Peptic Ulcer Disease - Treatment Overview

Treatment Overview

• If you have been diagnosed with a peptic ulcer caused by infection with Helicobacter pylori (H. pylori) bacteria, you will need treatment with antibiotic medications to kill the bacteria.
• If your ulcer is caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), stop using them. NSAIDs slow or prevent the healing of an ulcer.
• Medications that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. These include histamine H₂ acid reducers and proton pump inhibitors.
• Lifestyle changes, such as quitting smoking and not drinking too much caffeine or alcohol, may make you feel better.
• Ulcers that do not respond to treatment may have developed complications or may actually be cancer. You may need an endoscopy so that your doctor can look at the inside of your stomach and upper small intestine to check for H. pylori or can collect a tissue sample (biopsy) that can be tested for cancer.
• If an ulcer eats through the wall of the stomach or intestine into the abdominal cavity (perforation), or if your ulcer continues to bleed despite therapy, you may require surgery. However, these complications are rare.

Many cases of peptic ulcer disease are caused by an infection with Helicobacter pylori (H. pylori) bacteria or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Medications that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. If an H. pylori infection is present, antibiotics to eliminate the infection are used in combination with these medications.

Because the medications now used to treat peptic ulcer disease are so effective, surgery is rarely used to treat peptic ulcer disease. Surgery generally is reserved for people who develop a life-threatening complication of an ulcer, such as severe bleeding, perforation, or obstruction. In some cases, even these complications can be treated without surgery.

Initial treatment

Initial treatment of peptic ulcer disease depends on its cause.

• H. pylori infection. Treatment to eliminate Helicobacter pylori (H. pylori) bacteria usually involves combining two antibiotics with an acid reducer such as a proton pump inhibitor or sometimes a bismuth compound. Curing the infection speeds the healing of an ulcer and makes the ulcer less likely to recur. It is important to receive the proper combination of antibiotics to cure the infection; if the bacteria are not eliminated by the antibiotics, they may become even more difficult to kill later (resistant).
• NSAIDs. If at all possible, you will need to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs). In some cases, NSAIDs with a lower risk for causing ulcers may be substituted. If you must continue taking an NSAID, other medications may be used to protect the stomach.⁶ For more information, see the Medications section of this topic.
• Hypersecretory condition. Acid reducers are most often used to treat an ulcer caused by a hypersecretory condition (a condition in which your stomach produces excessive acid). In addition, your doctor may want to conduct other tests to determine whether there is another cause for the ulcer.
• Unknown cause. If no cause can be found (idiopathic ulcer), your ulcer will usually be treated with an acid reducer. Long-term treatment depends on the severity of the ulcer and other factors, such as the size of the ulcer, whether you have had complications, and what other treatments have been used.

No matter what is causing your ulcer, it is important to stop taking NSAIDs and to quit smoking.

Most treatments will be continued for 4 to 8 weeks, depending on various factors, including the size of the ulcer and whether you had complications.

Ongoing treatment

If you feel that you need to continue to use nonsteroidal anti-inflammatory drugs (NSAIDs) after being diagnosed with a peptic ulcer, work with your doctor to find an alternative pain reliever. Use of NSAIDs can slow the healing of an ulcer or prevent it from healing altogether. If you must continue to use NSAIDs, your doctor may recommend that you take a prostaglandin analog, such as misoprostol, or a proton pump inhibitor. Misoprostol does not help ulcers heal, but it can help prevent ulcers from coming back.

If ulcer symptoms do not respond to treatment, follow up with your doctor to be sure Helicobacter pylori (H. pylori) bacteria have been identified and treated. Most peptic ulcers are caused by infection with H. pylori bacteria. Persistent infection will likely be treated with an alternate combination of medications. Antibiotic treatment for H. pylori should be taken exactly according to your doctor's instructions for it to be effective.

Tests such as the urea breath test and a stool antigen test can determine whether an H. pylori infection has been cured. If you have a history of ulcer complications or a family history of stomach cancer, you may need an endoscopy so that your doctor can look at the inside of your stomach and upper small intestine to see whether an ulcer is present. An endoscopy can also be used to collect a tissue sample (biopsy) that can be tested for H. pylori or cancer. For more information on these tests, see the Exams and Tests section of this topic.

Treatment if the condition gets worse

Recurring ulcers will likely be treated with an alternate combination of medications.

Your doctor may conduct follow-up tests to determine whether an infection with Helicobacter pylori (H. pylori) has continued or returned. Tests for H. pylori include testing your breath, stool, and blood and a biopsy of your stomach lining. For more information on these tests, see the Exams and Tests section of this topic.

If you have experienced significant complications from a peptic ulcer such as bleeding or obstruction, you may need an endoscopy, even if you have already had one. If your stomach or intestine has a perforation or your ulcer continues to bleed despite treatment, you may require surgery. But surgery is rarely used to treat an ulcer.

What To Think About

Risk of not treating ulcers

• Left untreated, many ulcers eventually heal. But ulcers often recur if the cause of the ulcer is not eliminated or treated. If ulcers keep coming back, you have an increased risk of developing a serious complication.
• A stomach (gastric) ulcer that does not respond to treatment may be cancer. Your doctor will likely recommend a biopsy of stomach ulcers before beginning treatment. This procedure can rule out stomach cancer.

When deciding whether to use NSAIDs during the treatment of an ulcer, it is important to consider any other conditions you may have, such as serious heart, lung, or kidney disease. These conditions could increase your risk of death if your ulcer bleeds.⁷