Claire Dawson
Stomach ulcers, also known as gastric ulcers, are open sores in the stomach lining that cause focal stomach pain. The two most common causes of stomach ulcers are the H. pylori bacterial infection and overuse of nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment for stomach ulcers is typically done through medication, unless there are complications such as internal bleeding. In such cases, doctors may recommend hospital procedures like upper GI endoscopy or, rarely, surgery.
| Characteristics | Values |
|---|---|
| Treatment location | Hospital or outpatient |
| Treatment type | Medication, surgery, endoscopy |
| Medication type | Antibiotics, PPIs, H2-receptor antagonists, antacids, COX-2 inhibitors |
| Treatment duration | 4–8 weeks |
| Treatment success | Most ulcers heal in a few months |
| Treatment side effects | Mild |
| Lifestyle recommendations | Avoid stress, alcohol, spicy food, smoking |
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What You'll Learn
Treatment for peptic ulcers
Peptic ulcers, also known as stomach ulcers, are open sores in the stomach lining. They are usually caused by the bacterial infection H. pylori or the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment for peptic ulcers involves addressing the underlying cause and typically includes medication to help the ulcer heal.
If the ulcer is caused by an H. pylori infection, a course of antibiotics is usually prescribed alongside a proton pump inhibitor (PPI) or an H2-receptor antagonist. Antibiotics such as amoxicillin, clarithromycin, and metronidazole are commonly used to eradicate the bacteria. PPIs like omeprazole, pantoprazole, and lansoprazole are prescribed for 4 to 8 weeks to reduce stomach acid production and prevent further damage to the ulcer as it heals. H2-receptor antagonists, including famotidine, work similarly to PPIs by reducing acid levels in the stomach.
For ulcers caused by NSAID use, a course of PPI medication is typically recommended. In some cases, H2-receptor antagonists may be used instead of PPIs. Additionally, antacids can be taken to quickly neutralise stomach acid and provide short-term relief from symptoms.
In cases where NSAIDs are necessary to reduce the risk of embolism (blood clots), a PPI or H2-receptor antagonist may be prescribed alongside the NSAID to prevent further ulcer development. A less common type of NSAID, called a COX-2 inhibitor, is sometimes recommended as it is less likely to cause stomach ulcers.
If an ulcer does not heal or recurs after initial treatment, further investigation and management may be required. Doctors may recommend quitting smoking, as it can slow ulcer healing. Additional medications or procedures, such as upper GI endoscopy, may be suggested. In rare cases, surgery may be recommended for peptic ulcers that do not respond to other treatments.
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Antibiotics for H. pylori infections
Stomach ulcers, also known as gastric ulcers, are open sores in the stomach lining. They are often caused by the bacterial infection H. pylori, which affects up to half of the world's population. H. pylori bacteria eat into the stomach lining, causing chronic inflammation that leads to ulcers.
If a stomach ulcer is caused by an H. pylori infection, a course of antibiotics is recommended. The antibiotics prescribed will depend on regional bacterial resistance patterns, local recommendations, and drug availability. Typically, a combination of two antibiotics is used, with each taken twice a day for a week. The antibiotics most commonly used are amoxicillin, clarithromycin, and metronidazole. The side effects of these antibiotics are usually mild and may include nausea, taste disturbances, and yeast infections.
In addition to antibiotics, a medication called a proton pump inhibitor (PPI) is also recommended. PPIs work by reducing the amount of acid produced in the stomach, preventing further damage to the ulcer as it heals naturally. They are usually prescribed for 4 to 8 weeks. Omeprazole, pantoprazole, and lansoprazole are the PPIs most commonly used to treat stomach ulcers.
In some cases, a 14-day bismuth-based quadruple therapy or rifabutin-based triple therapy may be chosen as the initial treatment for H. pylori infections. Proton pump inhibitor (PPI)–based triple therapy is also an option for first-line therapy in areas with low (<15%) clarithromycin resistance. This therapy combines a PPI with either clarithromycin or metronidazole.
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Medication to reduce acid
Stomach ulcers are a common condition, affecting about 4 million people in the US each year. They are treatable, but can become serious if left untreated. Ulcers are open sores in the stomach lining, caused by the stomach acid eating through the protective stomach lining. The two most common causes of stomach ulcers are the H. pylori bacterial infection and overuse of non-steroidal anti-inflammatory drugs (NSAIDs).
There are several medications that can be used to reduce stomach acid and treat ulcers. The medication prescribed will depend on the cause of the ulcer. If the ulcer is caused by an H. pylori infection, a course of antibiotics is usually prescribed, along with proton pump inhibitors (PPIs). PPIs work by reducing the amount of acid the stomach produces, allowing the ulcer to heal naturally. Omeprazole, pantoprazole, and lansoprazole are the PPIs most commonly used to treat stomach ulcers. PPIs are usually prescribed for 4 to 8 weeks, and side effects are typically mild.
H2-receptor antagonists, such as famotidine, are another class of medication that can be used to treat stomach ulcers. Like PPIs, they work by reducing stomach acid production. They may be used instead of PPIs, particularly if the patient is taking low-dose aspirin (an NSAID) to prevent blood clots. Antacids can also be used alongside PPIs or H2-receptor antagonists to quickly neutralise stomach acid and relieve symptoms in the short term. Antacids containing alginates form a protective coating on the stomach lining and are best taken after meals. However, antacids alone are not sufficient to treat stomach ulcers. Magnesium hydroxide is a fast-acting and effective antacid, but it can cause diarrhoea if taken in high doses, and people with kidney damage should only take it in small doses.
Misoprostol is another medication that may be used to reduce the likelihood of developing stomach ulcers caused by NSAIDs. It works by reducing stomach acid production and making the stomach lining more resistant to acid. However, it can cause digestive problems and diarrhoea in 30% of people who take it, and it can cause spontaneous abortions in pregnant women. Sucralfate is another alternative to antacids, which forms a protective coating at the base of an ulcer to promote healing. It has few side effects and works well on peptic ulcers.
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Surgery for complications
Surgery for stomach ulcers is usually required when complications arise from peptic ulcer disease or when medication and lifestyle changes are ineffective.
One such complication is perforation, where the ulcer forms a hole in the stomach wall, allowing digestive juices, food, and bacteria to leak into the abdominal cavity. This life-threatening condition can cause sudden, intense stomach pain, fever, profuse bleeding, abnormal blood chemistry, and loss of consciousness. Emergency surgery is often necessary to address this issue.
Bleeding ulcers are another complication that may require surgery. Bleeding can manifest with blood in the stool, which can appear bright red or black, and hematemesis (vomiting blood). Bleeding ulcers are typically treated with endoscopic repair, but emergency surgery may be required if the bleeding is sudden and severe.
Gastric outlet obstruction is a rare complication of stomach ulcers, causing swelling or scarring that narrows the stomach and prevents its contents from passing through. Laparoscopic gastrojejunostomy is a surgical procedure used to treat this condition.
Postoperative complications can also arise from stomach ulcer surgery. These include infection, bleeding, perforation, or injury to the oesophagus, stomach, or small intestine. Delayed digestive issues such as gastroparesis (delayed gastric emptying) and dumping syndrome (rapid gastric emptying) can also occur due to structural changes or loss of muscle/nerve tissue.
In addition, patients with intractable ulcer disease or those who are noncompliant may require proximal gastric vagotomy, which is the preferred operation for such cases. Recurrent ulceration may also necessitate reoperation in about 50% of patients. The most effective procedure for peptic ulcer disease is considered to be truncal vagotomy-antrectomy, with a recurrence rate of less than 1%.
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Lifestyle changes to reduce symptoms
While lifestyle changes alone cannot treat ulcers, they can help reduce symptoms and promote healing. Ulcers are caused by an excess of stomach acid eroding the stomach's protective lining, so the goal of treatment is to reduce acid production and promote faster healing.
Diet
Dietary changes can help to reduce excess acid production, which aggravates ulcers. Spicy foods, chocolate, coffee, and alcohol can all increase acid production and should be avoided or limited. Large meals also require more stomach acid for digestion, so it is recommended to eat five or six small meals a day instead of three large ones. It is also important to chew food well and eat slowly, and to finish eating at least three hours before sleeping.
Some foods can help to boost healing. Skinless poultry, lean beef, fish, eggs, tofu, tempeh, dry beans, and peas are excellent sources of low-fat protein. Fatty fish like salmon, mackerel, and sardines provide omega-3 fatty acids, which can reduce inflammation and may help prevent another ulcer. Probiotics, found in products like kefir, sauerkraut, and Greek yogurt, may offer benefits in treating peptic ulcers. Whole grains are a good source of fibre, which supports digestive wellness. A diet rich in fruits and vegetables may also reduce the risk of developing ulcers, possibly due to their fibre content.
Smoking
Smoking should be avoided, as it can irritate the ulcer.
Stress
Avoiding stress may help to reduce symptoms.
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Frequently asked questions
Stomach ulcers, also known as gastric ulcers, are open sores in the stomach lining. They are usually caused by the H. pylori bacterial infection and the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs).
Treatment for stomach ulcers depends on the cause. Doctors typically treat peptic ulcers with medicines to help the ulcer heal. They may also recommend an upper GI endoscopy to obtain biopsies. In rare cases, surgery may be required for ulcers that don't heal.
Typical symptoms include burning stomach pain, indigestion, and bleeding. Ulcers can continuously bleed, leading to significant blood loss over time.
