Healing Stomach Ulcers: Hospital Treatment Options

Stomach ulcers, also known as gastric or peptic ulcers, are open sores in the stomach lining that cause burning stomach pain. They are typically caused by the Helicobacter pylori (H. pylori) bacterial infection and the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment for stomach ulcers involves addressing the underlying causes to prevent recurrence. This includes a combination of medications to reduce gastric acid and protect the stomach lining, as well as antibiotics to treat H. pylori infections. In some cases, surgery may be required, especially if there are complications like bleeding ulcers.

Identify the cause

Stomach ulcers are caused by a combination of stomach acids and other digestive juices that eat through the mucus layer protecting the stomach lining, resulting in an open sore. This is why the most common symptom of a stomach ulcer is a burning or gnawing pain in the abdomen.

The two most common causes of stomach ulcers are the H. pylori bacterial infection and overuse of non-steroidal anti-inflammatory drugs (NSAIDs). These two causes together account for about 99% of stomach ulcers treated by U.S. healthcare providers. H. pylori is a widespread bacterial infection that affects up to half of the world's population and primarily lives in the stomach. Although it does not seem to cause problems in many people, in some cases, it can multiply and take over, eating into the stomach lining and causing chronic inflammation that leads to gastric ulcers. NSAIDs are common over-the-counter pain relievers, such as ibuprofen, naproxen, and aspirin, that irritate the stomach lining and inhibit some of the chemicals that defend and repair it.

To identify the cause of a stomach ulcer, a doctor will typically recommend a gastroscopy, which involves inserting a thin, flexible tube with a camera down your throat to examine your stomach. They may also request a stool test to check for the presence of blood, as well as blood tests to check for H. pylori antibodies or a breath test to detect H. pylori bacteria.

Once the underlying cause of a stomach ulcer is identified, appropriate treatment can be prescribed. Treatment options include antibiotics to address H. pylori infections, proton pump inhibitors (PPIs) to reduce stomach acid production, and H2-receptor antagonists to block histamine and reduce acid production. In some cases, alternative NSAIDs that are less likely to cause stomach ulcers, known as COX-2 inhibitors, may be recommended.

Prescribe medication

Prescribing medication is a common method used to treat stomach ulcers. The medication prescribed depends on the cause of the ulcer. If the ulcer is caused by the H. pylori bacterial infection, a course of antibiotics is usually prescribed. The antibiotics used include amoxicillin, clarithromycin, and metronidazole, which are taken twice a day for a week. After completing the course of antibiotics, a test is conducted to check for the presence of H. pylori bacteria. If the bacteria are still present, a different course of antibiotics or other medicines may be prescribed.

Additionally, proton pump inhibitors (PPIs) are often prescribed alongside antibiotics to reduce stomach acid production and prevent further damage to the ulcer as it heals. Common PPIs include omeprazole, pantoprazole, and lansoprazole, which are typically taken for 4 to 8 weeks. PPIs are also recommended for patients who need to continue taking low-dose aspirin (an NSAID) to prevent blood clots. H2-receptor antagonists, such as famotidine, may be used as an alternative to PPIs. These medications also work by reducing stomach acid production.

To relieve symptoms, doctors may also prescribe additional short-term medication called antacids, which neutralise stomach acid. Some antacids contain alginate, which forms a protective coating on the stomach lining. These medications are available over the counter at pharmacies. For patients taking NSAIDs, doctors may recommend changes to medication type, dosage, or duration to reduce the risk of developing stomach ulcers.

Treat H. pylori infection

H. pylori is a very common bacterial infection, affecting up to half of the world's population. It is the main cause of peptic ulcers and is responsible for 60% of stomach ulcers. The H. pylori bacterium causes irritation by invading the surface cells of the stomach, triggering the cells to produce chemicals that promote inflammation. This inflammation can lead to gastric ulcers.

If you have an H. pylori infection, you will usually be prescribed a course of antibiotics to kill the infection. Typically, you will be given a course of two antibiotics, each taken twice a day for a week. The most commonly used antibiotics are amoxicillin, clarithromycin, and metronidazole. Antibiotic side effects are usually mild and may include diarrhea and rashes. It is important to complete the full course of antibiotics to prevent the H. pylori bacteria from developing antibiotic resistance. After finishing the course of antibiotics, you may need to be tested to see if the infection has cleared. If the bacteria are still present, a different course of antibiotics may be prescribed.

In addition to antibiotics, doctors may prescribe proton pump inhibitors (PPIs) to reduce stomach acid and prevent further damage to the ulcer as it heals. PPIs are usually prescribed for 4 to 8 weeks, and common examples include omeprazole, pantoprazole, and lansoprazole. H2-receptor antagonists, such as famotidine, may also be used to reduce stomach acid. To relieve symptoms in the short term, doctors may recommend additional antacid medication, which can be purchased over the counter at pharmacies.

To diagnose an H. pylori infection, doctors may perform an upper GI endoscopy, a C14 breath test, or a biopsy. During an endoscopy, a thin, flexible tube with a video capture device is threaded down the oesophagus into the stomach to obtain detailed images of the stomach lining. A C14 breath test involves swallowing radioactive carbon, and testing the exhaled air to detect the presence of H. pylori. A biopsy involves taking a small tissue sample during an endoscopy for laboratory testing.

Reduce acid production

The treatment for stomach ulcers depends on what caused them. One of the most common causes of stomach ulcers is the H. pylori bacterial infection, which invades the surface cells of the stomach, triggering the production of chemicals that cause inflammation. To treat this, a course of antibiotics is usually prescribed to kill the infection.

In addition to antibiotics, medication called proton pump inhibitors (PPIs) is often recommended to reduce acid production and prevent further damage to the ulcer as it heals. PPIs are usually prescribed for 4 to 8 weeks, and the most commonly used ones include omeprazole, pantoprazole, and lansoprazole. The side effects of PPIs are typically mild and may include diarrhoea and rashes.

H2-receptor antagonists are another type of medication that can be used instead of PPIs to reduce stomach acid production. Examples include famotidine. Antacids may also be taken alongside PPIs or H2-receptor antagonists to quickly neutralise stomach acid and relieve symptoms in the short term. Some antacids contain a medicine called alginate, which produces a protective coating on the lining of the stomach.

If the stomach ulcer is caused by the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), doctors may recommend changes to lower the risk of developing peptic ulcers, such as changing the type of NSAID, lowering the dose, or prescribing NSAIDs for a shorter duration. In some cases, an alternative type of NSAID called a COX-2 inhibitor, which is less likely to cause stomach ulcers, may be recommended.

Surgery in rare cases

Surgery is rarely required to treat stomach ulcers. However, in some cases, doctors may recommend medical procedures such as an upper GI endoscopy or surgery to address ulcer complications.

In rare cases, immediate surgery may be required to treat a stomach ulcer. An endoscopy is a thin, flexible tube threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a video capture device that provides detailed images of the stomach lining. If a gastric ulcer is found, the endoscopy must be repeated after treatment to ensure healing and rule out the possibility of cancer.

A biopsy, in which a small tissue sample is taken during an endoscopy and tested in a laboratory, should always be performed if a gastric ulcer is discovered. A C14 breath test can also be used to check for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing radioactive carbon (C14) and testing the exhaled air from the lungs. A non-radioactive test can be used for children and pregnant women.

If a stomach ulcer is caused by an H. pylori bacterial infection, a course of antibiotics and a medication called a proton pump inhibitor (PPI) is recommended. This is also recommended if the ulcer is thought to be caused by a combination of an H. pylori infection and the use of non-inflammatory medicines (NSAIDs). If the ulcer is solely caused by NSAIDs, a course of PPI medication is recommended.

In some cases, an alternative type of NSAID that is less likely to cause stomach ulcers, called a COX-2 inhibitor, may be recommended. If a patient needs to continue taking low-dose aspirin (an NSAID) to reduce the risk of embolism (blood clots), a doctor will advise whether to continue. If so, long-term treatment with a PPI or H2-receptor antagonist may be prescribed alongside the aspirin to prevent further ulcers.

Frequently asked questions