Peptic ulcers: treatment
Peptic ulcers occur in the stomach — gastric ulcers — and the duodenum (the first part of the small intestine) — duodenal ulcers. They result from an imbalance between the amount of acid in your stomach and its protective lining.
If you have an ulcer, it is very likely that you will be prescribed medication to help heal it. In the past it was believed that ulcers were caused by stress, poor eating habits, too much rich, fatty food or spicy food, alcohol or caffeine. Nowadays, doctors know that most peptic ulcers are caused by the Helicobacter pylori bacterium (also known as H. pylori). This is particularly true of duodenal ulcers.
Medications used today to treat peptic ulcers may be aimed at reducing the amount of acid in your stomach, protecting your ulcer from further damage, eradicating the H. pylori bacteria, or all of these.
H2 blockers or H2 antagonists (histamine receptor antagonists)
These include cimetidine (Tagamet), famotidine (Pepcidine), nizatidine (Tazac) and ranitidine (Zantac). They work by blocking the action of histamine, a substance which stimulates the secretion of stomach acid, thus reducing the amount of acid produced. Because less acid is being produced by the stomach, they relieve the pain of your ulcer.
H2 antagonists are very effective and have relatively few side effects, even with long-term use, but some people, particularly older people, may experience central nervous system related effects such as headaches, confusion and tiredness. H2 blockers will not cure ulcers caused by H. pylori in the long term, and are usually used to treat ulcers induced by taking medications such as aspirin or ibuprofen — the so-called non-steroidal anti-inflammatory drugs (NSAIDs).
Proton pump inhibitors
Doctors consider these medicines to be the most effective in holding back the production of stomach acid and one of these may be prescribed if you have severe symptoms which haven’t been helped by H2 blockers. They include esomeprazole (Nexium), lansoprazole (Zoton), omeprazole (Losec), pantoprazole (Somac) and rabeprazole (Pariet). They stop the mechanism that ‘pumps’ acid into the stomach, which reduces the amount of acid and so relieves ulcer pain.
Generally they are well tolerated, but the most common side effects, when they do occur, include headaches, nausea, and diarrhoea.
Proton pump inhibitors alone will not cure ulcers caused by Helicobacter pylori, but they may be used as part of a combination of medications to treat ulcers caused by H. pylori. These combinations are called triple therapies, because they combine a proton pump inhibitor, to reduce acid secretion, with 2 different antibiotics to kill the H. pylori bacteria.
Mucosal protective medicines
These medications protect the lining of the stomach from being eroded further by stomach acid. They are sometimes called cytoprotectants by doctors. Unlike H2 blockers and proton pump inhibitors, they do not reduce the amount of acid the stomach produces.
Sucralfate (Carafate) sticks to the ulcer, providing a protective barrier between the damaged area and the acid in the stomach. This gives the ulcer time to heal.
Misoprostol (Cytotec) is a synthetic version of prostaglandin, a substance naturally produced by the body. It protects the stomach lining by increasing the body’s production of protective mucus, and by increasing blood flow to the stomach. It can be taken by people who have ulcers which are caused by NSAIDs (see below) and who need to keep taking these medicines.
Combination therapy or triple therapy
Doctors now widely accept that the majority of duodenal ulcers and a large percentage of gastric ulcers are caused by the bacterium H. pylori. Most people with ulcers will be tested (usually with a special breath test) to see if they are infected with H. pylori. If you are infected with this bacterium, your doctor may decide to prescribe you antibiotics to eradicate it. Unfortunately, no single antibiotic is effective against H. pylori, so combination therapy is given to reduce the risk of the bacteria becoming resistant to treatment. Usually at least 3 drugs have to be taken 2 to 4 times a day for one to 2 weeks.
The antibiotics most commonly used in combination treatment are clarithromycin, amoxycillin, metronidazole and tetracycline. The antibiotics to kill the H. pylori bacteria are given together with either a proton pump inhibitor (such as omeprazole) to hold back acid and allow the ulcer time to heal or, more rarely, bismuth. Your doctor will advise you which combination will be most likely to work for you — convenient ‘combination packs’ containing all the medicines for the treatment are available under the Pharmaceutical Benefits Scheme.
This treatment has revolutionised the treatment of peptic ulcers worldwide. Depending on the medicines used, it can have a success rate of 80 to 90 per cent in eradicating ulcers.
It is vital that you follow the treatment exactly according to your doctor’s instructions — the success rate is much lower if the tablets are not taken as directed. Unfortunately, because a number of different medicines are used in the treatment, there is an increased risk of side effects that may include vomiting, dizziness, diarrhoea and yeast infections in women. Nevertheless, it is worth persisting because your ulcer will probably be eradicated if you complete the treatment. If metronidazole is included in your treatment, you should not drink alcohol while being treated or you will experience a very unpleasant reaction.
NSAID-induced ulcers
About 30 per cent of all gastric ulcers may be caused by the long-term use of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which are commonly used to treat arthritis. Some NSAIDs are more likely to cause ulcers than others. If possible, you should stop taking the NSAID and take one of the agents used to reduce acid secretion. This will allow the ulcer to heal without the aggravation of being bathed in so much stomach acid. If it's not possible for you to stop taking NSAIDs, a proton pump inhibitor or misoprostol may be prescribed to reduce damage from the NSAID.
Antacids
These medications neutralise the stomach’s acid and so usually give temporary relief from ulcer pain. They may also provide some protection to the lining of the stomach. There are many varieties available without a prescription. Ask your pharmacist for advice about which one would be best for you.
Your doctor may also give you dietary guidelines to follow, such as reducing or eliminating your intake of coffee and alcohol as it is possible they may stimulate acid production in the stomach.
If you are a smoker, your doctor may also recommend you stop smoking as it has been shown that smokers have a higher incidence of ulcer complications and that it takes longer to heal their ulcers than non-smokers.
Last Reviewed: 22 August 2008
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