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Ulcers Center

Stomach Ulcers Treatment

Ulcers treatment
Primary treatment for an ulcer will depend upon the cause of the ulcer. Treatment is important because people who have ulcers tend to have recurrent problems. If the bacteria H. pylori is identified in the system, doctors use one set of criteria during treatment. If H. pylori is not identified in the system, doctors treat ulcers differently.

1. Non H. pylori diagnosis
If H. pylori isn't identified, then it's likely that an ulcer is due to NSAIDs or acid reflux, which can cause esophageal ulcers. In both cases, your doctor will try to reduce acid levels - through use of acid blockers, antacids or proton pump inhibitors - and may also recommend cytoprotective drugs. 

While an ulcer is healing, watch what you eat and control stress. If stress is severe, it may delay the healing of an ulcer. Acidic or spicy foods may increase ulcer pain. The same is true for stress because stress may increase acid. Always wash your hands thoroughly, eat food that has been properly prepared and drink water from a clean, safe source. Other tips include:

  • Adjust NSAID dose and frequency
  • Avoid or limit use of alcohol when taking pain medications
  • Avoid spicy and fatty foods
  • Control acid reflux - avoid reclining after meals, raise the head of your bed and reduce your weight
  • Discuss ways to protect your stomach while getting pain relief with your doctor
  • Know your risk-factors
  • Quit smoking
  • Read medication labels and follow instructions
  • Substitute alternative pain-relief medications for the NSAID
  • Try a different NSAID

2. H. pylori diagnosis
Eliminating a H pylori infection prevents relapses. The main goals for treating peptic ulcers which are caused by H pylori are to:

  1. Kill the bacteria
  2. Reduce the level of acid in your digestive system to relieve pain and encourage healing.

Medications
The following treatments are recommended only for people who have an ulcer as a consequence of the presence of Helicobacter pylori. Combination drugs that include antibiotics and an acid suppressor or cytoprotective agent have been designed specifically for the treatment of H. pylori infection. For treatment to work, follow your doctor's instructions precisely. Treating a bacterial infection requires the use of at least two, and sometimes three or four, of the following medications:

Antibiotic medications - doctors use combinations of antibiotics to treat H. pylori because one antibiotic alone doesn't always sufficient kill the bacteria. You'll likely need to take antibiotics for two weeks. Antibiotics prescribed for treatment of H. pylori incude:

  • amoxicillin (Amoxil)
  • clarithromycin (Biaxin)
  • metronidazole (Flagyl)

Acid blockers or histamine (H-2) blockers - reduce the amount of hydrochloric acid released into the digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter (OTC), acid blockers include:

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

Antacids - instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief. An antacid may be taken in addition to an acid blocker or in place of one.

Cytoprotective agents - help protect the tissues that line the stomach and small intestine. They include prescription and nonprescription medications:

  • sucralfate (Carafate)
  • subsalicylate (Pepto-Bismol)
  • misoprostol (Cytotec)

Proton pump inhibitors - reduce acid by blocking the action of tiny pumps within acid-secreting cells and also appear to inhibit H. pylori. Doctors frequently prescribe proton pump inhibitors to promote the healing of peptic ulcers. If you're admitted to the hospital with a bleeding ulcer, taking intravenous proton pump inhibitors decreases the chance that bleeding will recur. Long-term use, particularly at high doses, may increase risk of hip fracture so you may need a calcium supplement while taking these medications. Prescription and over-the-counter medications include:

  • esomeprazole (Nexium)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec)
  • pantoprazole (Protonix)
  • rabeprazole (Aciphex)

Surgery
Fortunately, surgical therapy is rarely needed because of the efficacy of medical treatment.  With proper treatment, surgery is usually not necessary. However, you may need surgery if an ulcer fails to heal, if you have bleeding complications, or if a perforation (hole) or obstruction in the stomach develops.

During, the surgeon may remove an ulcer altogether or "oversew" it with tissue taken from another part of the intestine. Other options include tying off the bleeding artery or cutting off the nerve supply to the stomach to reduce the formation of stomach acid.

3. Refractory ulcers
Peptic ulcers that don't heal with treatment are called refractory ulcers. Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with stronger doses of ulcer medications. Sometimes, additional medications may be included. Surgery to help heal an ulcer is necessary only when the ulcer doesn't respond to aggressive drug treatment.

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