Peptic ulcers: treatment

Peptic ulcers occur in the stomach — gastric ulcers — and the duodenum (the first part of the small intestine) — duodenal ulcers. They result from an imbalance between the amount of acid in your stomach and its protective lining.

In the past it was believed that ulcers were caused by stress, poor eating habits, too much rich, fatty food or spicy food, alcohol or caffeine. However, it is now known that most peptic ulcers are caused by the Helicobacter pylori bacterium (also known as H. pylori). This is particularly true of duodenal ulcers.

The cause of most other peptic ulcers is the regular use of medicines such as aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS), which are often used to treat the symptoms of arthritis.

Treatment for peptic ulcers depends on the cause of the ulcer and can include any or all of the following:

  • antibiotics to eradicate the H. pylori bacteria;
  • medicines to reduce the amount of acid in your stomach and promote healing of the ulcer; and
  • stopping or changing any medicines that may have caused the ulcer.

Eradication of H. pylori

The majority of duodenal ulcers and a large percentage of gastric ulcers are caused by the bacterium H. pylori. Most people with ulcers will be tested to see if they are infected with H. pylori.

The medicines used to treat ulcers associated with H. pylori infection include:

  • a medicine that suppresses the production of stomach acid (usually a proton pump inhibitor), which helps the ulcer to heal and relieves peptic ulcer pain; plus
  • antibiotics to eradicate the H. pylori bacteria.

Unfortunately, no single antibiotic is effective against H. pylori, so combination therapy is given to reduce the risk of the bacteria becoming resistant to treatment.

Triple therapy

The first-choice treatment for eradicating H. pylori is called triple therapy, and includes a proton pump inhibitor (omeprazole or esomeprazole) plus 2 antibiotics — clarithromycin and amoxycillin. These medicines need to be taken twice daily for 7 days.

There are other combinations of medicines that can be used if you are allergic to penicillin or if first-line therapy is not effective in eradicating H. pylori. Your doctor will advise you which combination will be most likely to work for you. Convenient ‘combination packs’ containing all the medicines for the treatment are available.

This treatment has revolutionised the treatment of peptic ulcers worldwide. Depending on the medicines used, it can have a success rate of 85 to 90 per cent in eradicating H. Pylori and treating peptic ulcers. Eradicating H. pylori also significantly reduces the chance of relapse.

It is vital that you follow the treatment exactly according to your doctor’s instructions — the success rate is much lower if the tablets are not taken as directed. Common side effects include taste disturbance, nausea and loose stools, although side effects are usually mild.

Some people (for example, those with complicated ulcers or ulcers associated with both H.pylori infection and use of NSAIDs) may need ongoing treatment with a proton pump inhibitor for a period of time after completing the antibiotic course. Histamine H2-receptor antagonists (a different type of medicine that reduces stomach acid secretion) can be used but are less effective than proton pump inhibitors.

NSAID-induced ulcers

About 30 per cent of all gastric ulcers may be caused by the long-term use of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Some NSAIDs are more likely to cause ulcers than others.

In addition, among people who use NSAIDs, some are at higher risk of developing peptic ulcers than others. NSAID users who are infected with H.pylori have a greatly increased risk of developing a peptic ulcer. Other risk factors include older age, a history of peptic ulcer disease and being a smoker.

The risk of developing an ulcer while taking an NSAID can be reduced by minimising the use of NSAIDs, treating H. pylori infection (if present) and, in some cases, taking a proton pump inhibitor.

Treatment for NSAID-induced ulcers

Treatment for NSAID-induced ulcers involves stopping the NSAID (if possible) and taking a medicine to suppress acid secretion and promote healing. Proton pump inhibitors are usually used, as they are more effective than H2-receptor antagonists.

Your doctor will also recommend testing for H. pylori infection and eradication treatment if necessary.

Antacids

Antacids neutralise the stomach’s acid and so usually give temporary relief from ulcer pain. There are many varieties available without a prescription. Ask your pharmacist for advice about which one would be best for you.

If you are being treated for H. pylori infection, you should check with your doctor before taking an antacid, because some of the antibiotics used in eradication therapy for H. pylori don’t work as well when combined with an antacid.

Lifestyle changes

Your doctor may also give you dietary guidelines to follow, such as reducing or eliminating alcohol, as it can worsen ulcers and prevent healing. It’s a good idea to avoid any foods that tend to aggravate your symptoms.

If you are a smoker, your doctor will also recommend you stop smoking as it has been shown that smokers have a higher incidence of ulcer complications and that it takes longer to heal their ulcers than non-smokers.

Last Reviewed: 20 June 2013
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References

1. Helicobacter pylori: effects of infection and indications for eradication (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
2. Eradication of Helicobacter pylori and ulcer healing (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
3. NSAID-induced ulcers (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
4. Gastroenterological Society of Australia (GESA); Digestive Health Foundation (DHF). Helicobacter Pylori (H. pylori); Third Edition 2010. http://www.gesa.org.au/consumer.asp?id=80 (accessed Jun 2013.
5. National Digestive Diseases Information Clearinghouse (NDDIC). H. pylori and peptic ulcers (updated 30 Apr 2012). http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/ (accessed Jun 2013).
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