Treatment of H. pylori peptic ulcers
Peptic ulcers that are caused by H. pylori are treated with medications to accomplish 3 different goals:
- to kill the H. pylori bacteria
- to reduce the amount of acid in your stomach and duodenum
- to protect the lining of your stomach and duodenum
Killing the bacteria
Antibiotics are used to kill the H. pylori bacteria, curing your bacterial infection. Usually at least 2 different kinds of antibiotics are used at the same time. The antibiotics most commonly used to treat H. pylori infections include metronidazole, tetracycline, clarithromycin, and amoxicillin. A 2-week course of treatment with the antibiotics is usually prescribed.
Reducing the stomach acid
There are 2 different types of medications that suppress the acid in your stomach. They are H2-receptor antagonists and proton pump inhibitors.
- H2-receptor antagonists
These include: famotidine (Pepcid®); cimetidine (Tagamet®); ranitidine (Zantac®); nizatidine (Axid®). There are both prescription and non-prescription formulations of H2-antagonists available. This class of medication can be effective in reducing the amount of acid in your stomach and duodenum by blocking histamine, which stimulates acid secretion. They help reduce ulcer pain after a few weeks. H2-antagonists have been used since the mid-1970s and have an excellent safety profile. They are generally less expensive than proton pump inhibitors.
- Proton pump inhibitors
These include: omeprazole (Prilosec®/Losec®); lansoprazole (Prevacid®); pantoprazole (Pantoloc®).
This class of medication results in marked suppression of stomach acid by halting the mechanism that pumps the acid into your stomach. In fact, proton pump inhibitors more completely block stomach acid production than H2-receptor antagonists. However, either class of medication is appropriate in the treatment of peptic ulcers.
For many years H2-blockers and proton pump inhibitors were prescribed alone to treat peptic ulcers. But they don't kill H. pylori and therefore they can not cure ulcers caused by this bacterial infection.
Protecting the lining of the stomach and duodenum
Medications that protect the lining of the stomach and duodenum are important in the treatment of peptic ulcers. These medications do not suppress the release of stomach acid but they shield the lining from the acid. Some of the more common protective agents include sucralfate (Carafate, Sulcrate®), antacids (Tums, Rolaids, Mylanta, Maalox®), and bismuth subsalicylate (a component of Pepto-Bismol). There is evidence that bismuth subsalicylate also works to kill H. pylori bacteria.
At this time, the most effective treatment is a 2-week course of therapy called triple therapy. This involves taking 2 antibiotics to kill the bacteria and either an acid suppressor or a stomach and duodenum lining protector. This 2-week therapy reduces ulcer symptoms, kills the bacteria, and prevents the ulcer from returning in more than 90% of patients.
Unfortunately, many people find the 2-week triple therapy complicated and they may experience some side effects. These side effects may include nausea, vomiting, diarrhea, dark stools, a metallic taste in the mouth, dizziness, headache, and yeast infections in women. However, new studies are suggesting that one week of triple therapy may be as effective as 2 weeks, resulting in fewer side effects.
After you have been treated for your H. pylori peptic ulcer, your doctor will want to make sure that your infection and your ulcer are gone. Either endoscopy or a breath test to check for the bacteria, 6 to 12 months after your treatment, will be performed.
Treatment of NSAID-induced peptic ulcer
To treat a peptic ulcer that has been caused by nonsteroidal anti-inflammatory drugs (NSAIDs), the medication should be stopped if at all possible. If you must keep taking NSAIDs, a proton pump inhibitor should be taken as well to reduce the amount of acid in your stomach. Another medication called misoprostol (Cytotec®) may be useful in the prevention and treatment of NSAID-induced peptic ulcers. Misoprostol is a prostaglandin that protects the lining of the stomach and duodenum by enhancing the protective mucous layer.
Surgery to treat peptic ulcers
In very rare cases that do not respond to medication or if there are complications, surgery may be required to treat a peptic ulcer.
