Because most ulcers stem from
bacteria, doctors use a two-pronged approach:
Accomplishing these two steps requires the use of at
least two, and sometimes three or four, of the following medications:
Several combinations of antibiotics kill
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
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
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
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.
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
However, the drugs cost almost twice as much as acid blockers.
Uncommon side effects include stomach pain, diarrhea and headache.
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
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
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
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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