How are peptic ulcers treated?

The cause of the peptic ulcer will lead the treatment protocol. Typically, the treatment plan will involve eliminating the bacteria, if H. pylori are the cause, or reducing, if not entirely stopping the use of pain medications. This will all be coupled with aiding your ulcer to heal through the administration of medication and lifestyle changes.

The medications used to treat ulcers include:

• Antibiotics – There are a number of antibiotic medications that will be needed to eliminate the bacteria. If H. pylori have been detected in the digestive tract, then it is likely that your doctor will suggest you take a combination of prescription antibiotics. Some options of these drugs may include:
  • Amoxicillin (Amoxil)
  • Metronidazole (Flagyl)
  • Clarithromycin (Biaxin)
  • Levofloxacin (Levaquin)
  • Tetracycline (Tetracycline HCL)

These antibiotics will be chosen according to your medical history and state of antibiotic resistance. You will typically take a course of the drugs for a period of two weeks with additional medications that will aid in reducing your stomach acid, this includes proton pump inhibitors (PPIs).

• PPIs – These medications aid in blocking the production of stomach acid which will promote healing of the peptic ulcer.

PPIs include:

• Esomeprazole (Nexium)
• Pantoprazole (Protonix)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Rabeprazole (Aciphex)

Your doctor may also couple a PPI with Pepto-Bismol (bismuth subsalicylate). If these drugs are used long-term in high doses, this may put you at risk of wrist, hip and spine fractures. It is best to speak to your doctor about calcium supplements you should be taking in order for this risk to be reduced.

• Acid blockers – These drugs will also aid in the production of acid being reduced and are known as histamine (H-2) blockers. These are available over-the-counter and include:
  • Ranitidine (Zantac)
  • Cimetidine (Tagamet HB)
  • Famotidine (Pepcid)
• Antacids – These drugs will aid in neutralising the stomach acid that already exists in the digestive tract which often provides relief from the pain experienced due to an ulcer. The side effects may include diarrhoea or constipation, but this will be dependent on the ingredients of the drugs. These medications generally provide pain relief but are not used in the treatment of the ulcer to promote healing.
• Cytoprotective agents – These are medications that help in protecting the lining of the small intestine and stomach. Some of these may include:
  • Misoprostol (Cytotec)
  • Sucralfate (Carafate)

Follow-up care after the initial treatment and medications

Peptic ulcers will often heal after treatment is administered and guidelines are followed accordingly. However, in some cases, the symptoms can be very severe or continue regardless of the treatment, in this case, a doctor may suggest you undergo an endoscopy before and after treatment to ensure that the ulcer has healed. Speak to your doctor about your symptoms and if you have any concerns regarding the success of the treatment administered or medications that he or she has issued you with.

Ulcers failing to heal

If your peptic ulcer does not heal, despite the treatment, this is known as a refractory ulcer. Refractory refers to the ulcer being resistant to the chosen methods of treatment. There are a number of reasons as to why your ulcer will not heal, these include:

• Not following the specific treatment plan accordingly
• There are some types of H. pylori bacteria that can be resistant to the antibiotics
• Regularly smoking cigarettes
• Regularly using painkillers such as aspirin and ibuprofen as these can increase your risk of developing an ulcer and aggravate any ulcer you currently have, preventing it from healing.

In fewer cases, your refractory ulcer may be from:

• An extreme amount of stomach acid being produced due to a disorder called Zollinger-Ellison syndrome. This is a very rare condition wherein one or more tumours will form in the small intestine or pancreas and cause a large amount of a hormone known as gastrin to be secreted which will result in a large production of stomach acid.
• Stomach cancer
• A bacterial infection that is not H. pylori
• A number of other conditions that may result in sores similar to ulcers in the small intestine and stomach, one of these conditions is Crohn’s disease.

The treatment for your refractory ulcer will typically involve the elimination of some factors that are likely to be interfering with the healing of your ulcer, combined with a different course of antibiotics. If a severe complication has developed from your ulcer such as perforation or acute bleeding, then you may require surgery. However, the cases of surgery are few are far between now with the advances in medicine.

What are the surgical options for a peptic ulcer?

When medical therapy is not effective in treating ulcers, then surgery may be required. Surgery is not commonly used as an alternative to medication.

Some of the surgical options that are used for peptic ulcers may include:

• Vagotomy – This surgery involves removing part of a nerve known as the vagus nerve. This is responsible for the transmission of messages between the brain and the stomach and removal can reduce the amount of acid secreted. This nerve is spread across a number of different locations from the thorax to the abdomen. However, in cutting off some of this nerve, other stomach functions may be interfered with. There is a more advanced form operation that can cut the only part of the vagus nerve that directly affects the secretion of acid.
• Antrectomy – This procedure is often conducted with a vagotomy. This surgery involves the antrum (lower portion of the stomach) being removed. The antrum is the part of the stomach that is responsible for producing a hormone that increases stomach acid production. Other adjacent sections of the stomach may also need to be removed.
• Pyloroplasty – This is a procedure that is also conducted in a combination with a vagotomy. This surgery will enlarge the pylorus (this is the opening between the small intestine and stomach, which will encourage the passing of food that has been partially digested. When the food is able to pass, this will normally stop acid production.
• Artery surgery – If there is a large amount of internal bleeding, then a surgery may be conducted to tie off one of the arteries to stop the flow of blood to the peptic ulcer and in turn, stop the bleeding.

Alternative medicine

There are a number of over-the-counter (OTC) medications available that contain a component called calcium carbonate, such as Rolaids or Tums, which may be able to aid in treating peptic ulcers, but these should not be the primary option of treatment. There has also been some evidence suggesting that zinc may help in the healing of ulcers.

Over-the-counter options are helpful and easily obtained, however, you should never use these as the primary means of treatment as there is no evidence that suggests that they are effective in the initial healing of peptic ulcers. Therefore, it is best to always speak to your doctor regarding diagnosis and appropriate treatment. 

What are some home remedies for a peptic ulcer?

There are several ways that your pain may be relieved from a peptic ulcer that can be followed at home. These remedy methods include the following:

• Sticking to a healthy eating plan consisting of vegetables, fruits and whole grains. It is best to eat foods that are rich in vitamins to help your body heal the ulcer.
• Eliminating most dairy products as milk and other dairy products may make your ulcer even worse. Most people may tell you to drink milk as this can help in relieving the pain short-term, but in reality, dairy will cause the stomach to produce more digestive juices and acid which can aggravate the ulcer.

• Switching your painkillers and eliminating the dangerous ones entirely will help in the healing of your ulcer. Your doctor may allow you to use Tylenol, but it best to speak to a medical professional first.
• Controlling stress will also help as stress can aggravate the symptoms and signs of the peptic ulcer. It is understandable that some stress cannot be avoided, but there are a number of ways to deal with it through breathing techniques, meditation, psychological therapy and exercise.
• Stop smoking cigarettes as the smoke affects the lining of the digestive tract, therefore making your stomach more vulnerable to an ulcer developing. Smoke will also increase the amount of stomach acid produced.
• Avoiding alcohol particularly in excessive amounts as alcohol can erode the mucosal wall of the digestive tract and result in bleeding and inflammation.
• Ensuring you are getting enough sleep and this aids in giving your immune system the strength it needs to heal the ulcer.