Heartburn

Updated 15 March 2016

Treating peptic ulcers

The first step in a treatment plan for ulcers aims at reducing risk factors like smoking and the use of anti-inflammatory medication.

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Peptic ulcers tend to respond well to treatment but often recur in many people. The goal of treating an ulcer is to relieve pain and prevent complications. The first step in such a treatment plan aims at reducing risk factors (smoking and use of anti-inflammatory medication). Medication can be taken as a second step. Surgery may be necessary in severe cases.

Home treatment

  • Stop smoking.
  • Take paracetamol, instead of aspirin, ibuprofen or naproxen, to relieve pain.
  • Try to eat smaller and more frequent meals, but if this does not help, return to your regular eating pattern.
  • Avoid foodstuffs such as alcohol, caffeine and spicy foods that seem to bring on symptoms.
  • If a particular food does not cause any problems, there is no need to eliminate it from your diet.
  • If you need an antacid to neutralise stomach acid, speak to your doctor about the best one, especially if you are on a low-salt diet, as many of the antacids have high sodium content.
  • Keep emotional stress under control by using relaxation techniques such as muscle relaxation exercises, positive mental imagery and breathing exercises.
  • Change your lifestyle to help you cope with stress by exercising, eating balanced meals and getting enough rest.
  • Get professional assistance to help you to change stressful life circumstances and to develop positive coping mechanisms.
  • Nurture positive relationships.

Medication

Antacids

This kind of medication neutralises the acid present in the stomach. They are very useful for an occasional episode of symptoms. Taken on a regular/daily basis, they have more side effects than the newer H2 Blockers and proton pump inhibitors described below.

H2 blockers

Studies have shown that a protein in the stomach, histamine, stimulates the secretion of gastric acid. Histamine antagonists (H2 blockers such as ranitidine and cimetidine) can block this action of histamine on gastric cells and thereby reduce the amount of acid produced. This kind of medication is quite effective in healing peptic ulcers.

H2 blockers have few side effects and are well tolerated even when used continuously for a long time. However, ulcers often return when people stop taking this medication if the causative factors are not addressed.

Proton pump inhibitors

These drugs are the most potent suppressors of gastric acid secretion. There are five main drugs available – omeprazole, lansoprazole, pantoprazole, esomeprazole and rabeprazole. The most frequent side effects are nausea, headaches diarrhoea, flatulence and constipation.

Antibiotics for H. pylori infection

H. pylori bacteria can infect the stomach lining, but this may or may not cause a peptic ulcer. Although H. pylori can be difficult to eradicate completely, treatment with several antibiotics, sometimes in combination with other medications such as H2 blockers or proton pump inhibitors, can be effective.

Commonly used antibiotics are amoxycillin clarithromycin or metromedazole. If the bacteria are eliminated completely, this can prevent ulcers from recurring.

It is important for patients to note that treatment with antibiotics does have a risk of causing allergic reactions, diarrhoea and sometimes inflammation of the colon. It can take two to three weeks for infection with H. pylori to clear and may require two to three antibiotics in combination. Some patients find that this regime is difficult to adhere to.

For gastric ulcers a follow-up gastroscope is needed six to eight weeks later to ensure that the ulcer has healed. Further biopsies are needed if healing is not occurring as fast as expected.

Surgery

In the past, surgery was done for peptic ulcers.  This has been replaced with adequate medical therapy.

Surgery may be necessary if serious complications develop. In the case of a bleeding ulcer, the doctor will repair the source of the bleeding. If the ulcer has perforated the stomach or duodenal wall, an emergency operation is required to close the perforation.

Peptic ulcer surgery is performed only in emergencies because of the associated risk of complications. These include recurrence of the ulcer(s); the formation of fistulae (connections between the small intestine and colon); vomiting of bile; diarrhoea; haematological complications (anaemia); and dumping syndrome.

Dumping syndrome occurs when the stomach empties rapidly ("dumps") into the small intestine. This may lead to reactive hypoglycaemia (low blood sugar).

Symptoms include colic-like abdominal pain, diarrhoea, vomiting and/or sweating an hour after eating. Dumping syndrome may be lessened by a regimen of small meals at frequent intervals.

Read more: 

The causes of peptic ulcers

The complications of peptic ulcers

Preventing peptic ulcers

Revised and reviewed by Dr John P Wright MBChB, MRCP (UK), PhD. Gastroenterologist in private practice, Cape Town. February 2015

Previously reviewed by Prof Jan van Zyl, Department of Gastroenterology, University of the Free State, July 2011