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Peptic ulcer
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Peptic ulcer

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DIGESTIVE SYSTEM
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From MayoClinic.com

Treatment

Because most ulcers stem from H. pylori bacteria, doctors use a two-pronged approach:

  • Kill the bacteria.

  • Reduce the level of acid in your digestive system to relieve pain and encourage healing.

Accomplishing these two steps requires the use of at least two, and sometimes three or four, of the following medications:

  • Antibiotics. Several combinations of antibiotics kill H. pylori. Most of the medications are equally effective. However, for the treatment to work, it's essential that you follow your doctor's instructions precisely. Antibiotics most commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil, Wymox), clarithromycin (Biaxin), metronidazole (Flagyl) or tetracycline (Achromycin V). Some pharmaceutical companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent specifically for treatment of H. pylori infection. These combination treatments are sold under the names Prevpac and Helidac. You'll need to take antibiotics for only 1 to 2 weeks, depending on their type and number. Other medications prescribed in conjunction with antibiotics generally are taken for a longer period.

  • Acid blockers. Acid blockers — also called histamine (H-2) blockers — reduce the amount of hydrochloric acid released into your digestive tract, which relieves ulcer pain and encourages healing. Acid blockers work by keeping histamine from reaching histamine receptors. Histamine is a substance normally present in your body. When it reacts with histamine receptors, the receptors signal acid-secreting cells in your stomach to release hydrochloric acid. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) and cimetidine (Tagamet). For treatment of ulcers, prescription-strength acid blockers are more effective.

  • Antacids. Your doctor may include an antacid in your drug regimen. An antacid may be taken in addition to an acid blocker or in place of one. Instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief.

  • Proton pump inhibitors. A more effective way to reduce stomach acid is to shut down the "pumps" within acid-secreting cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. They include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). Another drug, pantoprozole (Protonix), can be taken orally or administered intravenously in the hospital. Proton pump inhibitors also appear to inhibit H. pylori. However, the drugs cost almost twice as much as acid blockers. Uncommon side effects include stomach pain, diarrhea and headache.

  • Cytoprotective agents. These medications help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). The drugs cause some side effects. Sucralfate may cause constipation. Misoprostol may cause diarrhea and uterine bleeding. Misoprostol shouldn't be taken by pregnant women because it can cause miscarriage. Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol). In addition to protecting the lining of your stomach and intestines, bismuth preparations appear to inhibit H. pylori activity.

  • Ulcers that fail to heal
    Most peptic ulcers heal within 1 to 3 months. Those that don't are called refractory ulcers. There are many reasons why an ulcer may fail to heal. Not taking medications according to directions is one reason. Another is that some types of H. pylori are resistant to antibiotics. Other factors that can interfere with the healing process include regular use of tobacco, alcohol or nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes the problem is accidental: People are unaware that a medication they're taking contains an NSAID.

  • In rare cases refractory ulcers may be a result of extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome, an infection other than H. pylori, or other digestive diseases, including Crohn's disease or cancer.

  • 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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