Materiały źródłowe

• #1 Treatment for Peptic Ulcers (Stomach or Duodenal Ulcers) – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment

  To treat peptic ulcers, doctors typically recommend medicines to help the ulcer heal. They also look for the cause of ulcers and treat or manage the cause. Talk with your doctor about the best treatment plan for you. […] Medicines that doctors recommend or prescribe to treat peptic ulcers include proton pump inhibitors (PPIs), H2 blockers, and other medicines. […] Doctors treat the underlying causes of peptic ulcers to help the ulcers heal and prevent them from coming back. […] Doctors treat H. pylori infection with a combination of medicines. These medicines most often include two or more antibiotics, a PPI, and in some cases, bismuth subsalicylate. […] If you have a peptic ulcer caused by taking NSAIDs, your doctor may recommend changing your medicines. […] If you need to keep taking NSAIDs, your doctor may recommend you also take a PPI.

• #2 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. […] Recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors. […] Eradication of H. pylori is recommended in all patients with PUD. […] First-line therapy should have an eradication rate of more than 80%. […] Standard triple therapy is a reasonable initial therapy where clarithromycin resistance is low. […] A seven- to 10-day triple drug regimen consisting of a PPI, amoxicillin 1 g, and clarithromycin 500 mg (Biaxin) twice daily has long been the first-line therapy to eradicate H. pylori.

• #3 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Treatment for peptic ulcers involves killing the H. pylori germ, if needed. Treatment also might involve stopping NSAIDs or lowering the amount, if possible, and taking medicine to help the ulcer heal. […] Medicines can include: […] Antibiotics to kill H. pylori. If you have H. pylori in your digestive tract, your healthcare professional may suggest a mix of antibiotics. These may include amoxicillin (Amoxil, Larotid), clarithromycin (Biaxin XL), metronidazole (Flagyl, Likmez), tinidazole (Tindamax), tetracycline and levofloxacin. […] Medicines that block acid. Proton pump inhibitors (PPIs) reduce stomach acid. PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). […] Medicines to reduce stomach acid. Acid blockers, also called histamine (H-2) blockers, help relieve ulcer pain and help with healing. Acid blockers include famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine (Axid AR).

• #4 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. […] Recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors. […] Eradication of H. pylori is recommended in all patients with PUD. […] First-line therapy should have an eradication rate of more than 80%. […] Standard triple therapy is a reasonable initial therapy where clarithromycin resistance is low. […] A seven- to 10-day triple drug regimen consisting of a PPI, amoxicillin 1 g, and clarithromycin 500 mg (Biaxin) twice daily has long been the first-line therapy to eradicate H. pylori.

• #5 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. […] Recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors. […] Eradication of H. pylori is recommended in all patients with PUD. […] First-line therapy should have an eradication rate of more than 80%. […] Standard triple therapy is a reasonable initial therapy where clarithromycin resistance is low. […] A seven- to 10-day triple drug regimen consisting of a PPI, amoxicillin 1 g, and clarithromycin 500 mg (Biaxin) twice daily has long been the first-line therapy to eradicate H. pylori.

• #6 Peptic ulcer disease – Wikipedia

  https://en.wikipedia.org/wiki/Peptic_ulcer_disease

  Treatment includes stopping smoking, stopping use of NSAIDs, stopping alcohol, and taking medications to decrease stomach acid. The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker, with four weeks of treatment initially recommended. Ulcers due to H. pylori are treated with a combination of medications, such as amoxicillin, clarithromycin, and a PPI. Antibiotic resistance is increasing and thus treatment may not always be effective. Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful. […] Once the diagnosis of H. pylori is confirmed, the first-line treatment would be a triple regimen in which pantoprazole and clarithromycin are combined with either amoxicillin or metronidazole. This treatment regimen can be given for 7-14 days. However, its effectiveness in eradicating H. pylori has been reducing from 90% to 70%. However, the rate of eradication can be increased by doubling the dosage of pantoprazole or increasing the duration of treatment to 14 days. Quadruple therapy (pantoprazole, clarithromycin, amoxicillin, and metronidazole) can also be used. The quadruple therapy can achieve an eradication rate of 90%. If the clarithromycin resistance rate is higher than 15% in an area, the usage of clarithromycin should be abandoned. Instead, bismuth-containing quadruple therapy can be used (pantoprazole, bismuth citrate, tetracycline, and metronidazole) for 14 days. The bismuth therapy can also achieve an eradication rate of 90% and can be used as second-line therapy when the first-line triple-regimen therapy has failed.

• #7 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  However, increasing resistance to clarithromycin is associated with declining eradication rates, now well below 80%. […] Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) or tinidazole 500 mg (Tindamax) taken twice daily. […] Nonbismuth-based quadruple therapy may be more effective than sequential therapy in patients with dual antibiotic resistance to clarithromycin and metronidazole. […] Bismuth-based quadruple therapy is often employed as salvage therapy if first-line treatment fails, but it may be used as first-line therapy in areas of high resistance or when cost is an important consideration. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #8 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  However, increasing resistance to clarithromycin is associated with declining eradication rates, now well below 80%. […] Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) or tinidazole 500 mg (Tindamax) taken twice daily. […] Nonbismuth-based quadruple therapy may be more effective than sequential therapy in patients with dual antibiotic resistance to clarithromycin and metronidazole. […] Bismuth-based quadruple therapy is often employed as salvage therapy if first-line treatment fails, but it may be used as first-line therapy in areas of high resistance or when cost is an important consideration. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #9 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  However, increasing resistance to clarithromycin is associated with declining eradication rates, now well below 80%. […] Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) or tinidazole 500 mg (Tindamax) taken twice daily. […] Nonbismuth-based quadruple therapy may be more effective than sequential therapy in patients with dual antibiotic resistance to clarithromycin and metronidazole. […] Bismuth-based quadruple therapy is often employed as salvage therapy if first-line treatment fails, but it may be used as first-line therapy in areas of high resistance or when cost is an important consideration. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #10 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  Acid suppression is the general pharmacologic principle of medical management of acute bleeding from a peptic ulcer. Reducing gastric acidity is believed to improve hemostasis primarily through the decreased activity of pepsin in the presence of a more alkaline environment. […] Two classes of acid-suppressing medications currently in use are histamine-2 receptor antagonists (H2RAs) and PPIs. […] H2RAs are an older class of medications, and in the setting of an actively bleeding duodenal ulcer, their use has been largely superseded by the use of PPIs. […] The 2017 American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection strongly recommend 10-14 days of quadruple therapy with bismuth, a proton pump inhibitor (PPI), tetracycline, and a nitroimidazole.

• #11 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  However, increasing resistance to clarithromycin is associated with declining eradication rates, now well below 80%. […] Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) or tinidazole 500 mg (Tindamax) taken twice daily. […] Nonbismuth-based quadruple therapy may be more effective than sequential therapy in patients with dual antibiotic resistance to clarithromycin and metronidazole. […] Bismuth-based quadruple therapy is often employed as salvage therapy if first-line treatment fails, but it may be used as first-line therapy in areas of high resistance or when cost is an important consideration. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #12 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  Treatment of H. pylori — H. pylori is treated with several medications, usually including at least two antibiotics (to kill the bacteria) and a proton pump inhibitor for acid suppression. Treatment for H. pylori usually takes two weeks. It is important to take all of the medicines for the entire course of treatment. […] Treatment of ulcers not due to H. pylori — If you have an ulcer but tested negative for H. pylori, your health care provider will still prescribe an acid-suppressing medication in order to help the ulcer heal. This will usually be a proton pump inhibitor. (See 'Acid suppression’ above.) […] You should take your ulcer medication as directed, even if your ulcer doesn’t cause bothersome symptoms. Some people can stop the medication after four to six weeks; others may need to keep taking it for longer if their ulcers are large or at risk of recurring, or if they have had complications due to ulcers in the past. (See 'Peptic ulcer complications’ below.)

• #13 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  If the person is infected with Helicobacter pylori this infection should be treated. Completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”. […] When someone has an ulcer that has bled significantly, treatment might be done at the time of EGD. There are a number of techniques that can be performed during an EGD to control bleeding from an ulcer. The gastroenterologist might inject medications, use a catheter to cauterize the ulcer (burn a bleeding vessel shut) or place a small clip to clamp off a bleeding vessel. Not all ulcers need to be treated this way. The doctor doing the EGD will decide if treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer that is actually bleeding when it is seen and will also often treat other ulcers if they have a certain appearance. These findings are sometimes called “stigmata of recent hemorrhage” or just “stigmata”. Stigmata will usually get treated during the EGD if they are classified as high-risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.

• #14 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  If the person is infected with Helicobacter pylori this infection should be treated. Completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”. […] When someone has an ulcer that has bled significantly, treatment might be done at the time of EGD. There are a number of techniques that can be performed during an EGD to control bleeding from an ulcer. The gastroenterologist might inject medications, use a catheter to cauterize the ulcer (burn a bleeding vessel shut) or place a small clip to clamp off a bleeding vessel. Not all ulcers need to be treated this way. The doctor doing the EGD will decide if treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer that is actually bleeding when it is seen and will also often treat other ulcers if they have a certain appearance. These findings are sometimes called “stigmata of recent hemorrhage” or just “stigmata”. Stigmata will usually get treated during the EGD if they are classified as high-risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.

• #15 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  Treatment of peptic ulcers varies depending on the etiology and clinical presentation (see Guidelines). The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. […] Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath testing for active H pylori infection may be used. […] Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease. Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers.

• #16 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Treatment for peptic ulcers involves killing the H. pylori germ, if needed. Treatment also might involve stopping NSAIDs or lowering the amount, if possible, and taking medicine to help the ulcer heal. […] Medicines can include: […] Antibiotics to kill H. pylori. If you have H. pylori in your digestive tract, your healthcare professional may suggest a mix of antibiotics. These may include amoxicillin (Amoxil, Larotid), clarithromycin (Biaxin XL), metronidazole (Flagyl, Likmez), tinidazole (Tindamax), tetracycline and levofloxacin. […] Medicines that block acid. Proton pump inhibitors (PPIs) reduce stomach acid. PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). […] Medicines to reduce stomach acid. Acid blockers, also called histamine (H-2) blockers, help relieve ulcer pain and help with healing. Acid blockers include famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine (Axid AR).

• #17 Stomach Ulcer: Signs, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22314-stomach-ulcer

  A stomach ulcer occurs when stomach acid eats through your protective stomach lining, producing an open sore. […] A healthcare provider must identify the cause of your ulcer to recommend the right treatment. […] Stomach ulcers are common and treatable, but they can become serious if they go too long without treatment. […] Sometimes, a stomach ulcer is called a peptic ulcer. Stomach ulcers are one type of peptic ulcer disease. […] Your stomach lining will begin to heal when the cause of the ulcer goes away. […] If you have an H. pylori infection, you’ll probably need antibiotics to make it go away. […] Healthcare providers treat most ulcers with a combination of medications to reduce stomach acid, coat and protect the ulcer during healing, and kill any infection involved. […] Medications to treat stomach ulcers include antibiotics, cytoprotective agents, histamine receptor blockers (H2 blockers), and proton pump inhibitors (PPIs).

• #18 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  The way that ulcers are treated depends on a number of features. Nearly all peptic ulcers will be treated with a proton pump inhibitor (PPI). PPIs are powerful acid blocking drugs that can be taken as a pill or given in an IV. Often, the potent IV form is used if a patient is hospitalized with a bleeding ulcer. There are six PPIs available in the United States. These are omeprazole (Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), esomeprazole (Nexium®), and dexlansoprazole (Dexilant®). There are very few medical differences between these drugs. […] An important part in treating ulcers is by identifying what caused them Patients with ulcers caused by NSAIDs should talk to their doctor about other medications that can be used to treat pain.

• #19 Peptic Ulcer Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534792/

  Peptic ulcer disease (PUD) is characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. […] This activity reviews the cause, pathophysiology, and presentation of peptic ulcer disease and highlights the role of the interprofessional team in its management. […] Summarize the treatment options for peptic ulcer disease. […] Today, most patients can be managed with a proton pump inhibitor (PPI) based triple-drug therapy. […] Antisecretory drugs used for peptic ulcer disease (PUD) include H2-receptor antagonists and proton pump inhibitors (PPIs). […] PPIs have largely replaced H2 receptor blockers due to their superior healing and efficacy. […] First-line treatment for H. pylori-induced PUD is a triple regimen comprising two antibiotics and a proton pump inhibitor.

• #20 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Peptic ulcer disease usually occurs in the stomach and proximal duodenum. […] Patients taking nonsteroidal anti-inflammatory drugs should discontinue their use. […] If H. pylori infection is diagnosed, the infection should be eradicated and antisecretory therapy (preferably with a proton pump inhibitor) given for four weeks. […] Surgery is indicated if complications develop or if the ulcer is unresponsive to medications. […] Administration of proton pump inhibitors and endoscopic therapy control most bleeds. […] In patients with peptic ulcer disease, Helicobacter pylori should be eradicated to assist in healing and to reduce the risk of gastric and duodenal ulcer recurrence. […] In patients with peptic ulcers, proton pump inhibitors provide acid suppression, healing rates, and symptom relief superior to other antisecretory therapies.

• #21 Peptic ulcers: treatment – myDr.com.au

  https://mydr.com.au/gastrointestinal-health/peptic-ulcers-treatment/

  Eradication therapy has revolutionised the treatment of peptic ulcers worldwide. Depending on the medicines used, it can have a success rate of 85 to 90 per cent in eradicating H. Pylori and treating peptic ulcers. Eradicating H. pylori also significantly reduces the chance of relapse. […] Treatment for NSAID-induced ulcers involves stopping the NSAID (if possible) and taking a medicine to suppress acid secretion and promote healing. […] Acid-suppressing medicines are usually given for 8-12 weeks, depending on whether it is a duodenal or gastric ulcer. Proton pump inhibitors are usually used, as they are effective and heal ulcers faster than H2-receptor antagonists. […] In people who cannot stop taking NSAIDs, taking them in combination with a proton pump inhibitor can reduce the risk of peptic ulcers. Some people at high risk may be offered long-term treatment with PPIs to prevent a recurrence. […] Your doctor will also recommend testing for H. pylori infection and eradication treatment if necessary.

• #22 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Treatment for peptic ulcers involves killing the H. pylori germ, if needed. Treatment also might involve stopping NSAIDs or lowering the amount, if possible, and taking medicine to help the ulcer heal. […] Medicines can include: […] Antibiotics to kill H. pylori. If you have H. pylori in your digestive tract, your healthcare professional may suggest a mix of antibiotics. These may include amoxicillin (Amoxil, Larotid), clarithromycin (Biaxin XL), metronidazole (Flagyl, Likmez), tinidazole (Tindamax), tetracycline and levofloxacin. […] Medicines that block acid. Proton pump inhibitors (PPIs) reduce stomach acid. PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). […] Medicines to reduce stomach acid. Acid blockers, also called histamine (H-2) blockers, help relieve ulcer pain and help with healing. Acid blockers include famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine (Axid AR).

• #23

  https://www.nhs.uk/conditions/stomach-ulcer/treatment/

  H2-receptor antagonists, such as famotidine, are often used to treat stomach ulcers. […] If your stomach ulcer has been caused by taking NSAIDs, your GP will want to review your use of them. […] Sometimes an alternative type of NSAID that’s less likely to cause stomach ulcers, called a COX-2 inhibitor, may be recommended. […] If you do need to keep taking it, long-term treatment with a PPI or H2-receptor antagonist may be prescribed alongside the aspirin to try to prevent further ulcers.

• #24 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  Acid suppression is the general pharmacologic principle of medical management of acute bleeding from a peptic ulcer. Reducing gastric acidity is believed to improve hemostasis primarily through the decreased activity of pepsin in the presence of a more alkaline environment. […] Two classes of acid-suppressing medications currently in use are histamine-2 receptor antagonists (H2RAs) and PPIs. […] H2RAs are an older class of medications, and in the setting of an actively bleeding duodenal ulcer, their use has been largely superseded by the use of PPIs. […] The 2017 American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection strongly recommend 10-14 days of quadruple therapy with bismuth, a proton pump inhibitor (PPI), tetracycline, and a nitroimidazole.

• #25 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Medicines that protect the lining of the stomach and small intestine. These are called cytoprotective agents. They include the prescription medicines sucralfate (Carafate) and misoprostol (Cytotec). […] Treatment for refractory ulcers most often involves getting rid of factors that keep the ulcer from healing and trying other antibiotics. If you smoke, your healthcare professional may suggest you quit. Smoking can slow ulcer healing. […] A serious complication from an ulcer, such as bleeding or a hole in the stomach, may need treatment with endoscopy or surgery. But because there are many medicines that work well, people with peptic ulcers need surgery far less often than in the past.

• #26 Peptic Ulcer Disease: Symptoms, Causes & Treatments Gastroenterologist Folsom,CA-Reflux,Stomach Pain,Ulcers

  https://www.gastromedclinic.com/peptic-ulcer-disease/

  Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. […] Medications to reduce acid production. Acid blockers also called histamine (H-2) blockers reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. […] Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR). […] Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. […] Antacids can provide symptom relief, but generally aren’t used to heal your ulcer. […] Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

• #27 Peptic Ulcer Disease Medication: Proton Pump Inhibitors, H2-Receptor Antagonists, Antimicrobials, Antidiarrheal Agents, Cytoprotective Agents

  https://emedicine.medscape.com/article/181753-medication

  Misoprostol is a prostaglandin analog that can be used to decrease the incidence of peptic ulcers and complications in long-term NSAID users at high risk. […] Sucralfate binds with positively charged proteins in exudates and forms a viscous adhesive substance that protects the GI lining against pepsin, peptic acid, and bile salts. It is used for short-term management of ulcers.

• #28

  https://www.nhs.uk/conditions/stomach-ulcer/treatment/

  Treatment for your stomach ulcer will depend on what caused it. With treatment, most ulcers heal in a few months. […] If your stomach ulcer is caused by a Helicobacter pylori (H. pylori) bacterial infection, a course of antibiotics and a medication called a proton pump inhibitor (PPI) is recommended. […] If your stomach ulcer is just caused by taking NSAIDs, a course of PPI medication is recommended. […] An alternative type of medication, known as H2-receptor antagonists, is occasionally used instead of PPIs. […] Sometimes you may be given additional medication called antacids to relieve your symptoms in the short term. […] PPIs work by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally. They’re usually prescribed for 4 to 8 weeks.

• #29 Stomach ulcer (gastric ulcer) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/stomach-ulcer/

  These also reduce the amount of acid your stomach produces. […] As these treatments can take several hours before they start to work, your GP may recommend taking additional antacid medication. […] Antacids: neutralise your stomach acid, provide immediate, but short-term, symptom relief, should be taken when you experience symptoms or when you expect them, such as after meals or at bedtime. […] There aren’t any special lifestyle measures you need to take during treatment. However, avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals.

• #30 Treatment for Peptic Ulcers (Stomach or Duodenal Ulcers) – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment

  To treat peptic ulcers, doctors typically recommend medicines to help the ulcer heal. They also look for the cause of ulcers and treat or manage the cause. Talk with your doctor about the best treatment plan for you. […] Medicines that doctors recommend or prescribe to treat peptic ulcers include proton pump inhibitors (PPIs), H2 blockers, and other medicines. […] Doctors treat the underlying causes of peptic ulcers to help the ulcers heal and prevent them from coming back. […] Doctors treat H. pylori infection with a combination of medicines. These medicines most often include two or more antibiotics, a PPI, and in some cases, bismuth subsalicylate. […] If you have a peptic ulcer caused by taking NSAIDs, your doctor may recommend changing your medicines. […] If you need to keep taking NSAIDs, your doctor may recommend you also take a PPI.

• #31 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  For patients who must continue with their NSAIDs, PPI maintenance is recommended to prevent recurrences even after eradication of H pylori. […] Active ulcers associated with NSAID use are treated with an appropriate course of PPI therapy and the cessation of NSAIDs. […] Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated in high-risk patients. High-risk patients include those with recurrent ulcers and those with complicated or giant ulcers.

• #32

  https://www.nhs.uk/conditions/stomach-ulcer/treatment/

  H2-receptor antagonists, such as famotidine, are often used to treat stomach ulcers. […] If your stomach ulcer has been caused by taking NSAIDs, your GP will want to review your use of them. […] Sometimes an alternative type of NSAID that’s less likely to cause stomach ulcers, called a COX-2 inhibitor, may be recommended. […] If you do need to keep taking it, long-term treatment with a PPI or H2-receptor antagonist may be prescribed alongside the aspirin to try to prevent further ulcers.

• #33 Peptic ulcers: treatment – myDr.com.au

  https://mydr.com.au/gastrointestinal-health/peptic-ulcers-treatment/

  Eradication therapy has revolutionised the treatment of peptic ulcers worldwide. Depending on the medicines used, it can have a success rate of 85 to 90 per cent in eradicating H. Pylori and treating peptic ulcers. Eradicating H. pylori also significantly reduces the chance of relapse. […] Treatment for NSAID-induced ulcers involves stopping the NSAID (if possible) and taking a medicine to suppress acid secretion and promote healing. […] Acid-suppressing medicines are usually given for 8-12 weeks, depending on whether it is a duodenal or gastric ulcer. Proton pump inhibitors are usually used, as they are effective and heal ulcers faster than H2-receptor antagonists. […] In people who cannot stop taking NSAIDs, taking them in combination with a proton pump inhibitor can reduce the risk of peptic ulcers. Some people at high risk may be offered long-term treatment with PPIs to prevent a recurrence. […] Your doctor will also recommend testing for H. pylori infection and eradication treatment if necessary.

• #34 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  However, increasing resistance to clarithromycin is associated with declining eradication rates, now well below 80%. […] Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) or tinidazole 500 mg (Tindamax) taken twice daily. […] Nonbismuth-based quadruple therapy may be more effective than sequential therapy in patients with dual antibiotic resistance to clarithromycin and metronidazole. […] Bismuth-based quadruple therapy is often employed as salvage therapy if first-line treatment fails, but it may be used as first-line therapy in areas of high resistance or when cost is an important consideration. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #35 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  For patients who must continue with their NSAIDs, PPI maintenance is recommended to prevent recurrences even after eradication of H pylori. […] Active ulcers associated with NSAID use are treated with an appropriate course of PPI therapy and the cessation of NSAIDs. […] Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated in high-risk patients. High-risk patients include those with recurrent ulcers and those with complicated or giant ulcers.

• #36 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  Quit smoking, if you smoke […] Limit the amount of alcohol you drink […] Take antacids if they relieve your upset stomach […] PEPTIC ULCER COMPLICATIONS […] Although most peptic ulcers heal completely with treatment, they can sometimes lead to complications. The risk of serious complications depends on the cause of the ulcer, the size and location of the ulcer, and the person’s age and health. […] Bleeding — Bleeding ulcers most often affect older people. Symptoms may include blood in the vomit or in the stool (this can give stools a black, tar-like appearance). People with bleeding ulcers usually need to take a proton pump inhibitor (see 'Peptic ulcer treatment’ above). Those with heavy or rapid bleeding may require IV fluids and blood transfusions in the hospital. […] Ulcers that are actively bleeding, or are at risk of bleeding again, can be treated during an upper endoscopy (see 'Upper endoscopy’ above). Treatment may involve cauterizing the ulcer, applying tiny clips to close off the blood vessels, injecting a medication called epinephrine, or using a special type of powder to form a barrier. The goal is to stop the bleeding and prevent future bleeding.

• #37 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  Given the current understanding of the pathogenesis of peptic ulcer disease, most patients with peptic ulcer disease are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory agents (NSAIDs), along with the appropriate use of antisecretory therapy. […] The indications for urgent surgery include failure to achieve hemostasis endoscopically, recurrent bleeding despite endoscopic attempts at achieving hemostasis (many advocate surgery after two failed endoscopic attempts), and perforation. Many authorities recommend simple oversewing of the ulcer with treatment of the underlying H pylori infection or cessation of NSAIDs for bleeding peptic ulcer disease. […] Urgent esophagogastroduodenoscopy (EGD) is the treatment of choice in the setting of a bleeding peptic ulcer for diagnostic and therapeutic reasons. Endoscopy provides an opportunity to visualize the ulcer, to determine the degree of active bleeding, and to attempt hemostasis by direct measures.

• #38 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  If the person is infected with Helicobacter pylori this infection should be treated. Completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”. […] When someone has an ulcer that has bled significantly, treatment might be done at the time of EGD. There are a number of techniques that can be performed during an EGD to control bleeding from an ulcer. The gastroenterologist might inject medications, use a catheter to cauterize the ulcer (burn a bleeding vessel shut) or place a small clip to clamp off a bleeding vessel. Not all ulcers need to be treated this way. The doctor doing the EGD will decide if treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer that is actually bleeding when it is seen and will also often treat other ulcers if they have a certain appearance. These findings are sometimes called “stigmata of recent hemorrhage” or just “stigmata”. Stigmata will usually get treated during the EGD if they are classified as high-risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.

• #39 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  In rare cases, a person with a bleeding ulcer may need surgery or embolization. Embolization involves identifying the specific blood vessels that are the source of the bleeding and blocking off the flow of blood through them. […] Perforation — Perforation is when an ulcer causes a hole through the wall of the stomach or duodenum. Symptoms include sudden, severe abdominal pain and a rapid heartbeat. Pain may radiate to one or both shoulders, and the abdomen may become rigid. […] A perforated stomach or duodenal ulcer is a medical emergency and needs treatment immediately. Treatment usually involves a surgical procedure to close the perforation, insertion of a nasogastric tube (a tube that goes through the nose into the stomach), IV fluids, and medications to help the ulcer heal. […] Obstruction — Gastric outlet obstruction is a less common complication of peptic ulcers. It refers to an obstruction or blockage of the outlet of the stomach (the part that leads to the small intestine). Vomiting is the most common symptom; other symptoms include feeling full quickly after eating, bloating, abdominal pain, loss of appetite, and nausea.

• #40 Bleeding Peptic Ulcer: Treatment | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/bleeding-peptic-ulcer-treatment

  Interventional angiography. A long catheter is threaded into the arteries near the ulcer. A coil, absorbable sponge, or medicine is put into the blood vessel to stop the ulcer bleeding. […] Surgery. This can be done in two different ways: […] Open surgery. A cut (incision) is made in your belly (abdomen) to reach the ulcer. This lets the surgeon see and treat the ulcer directly. […] Laparoscopy. A few small cuts are made in your belly. A scope with a tiny camera is then inserted through one of the cuts. […] You will be given medicines to help manage pain and to ease symptoms. […] New types of treatment are also being studied. Ask your provider about any new treatment options. […] Keep all follow-up appointments with your provider. These are needed to check your health and recovery progress.

• #41 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  In rare cases, a person with a bleeding ulcer may need surgery or embolization. Embolization involves identifying the specific blood vessels that are the source of the bleeding and blocking off the flow of blood through them. […] Perforation — Perforation is when an ulcer causes a hole through the wall of the stomach or duodenum. Symptoms include sudden, severe abdominal pain and a rapid heartbeat. Pain may radiate to one or both shoulders, and the abdomen may become rigid. […] A perforated stomach or duodenal ulcer is a medical emergency and needs treatment immediately. Treatment usually involves a surgical procedure to close the perforation, insertion of a nasogastric tube (a tube that goes through the nose into the stomach), IV fluids, and medications to help the ulcer heal. […] Obstruction — Gastric outlet obstruction is a less common complication of peptic ulcers. It refers to an obstruction or blockage of the outlet of the stomach (the part that leads to the small intestine). Vomiting is the most common symptom; other symptoms include feeling full quickly after eating, bloating, abdominal pain, loss of appetite, and nausea.

• #42 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  In rare cases, a person with a bleeding ulcer may need surgery or embolization. Embolization involves identifying the specific blood vessels that are the source of the bleeding and blocking off the flow of blood through them. […] Perforation — Perforation is when an ulcer causes a hole through the wall of the stomach or duodenum. Symptoms include sudden, severe abdominal pain and a rapid heartbeat. Pain may radiate to one or both shoulders, and the abdomen may become rigid. […] A perforated stomach or duodenal ulcer is a medical emergency and needs treatment immediately. Treatment usually involves a surgical procedure to close the perforation, insertion of a nasogastric tube (a tube that goes through the nose into the stomach), IV fluids, and medications to help the ulcer heal. […] Obstruction — Gastric outlet obstruction is a less common complication of peptic ulcers. It refers to an obstruction or blockage of the outlet of the stomach (the part that leads to the small intestine). Vomiting is the most common symptom; other symptoms include feeling full quickly after eating, bloating, abdominal pain, loss of appetite, and nausea.

• #43 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  Gastric outlet obstruction is treated by inserting a nasogastric tube to remove food and fluid that has been unable to pass from the stomach into the small intestine and giving medications to reduce production of stomach acid and secretions. Many people also need IV fluids to stay hydrated. If the obstruction is related to an ulcer that was caused by H. pylori or nonsteroidal anti-inflammatory drug (NSAID) use, addressing those causes (treating the H. pylori infection and/or stopping NSAIDs, along with treating the ulcer with acid-suppressing medication) often resolves the obstruction. […] For people who don’t respond to medication, obstruction can be treated during an endoscopy (see 'Upper endoscopy’ above). This is done by inserting a tiny balloon to dilate (open) the gastric outlet. A biopsy may be performed to rule out other, more serious causes of obstruction, such as stomach cancer. […] If balloon dilation is not possible (or doesn’t work), surgery to remove or bypass the obstruction may be an option.

• #44 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  Surgical management of uncomplicated peptic ulcers is rarely necessary because they usually respond well to medical treatment. […] When malignancy is confirmed or complications such as massive bleeding or gastrointestinal perforation occur, surgery specific to these complications must be performed. […] Indications for surgery include refractory symptoms or recurrence of disease despite appropriate medical treatment. […] Cytoprotective agents (gastrointestinal mucosal protection) such as sucralfate and misoprostol are considered for ulcer prophylaxis in patients at high risk of developing NSAID-induced GI toxicity.

• #45 Peptic Ulcer Disease – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease

  Medications are given to reduce acid in the stomach, and antibiotics often are given to eliminate Helicobacter pylori. […] Treatment of Helicobacter pylori infection with 2 antibiotics together with bismuth subsalicylate and a proton pump inhibitor (called quadruple therapy) is given when infection is diagnosed. […] Acid-reducing medications block the production of stomach acid. The most commonly used acid-reducing medications include proton pump inhibitors and histamine-2 (H2) blockers. […] Neutralizing or reducing stomach acid promotes healing of peptic ulcers regardless of the cause. […] Surgery for ulcers is rarely needed because medications so effectively heal peptic ulcers and endoscopy so effectively stops active bleeding. […] Surgery is used primarily to deal with complications of a peptic ulcer, such as a perforation, an obstruction that fails to respond to medication or that recurs, two or more major episodes of bleeding ulcers, a gastric ulcer suspected of being cancerous, and severe and frequent recurrences of peptic ulcers. […] If Helicobacter pylori infection is successfully treated, peptic ulcer disease comes back in only 10% of people. However, peptic ulcer disease comes back in 50% of infected people when Helicobacter pylori infection is not eradicated.

• #46 Peptic Ulcers – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/esophagus-and-stomach/peptic-ulcer

  At Brigham and Womens Hospital (BWH), our board certified general and gastrointestinal surgeons offer innovative and effective treatment for patients who have peptic ulcers that do not heal with medication or have caused complications. […] Peptic ulcers typically heal with medication and lifestyle changes. For people who do not respond to medication or have experienced complications such as hemorrhage, perforation or obstruction, surgery is the best option. […] Brigham and Womens Hospital surgeons offer extensive expertise in all surgical approaches: […] Gastrectomy, subtotal or partial gastrectomy, removes part of the stomach. […] Vagotomy involves cutting the vagus nerve to reduce acid secretion. […] Antrectomy removes the lower part of the stomach which produces a hormone that stimulates the stomach to secrete digestive juices.

• #47 Peptic Ulcer Disease: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/stomach-diseases/peptic-ulcer-disease/treatment

  Vagotomy. This procedure involves cutting parts of the vagus nerve to interrupt the signals your brain sends to your stomach to make stomach acid, thereby reducing acid secretion. […] Antrectomy. The surgeon removes the lower part of your stomach (antrum), which produces a hormone that stimulates digestive juices. […] Pyloroplasty. During this procedure, which your surgeon may perform in combination with vagotomy, the opening into the duodenum and small intestine (pylorus) are enlarged to allow contents to pass more freely from the stomach. […] Armed with the results of diagnostic tests, your NewYork-Presbyterian team can customize a plan of treatment that meets your needs and addresses your symptoms.

• #48 Peptic Ulcers – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/esophagus-and-stomach/peptic-ulcer

  Pyloroplasty may be performed with a vagotomy. In pyloroplasty, the opening into the duodenum and small intestine are enlarged, enabling contents to pass from the stomach. […] Laparoscopic surgery uses a long, thin tube with a camera lens attached to examine the organs inside the abdominal cavity to check for abnormalities, and to operate through small incisions. […] Most people with peptic ulcers benefit from dietary and lifestyle changes and medication: […] Antibiotics to kill H. pylori if it has been detected. […] H2-blockers to reduce acid the stomach produces by blocking histamine. […] Acid pump inhibitors help to block stomach acid production by stopping the stomach’s acid pump. […] Mucosal protective agents shield the stomach’s mucous lining from the damage of acid, but do not inhibit the release of acid.

• #49 Approach to refractory peptic ulcer disease – UpToDate

  https://www.uptodate.com/contents/approach-to-refractory-peptic-ulcer-disease

  Approach to refractory peptic ulcer disease […] Most peptic ulcers respond to treatment with antimicrobial therapy for Helicobacter pylori, withdrawal of nonsteroidal antiinflammatory drugs, or treatment with antisecretory drugs. However, in some individuals, the ulcer is either refractory to conventional therapy or recurs following successful initial treatment. […] A refractory peptic ulcer is defined as an endoscopically proven ulcer greater than 5 mm in diameter that does not heal after 8 to 12 weeks of treatment with a proton pump inhibitor. […] In the absence of continued nonsteroidal antiinflammatory drug use, acid suppression heals >90 percent of peptic ulcers. However, approximately 5 to 10 percent of ulcers are refractory to 12 weeks of antisecretory therapy with a proton pump inhibitor (PPI). […] Address the etiology and risk factors […] Antisecretory therapy […] Repeat upper endoscopy […] Surgery in selected patients.

• #50 Peptic Ulcer Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534792/

  If first-line therapy fails, quadruple therapy with bismuth and different antibiotics is used. […] Surgical treatment is indicated if the patient is unresponsive to medical treatment, noncompliant, or at high risk of complications. […] A refractory peptic ulcer is one over 5 mm in diameter that does not heal despite 8-12 weeks of PPI therapy. […] The common causes are persistent H. pylori infection, continued use of NSAIDs, or significant comorbidities that impair ulcer healing or other conditions like gastrinoma or gastric cancer. […] Only through a team approach can the morbidity of peptic ulcer disease be decreased.

• #51 Approach to refractory peptic ulcer disease – UpToDate

  https://www.uptodate.com/contents/approach-to-refractory-peptic-ulcer-disease

  Approach to refractory peptic ulcer disease […] Most peptic ulcers respond to treatment with antimicrobial therapy for Helicobacter pylori, withdrawal of nonsteroidal antiinflammatory drugs, or treatment with antisecretory drugs. However, in some individuals, the ulcer is either refractory to conventional therapy or recurs following successful initial treatment. […] A refractory peptic ulcer is defined as an endoscopically proven ulcer greater than 5 mm in diameter that does not heal after 8 to 12 weeks of treatment with a proton pump inhibitor. […] In the absence of continued nonsteroidal antiinflammatory drug use, acid suppression heals >90 percent of peptic ulcers. However, approximately 5 to 10 percent of ulcers are refractory to 12 weeks of antisecretory therapy with a proton pump inhibitor (PPI). […] Address the etiology and risk factors […] Antisecretory therapy […] Repeat upper endoscopy […] Surgery in selected patients.

• #52 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Therapy for refractory peptic ulcer disease involves treatment of the underlying cause and prolonged administration of standard doses of a proton pump inhibitor. […] Surgery is indicated in patients who are intolerant of medications or do not comply with medication regimes, and those at high risk of complications. […] Surgical options for duodenal ulcers include truncal vagotomy and drainage, selective vagotomy and drainage, highly selective vagotomy, or partial gastrectomy. […] Coexisting H. pylori infection should be eradicated to reduce recurrence and minimize the need for long-term antisecretory therapy and further surgical intervention.

• #53 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Medicines that protect the lining of the stomach and small intestine. These are called cytoprotective agents. They include the prescription medicines sucralfate (Carafate) and misoprostol (Cytotec). […] Treatment for refractory ulcers most often involves getting rid of factors that keep the ulcer from healing and trying other antibiotics. If you smoke, your healthcare professional may suggest you quit. Smoking can slow ulcer healing. […] A serious complication from an ulcer, such as bleeding or a hole in the stomach, may need treatment with endoscopy or surgery. But because there are many medicines that work well, people with peptic ulcers need surgery far less often than in the past.

• #54 Peptic Ulcer Disease: Symptoms, Causes, Treatment & Medication

  https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease

  The most important things you can do to prevent peptic ulcer disease are to: Find and eradicate H. pylori. Most people who have an H. pylori infection aren’t aware of it. […] Peptic ulcers can heal if the conditions that caused them go away. But it usually takes a medical diagnosis to identify the cause. […] Most peptic ulcers heal within a few weeks. Most people will only need medication for about two months. Medications are very effective in treating peptic ulcers. […] Foods and drinks don’t cause peptic ulcers, but they can aggravate them if you have them, especially spicy and acidic foods and drinks. You should also avoid alcohol and smoking if you have symptoms or a history of peptic ulcer disease. […] Always see your provider if you suspect you have a peptic ulcer. While you may be able to manage your symptoms temporarily with over-the-counter medications, these won’t heal the ulcer. You need to identify and address the underlying cause.

• #55 Stomach ulcer | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/stomach-ulcer

  Most stomach ulcers are caused by infection with the Helicobacter pylori bacterium or anti-inflammatory medication, not stress or poor diet as once thought. […] Treatment for stomach ulcers includes the use of antibiotics to kill the infection, and acid-suppressing drugs. […] Treatment options can include: Medication including antibiotics, to destroy the H. pylori colony, and drugs to help speed the healing process. […] Resistance to some of these antibiotics is becoming more common, however 80% of treatment courses are successful. […] Lifestyle modifications including quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process.

• #56 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  Stopping NSAIDs — If you are taking any nonsteroidal anti-inflammatory drugs (NSAIDs), your provider may advise you to stop them or recommend that you switch to a different NSAID that is safer for your stomach and intestine. They may recommend alternative medications to NSAIDs to treat your pain, such as acetaminophen (sample brand name: Tylenol). If it is not possible for you to stop taking NSAIDs, you will likely need to keep taking a proton pump inhibitor medication as long as you are taking the NSAIDs. This will help protect the lining of the digestive tract and reduce the risk of bleeding. (See 'Bleeding’ below.) […] Other methods of symptom relief — In addition to taking prescribed medications and avoiding NSAIDs, there are other things you can do to relieve symptoms and help ulcers to heal:

• #57 Duodenal ulcer – causes, symptoms and treatment | healthdirect

  https://www.healthdirect.gov.au/duodenal-ulcer

  A duodenal ulcer is a sore that forms in the lining of the duodenum. […] If your ulcer is caused by H. pylori, the usual treatment is 'triple therapy’. This means taking 2 antibiotics and a proton pump inhibitor (PPI) medicine. The antibiotics kill the bacteria, while the PPI medicine reduces the acid made by your stomach. […] If you don’t have an H. pylori infection and you have been using anti-inflammatory medicines, you might be advised to stop taking them if possible. You will also need to start taking a PPI medicine to reduce the acid production in your stomach. […] You can make some other changes to improve your symptoms, such as drinking less alcohol, losing weight if you are living with obesity, quitting smoking, eating smaller meals, having your evening meals a few hours before bedtime, avoiding triggering foods such as coffee, fatty foods, spicy foods and acidic foods such as tomato.

• #58 Duodenal ulcer – causes, symptoms and treatment | healthdirect

  https://www.healthdirect.gov.au/duodenal-ulcer

  A duodenal ulcer is a sore that forms in the lining of the duodenum. […] If your ulcer is caused by H. pylori, the usual treatment is 'triple therapy’. This means taking 2 antibiotics and a proton pump inhibitor (PPI) medicine. The antibiotics kill the bacteria, while the PPI medicine reduces the acid made by your stomach. […] If you don’t have an H. pylori infection and you have been using anti-inflammatory medicines, you might be advised to stop taking them if possible. You will also need to start taking a PPI medicine to reduce the acid production in your stomach. […] You can make some other changes to improve your symptoms, such as drinking less alcohol, losing weight if you are living with obesity, quitting smoking, eating smaller meals, having your evening meals a few hours before bedtime, avoiding triggering foods such as coffee, fatty foods, spicy foods and acidic foods such as tomato.

• #59 Peptic ulcer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

  Peptic ulcers happen when acid in the organs that food travels through, called the digestive tract, eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed. […] Common causes include: Helicobacter pylori. This germ lives in the mucous layer that covers and protects tissues that line the stomach and small intestine. The H. pylori germ often causes no problems. But it can cause swelling and irritation, called inflammation, of the stomach’s inner layer. When this happens, it can cause an ulcer. […] If you often use NSAIDs, which can increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take pain relievers with meals. […] If you need an NSAID, you also may need to take other medicines to help protect your stomach. These include antacids, proton pump inhibitors, acid blockers or cytoprotective agents.

• #60 Patient education: Peptic ulcer disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-beyond-the-basics

  Stopping NSAIDs — If you are taking any nonsteroidal anti-inflammatory drugs (NSAIDs), your provider may advise you to stop them or recommend that you switch to a different NSAID that is safer for your stomach and intestine. They may recommend alternative medications to NSAIDs to treat your pain, such as acetaminophen (sample brand name: Tylenol). If it is not possible for you to stop taking NSAIDs, you will likely need to keep taking a proton pump inhibitor medication as long as you are taking the NSAIDs. This will help protect the lining of the digestive tract and reduce the risk of bleeding. (See 'Bleeding’ below.) […] Other methods of symptom relief — In addition to taking prescribed medications and avoiding NSAIDs, there are other things you can do to relieve symptoms and help ulcers to heal:

• #61 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  For patients who must continue with their NSAIDs, PPI maintenance is recommended to prevent recurrences even after eradication of H pylori. […] Active ulcers associated with NSAID use are treated with an appropriate course of PPI therapy and the cessation of NSAIDs. […] Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated in high-risk patients. High-risk patients include those with recurrent ulcers and those with complicated or giant ulcers.

• #62 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Patients with bleeding peptic ulcers should be given a proton pump inhibitor to reduce transfusion requirements, need for surgery, and duration of hospitalization. […] If test results are positive for H. pylori, the infection should be eradicated and antisecretory therapy, preferably with a proton pump inhibitor, administered for four weeks. […] Treatment of peptic ulcer disease should include eradication of H. pylori in patients with this infection. […] Proton pump inhibitors provide superior acid suppression, healing rates, and symptom relief and are recommended as initial therapy for most patients. […] Eradicating H. pylori is often sufficient in patients with small duodenal ulcers. […] Maintenance therapy with H2 blockers or proton pump inhibitors prevents recurrence in high-risk patients.

• #63 Peptic Ulcer Disease Medication: Proton Pump Inhibitors, H2-Receptor Antagonists, Antimicrobials, Antidiarrheal Agents, Cytoprotective Agents

  https://emedicine.medscape.com/article/181753-medication

  The goals of pharmacotherapy are to eradicate H pylori infection, to reduce morbidity, and to prevent complications in patients with peptic ulcers. Acid suppression is the general pharmacologic principle of medical management of acute bleeding from a peptic ulcer, using histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). […] The recommended primary therapy for H pylori infection is proton pump inhibitor (PPI) based triple therapy. […] Maintenance treatment with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated in high-risk patients. […] If H pylori eradication is not achieved despite repeat treatment, maintenance antisecretory therapy should be recommended. […] Primary prevention of NSAID-induced ulcers includes avoiding unnecessary use of NSAIDs, using acetaminophen or nonacetylated salicylates when possible, and using the lowest effective dose of an NSAID and switching to less toxic NSAIDs.

• #64 Peptic ulcers: treatment – myDr.com.au

  https://mydr.com.au/gastrointestinal-health/peptic-ulcers-treatment/

  Eradication therapy has revolutionised the treatment of peptic ulcers worldwide. Depending on the medicines used, it can have a success rate of 85 to 90 per cent in eradicating H. Pylori and treating peptic ulcers. Eradicating H. pylori also significantly reduces the chance of relapse. […] Treatment for NSAID-induced ulcers involves stopping the NSAID (if possible) and taking a medicine to suppress acid secretion and promote healing. […] Acid-suppressing medicines are usually given for 8-12 weeks, depending on whether it is a duodenal or gastric ulcer. Proton pump inhibitors are usually used, as they are effective and heal ulcers faster than H2-receptor antagonists. […] In people who cannot stop taking NSAIDs, taking them in combination with a proton pump inhibitor can reduce the risk of peptic ulcers. Some people at high risk may be offered long-term treatment with PPIs to prevent a recurrence. […] Your doctor will also recommend testing for H. pylori infection and eradication treatment if necessary.

• #65 Peptic Ulcer Disease: Symptoms, Causes, Treatment & Medication

  https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease

  The most important things you can do to prevent peptic ulcer disease are to: Find and eradicate H. pylori. Most people who have an H. pylori infection aren’t aware of it. […] Peptic ulcers can heal if the conditions that caused them go away. But it usually takes a medical diagnosis to identify the cause. […] Most peptic ulcers heal within a few weeks. Most people will only need medication for about two months. Medications are very effective in treating peptic ulcers. […] Foods and drinks don’t cause peptic ulcers, but they can aggravate them if you have them, especially spicy and acidic foods and drinks. You should also avoid alcohol and smoking if you have symptoms or a history of peptic ulcer disease. […] Always see your provider if you suspect you have a peptic ulcer. While you may be able to manage your symptoms temporarily with over-the-counter medications, these won’t heal the ulcer. You need to identify and address the underlying cause.

• #66 Peptic Ulcer Disease – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease

  Medications are given to reduce acid in the stomach, and antibiotics often are given to eliminate Helicobacter pylori. […] Treatment of Helicobacter pylori infection with 2 antibiotics together with bismuth subsalicylate and a proton pump inhibitor (called quadruple therapy) is given when infection is diagnosed. […] Acid-reducing medications block the production of stomach acid. The most commonly used acid-reducing medications include proton pump inhibitors and histamine-2 (H2) blockers. […] Neutralizing or reducing stomach acid promotes healing of peptic ulcers regardless of the cause. […] Surgery for ulcers is rarely needed because medications so effectively heal peptic ulcers and endoscopy so effectively stops active bleeding. […] Surgery is used primarily to deal with complications of a peptic ulcer, such as a perforation, an obstruction that fails to respond to medication or that recurs, two or more major episodes of bleeding ulcers, a gastric ulcer suspected of being cancerous, and severe and frequent recurrences of peptic ulcers. […] If Helicobacter pylori infection is successfully treated, peptic ulcer disease comes back in only 10% of people. However, peptic ulcer disease comes back in 50% of infected people when Helicobacter pylori infection is not eradicated.

• #67 St. Luke’s – Combination Drug Therapy for Peptic Ulcer Disease

  https://www.stlukesonline.org/health-services/health-information/healthwise/2015/05/15/13/54/combination-drug-therapy-for-peptic-ulcer-disease

  Combination drug therapy that includes at least two antibiotics, an acid reducer, and sometimes a bismuth compound is recommended for people who have peptic ulcer disease and are known to be infected with Helicobacter pylori (H. pylori). […] The right antibiotics combinations usually kill Helicobacter pylori (H. pylori) bacteria that are the cause of many peptic ulcers. At least two antibiotics are used, because combination treatment works better and is less likely to fail because of resistance to the antibiotics. […] Helicobacter pylori (H. pylori) infections are cured 70% to 85% of the time when the right combination drug treatment is used. […] It is very important that you take all of the medicine prescribed. Do not stop taking your medicine even if you feel better. It may seem like a lot of pills to take, but it is also important to take a regimen that contains at least three medicines to cure Helicobacter pylori (H. pylori). Combination regimens are the most effective way to help ensure that H. pylori bacteria do not develop resistance to the antibiotics used to treat them.

• #68 Peptic Ulcer Disease Treatment & Management: Approach Considerations, Bleeding Peptic Ulcers, H pylori Infection

  https://emedicine.medscape.com/article/181753-treatment

  Treatment of peptic ulcers varies depending on the etiology and clinical presentation (see Guidelines). The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. […] Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath testing for active H pylori infection may be used. […] Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis of peptic ulcer disease. Documentation of H pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers.

• #69 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  Most ulcers can be treated and will heal. Often, people with ulcers will have to take PPIs for several weeks to heal an ulcer. It is also important to correct what caused the ulcer. When possible, NSAIDs should be stopped. Patients with ulcers caused by NSAIDs should talk to their doctor about other medications that can be used to treat pain. […] If the person is infected with Helicobacter pylori, then completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”. […] People with gastric ulcers (only in the stomach) usually have another EGD several weeks after treatment to make sure that the ulcer is gone. This is because a very small number of gastric ulcers might contain cancer. Duodenal ulcers (at the beginning of the small intestine) usually don’t need to be looked at again.

• #70 8 Things to Know About Peptic Ulcers > News > Yale Medicine

  https://www.yalemedicine.org/news/8-things-to-know-about-peptic-ulcers

  Its also important to treat H. pylori if its detected. […] The treatment for ulcers associated with NSAID use is to take a PPI and stop taking the NSAIDs. […] If a PPI doesnt workor a patient has a severe ulcernew medications called potassium competitive acid blockers (PCABs) may lower the acid levels even more than the PPIs, says Dr. Hung. […] An upper endoscopy can be used to stop bleeding from an ulcer, in some cases by injecting the ulcer with medicine or applying heat therapy or clips during the procedure. […] Time and medication will heal most ulcers, he says, adding that most people will recover within a month or two.

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