Treatment for Peptic Ulcers (Stomach Ulcers)

How do doctors treat peptic ulcer disease?

There are several types of medicines used to treat a peptic ulcer. Your doctor will decide the best treatment based on the cause of your peptic ulcer.

How do doctors treat an NSAID-induced peptic ulcer?

If NSAIDs are causing your peptic ulcer and you don’t have an H. pylori infection, your doctor may tell you to

  • stop taking the NSAID
  • reduce how much of the NSAID you take
  • switch to another medicine that won’t cause a peptic ulcer

Your doctor may also prescribe medicines to reduce stomach acid and coat and protect your peptic ulcer. Proton pump inhibitors (PPIs), histamine receptor blockers, and protectants can help relieve pain and help your ulcer heal.

PPIs

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

  • esomeprazole (Nexium)
  • dexlansoprazole (Dexilant)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec, Zegerid)
  • pantoprazole (Protonix)
  • rabeprazole (AcipHex)

Histamine receptor blockers

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

  • cimetidine (Tagamet)
  • famotidine (Pepcid)
  • ranitidine (Zantac)
  • nizatidine (Axid) Protectants

Protectants

Protectants coat ulcers and protect them against acid and enzymes so that healing can occur. Doctors only prescribe one protectant—sucralfate (Carafate)—for peptic ulcer disease.

Tell your doctor if the medicines make you feel sick or dizzy or cause diarrhea or headaches. Your doctor can change your medicines.

If you smoke, quit. You also should avoid alcohol. Drinking alcohol and smoking slow the healing of a peptic ulcer and can make it worse.

What if I still need to take NSAIDs?

If you take NSAIDs for other conditions, such as arthritis, you should talk with your doctor about the benefits and risks of using NSAIDs. Your doctor can help you determine how to continue using an NSAID safely after your peptic ulcer symptoms go away. Your doctor may prescribe a medicine used to prevent NSAID-induced ulcers called Misoprosotol.

Tell your doctor about all the prescription and over-the-counter medicines you take. Your doctor can then decide if you may safely take NSAIDs or if you should switch to a different medicine. In either case, your doctor may prescribe a PPI or histamine receptor blocker to protect the lining of your stomach and duodenum.

If you need NSAIDs, you can reduce the chance of a peptic ulcer returning by

  • taking the NSAID with a meal
  • using the lowest effective dose possible
  • quitting smoking
  • avoiding alcohol

How do doctors treat an NSAID-induced peptic ulcer when you have an H. pylori infection?

If you have an H. pylori infection, a doctor will treat your NSAID-induced peptic ulcer with PPIs or histamine receptor blockers and other medicines, such as antibiotics, bismuth subsalicylates, or antacids.

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

Histamine receptor blockers

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

Antibiotics

A doctor will prescribe antibiotics to kill H. pylori. How doctors prescribe antibiotics may differ throughout the world. Over time, some types of antibiotics can no longer destroy certain types of H. pylori.

Antibiotics can cure most peptic ulcers caused by H. pylori or H. pylori-induced peptic ulcers. However, getting rid of the bacteria can be difficult. Take all doses of your antibiotics exactly as your doctor prescribes, even if the pain from a peptic ulcer is gone.

Bismuth subsalicylates

Medicines containing bismuth subsalicylate, such as Pepto-Bismol, coat a peptic ulcer and protect it from stomach acid. Although bismuth subsalicylate can kill H. pylori, doctors sometimes prescribe it with antibiotics, not in place of antibiotics.

Antacids

An antacid may make the pain from a peptic ulcer go away temporarily, yet it will not kill H. pylori. If you receive treatment for an H. pylori-induced peptic ulcer, check with your doctor before taking antacids. Some of the antibiotics may not work as well if you take them with an antacid.

Various antacids are shown in this picture without any brand names (left to right): chewable tablets, pink liquid, and ingestible pills.
Check with your doctor before taking antacids while your ulcers are healing.

How do doctors treat an H.pylori-induced peptic ulcer?

Doctors may prescribe triple therapy, quadruple therapy, or sequential therapy to treat an H. pylori-induced peptic ulcer.

Triple therapy

For triple therapy, your doctor will prescribe that you take the following for 7 to 14 days:

Quadruple therapy

For quadruple therapy, your doctor will prescribe that you take the following for 14 days:

  • a PPI
  • bismuth subsalicylate
  • the antibiotics tetracycline and metronidazole

Doctors prescribe quadruple therapy to treat patients who

  • can’t take amoxicillin because of an allergy to penicillin. Penicillin and amoxicillin are similar.
  • have previously received a macrolide antibiotic, such as clarithromycin.
  • are still infected with H. pylori after triple therapy treatment.

Doctors prescribe quadruple therapy after the first treatment has failed. In the second round of treatment, the doctor may prescribe different antibiotics than those that he or she prescribed the first time.

Sequential therapy

For sequential therapy, your doctor will prescribe that you take the following for 5 days:

  • a PPI
  • amoxicillin

Then the doctor will prescribe you the following for another 5 days:

Triple therapy, quadruple therapy, and sequential therapy may cause nausea and other side effects, including

  • an altered sense of taste
  • darkened stools
  • a darkened tongue
  • diarrhea
  • headaches
  • temporary reddening of the skin when drinking alcohol
  • vaginal yeast infections

Talk with your doctor about any side effects that bother you. He or she may prescribe you other medicines.

How do doctors treat peptic ulcers caused by ZES?

Doctors use medicines, surgery, and chemotherapy to treat Zollinger-Ellison syndrome. Learn more about Zollinger-Ellison syndrome treatment.

What if a peptic ulcer doesn't heal?

Most often, medicines heal a peptic ulcer. If an H. pylori infection caused your peptic ulcer, you should finish all of your antibiotics and take any other medicines your doctor prescribes. The infection and peptic ulcer will heal only if you take all medicines as your doctor prescribes.

When you have finished your medicines, your doctor may do another breath or stool test in 4 weeks or more to be sure the H. pylori infection is gone. Sometimes, H. pylori bacteria are still present, even after you have taken all the medicines correctly. If the infection is still present, your peptic ulcer could return or, rarely, stomach cancer could develop. Your doctor will prescribe different antibiotics to get rid of the infection and cure your peptic ulcer.

Can a peptic ulcer come back?

Yes, a peptic ulcer can come back. If you smoke or take NSAIDs, peptic ulcers are more likely to come back. If you need to take an NSAID, your doctor may switch you to a different medicine or add medicines to help prevent a peptic ulcer. Peptic ulcer disease can return, even if you have been careful to reduce your risk.

How can I prevent a peptic ulcer?

To help prevent a peptic ulcer caused by NSAIDs, ask your doctor if you should

  • stop using NSAIDs
  • take NSAIDs with a meal if you still need NSAIDs
  • take a lower dose of NSAIDs
  • take medicines to protect your stomach and duodenum while taking NSAIDs
  • switch to a medicine that won’t cause ulcers

To help prevent a peptic ulcer caused by H. pylori, your doctor may recommend that you avoid drinking alcohol.

November 2014
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