Surreptitious use of salicylates: a cause of chronic recurrent gastroduodenal ulcers.

We describe five patients who had chronic recurrent gastroduodenal ulcers and pain, intestinal obstruction, bleeding, or a combination of these symptoms. Four patients required surgical intervention because of a poor response to medical therapy. The ulcers recurred in all patients, despite evidence of achlorhydria in two of them. Although the patients denied the use of salicylates, all of them had therapeutic blood levels of salicylates. A salicylate level should be determined in patients with severe ulcer disease that is resistant to medical therapy or that is recurrent after appropriate surgical therapy when the presence of hypergastrinemia or hyperchlorhydria has been definitely excluded. A low serum level of uric acid can also be a clue to the abuse of salicylates.