Take the Tummy Trouble Quiz Digestive Disease Myths Slideshow Pictures Heartburn? Foods to Eat, Foods to Avoid Slideshow

Medical Author:

Michael W Stratemeier, MD

Coauthor:

Lisa Vignogna, MD

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Peptic Ulcer Self-Care at Home

Home care for peptic ulcers often centers on neutralizing the stomach acid.

• Don't smoke, and avoid coffee and alcohol. These habits increase gastric acid production and weaken the mucosal barrier of the GI tract promoting ulcer formation and slowing ulcer healing.
• Don't take aspirin or nonsteroidal anti-inflammatory medications. Acetaminophen is a good substitute for some conditions. If acetaminophen doesn't help, talk to your health care professional about alternatives.
• If your symptoms are mild, try an over-the-counter antacid or nonprescription histamine (H2) blocker to neutralize stomach acid. Usually stronger prescription medications are needed.

No particular diet is helpful for people with peptic ulcers.

• At one time a bland diet and avoidance of spicy or greasy foods was recommended.
• We now know that diet has little effect on ulcers. In some people, however, certain foods seem to aggravate symptoms. Avoid eating any foods that aggravate symptoms.

Peptic Ulcer Medical Treatment

The following treatments are recommended for ulcers:

• Lifestyle changes: Quit smoking, avoid alcohol, aspirin, and NSAIDs
• Acid-blocking medications
• Medications that protect the lining of the stomach and duodenum
• "Triple-therapy" or "dual-therapy" regimens for ulcers caused by H pylori

No single medication works to get rid of H pylori infection. Two combinations have been found that work well in most people.

• Triple therapy: The combination of bismuth subsalicylate (for example, Pepto-Bismol) and the antibiotics tetracycline and metronidazole are effective in 80%-95% of people and is the current standard of therapy. All are taken as pills. The bismuth subsalicylate and tetracycline have to be taken 4 times a day and the metronidazole 3 times a day. This complicated schedule is difficult for many people to follow.
• Dual therapy: This therapy was developed as a response to the complexity and side effects of triple therapy. It comprises 2 antibiotics, amoxicillin and metronidazole, both taken as pills 3 times a day. This simplified schedule is preferred by many people.
  • Clarithromycin can be substituted for the 15%-25% of people whose infections are resistant to metronidazole.
  • Sometimes an acid pump inhibitor such as omeprazole (Prilosec, Prolosec OTC) is added or substituted for one of the antibiotics.

These treatments usually take 2 weeks.

Once H pylori bacteria are eradicated from a person's digestive tract, it usually will not come back. The ulcers usually heal completely and do not return.

Treatment for bleeding ulcers depends on the severity of blood loss.

• IV fluids
• Bowel rest: Bed rest and clear fluids with no food at all for a few days. This gives the ulcer a chance to start healing without being irritated.
• Nasogastric tube: Placement of a thin, flexible tube through the nose and down into the stomach. This also relieves pressure on the stomach and helps it heal.
• Urgent endoscopy or surgery, if indicated: Damaged, bleeding blood vessels can usually be repaired with an endoscope. The endoscope has a small heating device on the end that is used to cauterize a small wound.

It is important to remember that treatment may not work if the diagnosis is not correct. If the doctor diagnoses an ulcer, it is important to ascertain whether the ulcer is caused by infection with H pylori.