Peptic Ulcers (cont.)
What is the medical treatment for peptic ulcers?
The following treatments are recommended for ulcers:
Lifestyle changes: Quit smoking, avoid alcohol, aspirin, and NSAIDs
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 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;
and a proton pump inhibitor (PPI). This simplified schedule is preferred by many people.
Clarithromycin can be substituted for the 15%-25% of people whose infections are resistant to metronidazole.
Usually a proton pump inhibitor such as omeprazole (Prilosec, Prilosec
OTC) is added to the treatment.
These treatments are generally given for two weeks.
Once H pylori bacteria are eradicated from a person's digestive tract, usually
it will not come back. The ulcers usually heal completely and do not return.
Treatment for bleeding ulcers depends on the severity of blood loss and
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
cauterized with an endoscope. The endoscope has a small heating device
at the end that is used to cauterize a blood vessels.
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
determine whether the ulcer is caused by infection with H pylori.
Medically Reviewed by a Doctor on 11/24/2015
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