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Ulcers
Treatment of Ulcers
Treatment for Peptic Ulcer
Treatment recommendations of the American College of Gastroenterology are based on the realization that peptic ulcer disease is usually the result of * Helicobacter pylori (H. pylori) infection, or is caused by taking prescription or non prescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium. The first step is to stop taking NSAIDs or aspirin if they are used. Successful eradication of the infection cures most patients who are not taking aspirin or a NSAID.
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* Helicobacter pylori (H. pylori): (HELL-ih-koh-BAK-tur py-LOH-ree) A spiral shaped type of bacteria that weakens the protective mucous coating of the stomach and duodenum (the first part of the * small intestine), which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
Patients with a prior history of peptic ulcer disease, active peptic ulcer disease, or gastric lymphoma (stomach cancer), should be tested for H. pylori infection. If they test positive, they should be treated with antibiotic therapy. If the tests are negative for H. pylori infection, patients are treated with traditional ulcer therapy that blocks the production of stomach acid and protects the tissues lining the stomach and duodenum (the first part of the small intestine). For NSAID induced ulcers, cytoprotective agents, or drugs that coat and protect the stomach mucosa, may be used.
Drug Classes Used For Treatment of Peptic Ulcer Disease
Antacids
Antacids neutralize or reduce stomach acids.
- Aluminum and Magnesium Hydroxide: (Alamag, Aludrox, Di-Gel, Maalox, Magnalox, Mylanta, Rulox)
- Calcium Carbonate: (Alka-Mints, Amitone, Calel-D, Caltrate 600, Chooz, Dicarbosil, Equilent, Mallamint, Os-Cal 500, Rolaids Calcium Rich, Titralac, Tums)
Cytoprotective Agents
Cytoprotective agents work in different ways. Some of them stimulate mucus production and enhance blood flow throughout the lining of the gastrointestinal (GI) tract. Other cytoprotective agents form a coating that protects the ulcerated tissue and promotes the healing process.
- Misoprostol (Cytotec)
- Sucralfate (Carafate)
Helicobacter Pylori Treatment Regimens
Helicobacter pylori, or H. pylori, is a bacteria responsible for more than 90 percent of ulcers. To heal ulcers caused by H. pylori, multi drug regimens are needed. These regimens consist of antibiotics, proton pump inhibitors (PPIs), H2-Blockers, and and cytoprotective agents. Also available are combination products, Helidac and Prevpac, that contain combinations of the above drug classes.
- Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination (Helidac)
- Lansoprazole, Clarithromycin and Amoxicillin (Prevpac)
Histamine 2 (H2) Receptor Blockers
Within the parietal cells of the stomach is the ATPase pump, also called the proton pump, which releases hydrochloric acid. This pump is activated when histamine stimulates H2 receptors. H2 blockers prevent histamine from binding to H2 receptors and activating the ATPase pump, thereby reducing the amount of acid that is released. Drugs in this class are available in lower non prescription doses and higher precription doses.
- Cimetidine Oral (Tagamet HB, Tagamet Oral)
- Famotidine Oral (Pepcid AC, Pepcid Oral)
- Nizatidine (Axid, Axid AR)
- Ranitidine Oral (Zantac AR, Zantac Oral)
Proton Pump Inhibitors (PPIs)
Hydrochloric acid is released by the proton pump (ATPase pump) located within the parietal cells of the stomach. Proton pump inhibitors (PPIs) bind to the ATPase enzyme, suppressing gastric acid output. They relieve pain and heal peptic ulcers faster than H2 blockers but are typically more expensive.
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Prilosec)
- Pantoprazole (Protonix)
- Rabeprazole (Aciphex)
Ulcers take time to heal. Take your medicines even if the pain goes away. If these medicines make you feel sick or dizzy, or cause diarrhea or headaches, your doctor can change your medicines. If prescription or non prescription nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers such as aspirin, ibuprofen caused your peptic ulcer, you'll need to stop taking them. If you smoke, quit. Smoking slows healing of ulcers.
If you have a peptic ulcer, taking antacids will stop the stomach acids from working, reduce the pain and help the ulcers heal. You can buy antacids at any grocery store or drugstore. But you must take them several times a day. Also, antacids won't kill the bacteria, you must take antibiotics the doctor prescribes for you.
Peptic ulcers can come back if you stop taking your antibiotic too soon, not all the bacteria will be gone and not all the sores will be healed. If you still smoke or take NSAIDs, your ulcers may come back. In many cases, medicine heals ulcers. You may need surgery if your ulcers don't heal, or keep coming back, perforate, bleed, or obstruct the stomach or duodenum (the first part of the small intestine). Surgery can remove the ulcers and reduce the amount of acid your stomach makes.
For more information about Helicobacter pylori (H. pylori) infection and ulcers, see your health care provider or call Toll Free MY-ULCER.
Definitions For This Page - In Alphabetical Order
* Small Intestine
The small intestine is the organ where most digestion occurs. It measures about 22 feet and includes the duodenum, jejunum, and ileum. More about Small Intestine.
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References:
www.cdc.gov/ulcer/
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