Treatment and Prevention
Medical treatment focuses on eliminating the H. pylori bacteria in people where it has been detected. The majority of peptic ulcers caused by H. pylori can be cured with a combination of antibiotics and acid-reducing medications called proton pump inhibitors (PPIs; e.g., omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole) plus two antibiotics (clarithromycin plus amoxicillin or metronidazole), all taken twice a day for 1 to 2 weeks.
Other combinations of acid-reducing medications and antibiotics may also be used, including ones that use a total of four medications. For some people, several courses of treatment may be needed to get rid of H. pylori. Once the treatment for H. pylori is complete, the acid-suppressing medication should be continued for a total of 4 to 6 weeks.
When an ulcer is not associated with H. pylori or is caused by NSAIDs, treatment with a PPI is prescribed for 2 to 6 weeks. Some people may need to continue treatment for longer periods of time. Another type of acid reducer, H2-antagonists (e.g., ranitidine, nizatidine), may also be used.
If the peptic ulcer was caused by NSAIDs, such as aspirin, your doctor will most often recommend that you stop taking them if possible. Some people are more susceptible to peptic ulcers caused by NSAIDs, including those who:
- are seniors
- have a history of a peptic ulcer
- are also taking glucocorticoids (e.g., prednisone, dexamethasone)
- are taking high doses of NSAIDs or aspirin
- have several medical conditions
- are taking more than one NSAID or aspirin
If you're taking an NSAID and have one of these risk factors, your doctor may prescribe a protective medication to take along with it. Acid-suppressing medications (e.g., PPIs) or misoprostol may be used for this. Misoprostol encourages the stomach to produce its protective mucus coating and improves blood flow.
It's important for people with PUD to quit smoking. Smoking can delay healing and can cause ulcers to return.
Very rarely, surgical treatment may be needed for PUD and its complications.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.