance exposure, persistent Helicobacter pylori infection, or poor adherence to medical treatment, along with less common conditions such as malignancy, acid hypersecretion syndromes, vascular disorders, or immune-mediated diseases.