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 Medications

Several types of medications are used to treat ulcers.

Antacids: These nonprescription medications simply neutralize acid.

• Most include aluminum hydroxide combined with magnesium or calcium. Examples are Maalox, Mylanta, Tums, and Rolaids.
• These can cause constipation, although those containing magnesium can cause diarrhea.
• These effects are especially likely if the medications are taken regularly.

Histamine (H2) blockers: These are acid-blocking medications widely used in the treatment of peptic ulcers.

• H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).
• They prevent production of acid by blocking histamine, a chemical that promotes acid production.
• Nonprescription strengths are available, but for most people the stronger prescription version are needed.
• H2 blockers work very well at reducing acid and pain. (Reducing acid helps the ulcers heal.)
• They may take a few days to start having an effect.
• Treatment with H2 blockers usually takes 6-8 weeks.

Acid pump inhibitors: These drugs are also known as proton pump inhibitors (PPIs).

• This group includes omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protnoix).
• Acid pump inhibitors are even stronger than H2 blockers.
• They work by stopping the "pump" that secretes acid into the stomach.
• They are being used increasingly in triple and double regimens for infection.

Protective agents: These drugs do not affect the amount of acid in the stomach; instead, they protect the mucous lining of the stomach from acid.

• One type is very thick and sticks to the ulcer, forming a physical barrier between the ulcer and the acid. An example is sucralfate (Carafate).
• The other type increases the amount of mucus, which forms a physical barrier, and bicarbonate, which helps neutralize the acid. An example is misoprostol (Cytotec); this agent is used only for treatment of ulcers caused by medication.
• Antacids and products containing bismuth subsalicylate (such as Pepto-Bismol) also have protective effects.

Antibiotics: As part of a combination regimen, antibiotics eradicate H pylori, the bacteria that causes ulcers in many people.

• A 2 week triple therapy that includes two antibiotics and bismuth subsalicylate is the most effective regimen. It eliminates the bacteria and prevents recurrence of ulcers in 90% of people who receive this treatment. Unfortunately, triple therapy has side effects such as upset stomach, nausea, vomiting, bad taste in the mouth, loose or dark stools, dizziness, and yeast infections in women.
• Any of several 2 week dual therapy regimens are simpler to follow, have fewer side effects, and work in about 80% of people who take them.
• A newer triple therapy combining antibiotics and rabeprazole (Aciphex) works in just 1 week to eradicate H pylori.

Peptic Ulcer Surgery

Medical therapy works in most people with peptic ulcers. Sometimes, medical therapy does not work, or a person can't take the therapy for some reason. Surgery is a good alternative to medical therapy for these people.

Surgical operations often used in peptic ulcers include the following:

• Vagotomy: Cutting the vagus nerve, which transmits messages from the brain to the stomach, can reduce acid secretion. However, this can also interfere with other functions of the stomach. A newer operation cuts only the part of the nerve that affects acid secretion.
• Antrectomy: This is often done in conjunction with a vagotomy. It involves removing the lower part of the stomach (the antrum). This part of the stomach produces a hormone that increases production of stomach acid. Adjacent parts of the stomach may also be removed.
• Pyloroplasty: This procedure also is sometimes done with vagotomy. It enlarges the opening between the stomach and duodenum (the pylorus) to encourage passage of partially digested food. Once the food has passed, acid production normally stops.
• Tying off an artery: If bleeding is a problem, cutting off the blood supply (artery) to the ulcer can stop the bleeding.