Peptic Ulcers (cont.)
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
- 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),
famotidine (Pepcid), and
- 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),
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
- 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,
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
Michael W Stratemeier, MD
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