NAMAT blog

peptic ulcer  is a sore in digestive tract lining.

Treatment:

Treatment for peptic ulcers depends on the cause.

• Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication.

Medications can include:

• Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

• Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).

Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.

• Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).

Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.

Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.

• Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.

Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

Treatment therapies:

There are two treatment therapies for peptic ulcers.These therapies are,

• Triple therapy
• Quadruple therapy  

Refractory ulcers:

Peptic ulcers that don’t heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:

1. Not taking medications according to directions
2. The fact that some types of H. pylori are resistant to antibiotics
3. Regular use of tobacco
4. Regular use of pain relievers — NSAIDs and aspirin — that increase the risk of ulcers

Less often, refractory ulcers may be a result of:

1. Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
2. An infection other than H. pylori
3. Stomach cancer
4. Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn’s disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.

The following treatments are recommended for refractory ulcers:

1.  Lifestyle changes: Quit smoking, avoid alcohol, aspirin, and NSAIDs
2. Acid-blocking medications
3. Medications that protect the lining of the stomach and duodenum
4. “Triple-therapy” or “dual-therapy” regimens for ulcers caused by H pylori
5. No single medication works to get rid of H pylori infection.

If you have a serious complication from an ulcer, such as acute bleeding or a perforation, you may require surgery. However, surgery is needed far less often than previously because of the many effective medications now available.