Ulcer Treatment

Ulcer treatment

        The following drugs, often used in combination, usually lead to recovery of more than 90% of ulcers in 4 to 8 weeks.

• H2 antihistamines. These medications reduce the amount of acid. The term refers to the H2 histamine receptors. The drug binds to histamine receptors in order to prevent their activation. Cimetidine, famotidine, nizatidine and ranitidine belong to this class of drugs.
• Inhibitors of proton pump. These medications omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole reduce the acidity of the stomach more effectively then H2 antihistamines. They work by inactivating the "pumps" that produce hydrochloric acid. They also inhibit the multiplication of bacteria H. pylori.
• Antiacids. Antiacids does not reduce acid secretion, but neutralize the acid in the stomach, which relieves pain. They take longer to act as H2 blockers and inhibitors of proton pump.
• Antibiotics. If the ulcer is caused by infection with H. pylori, as is the case for most people, doctors often prescribed 2 antibiotics for a period of 2 weeks. Antibiotics commonly used are amoxicillin, clarithromycin and metronidazole. They often combine 2 antibiotics to another drug or even bismuth. Blood tests and sometimes a biopsy of the lining of the stomach allow the physician to detect the bacteria.

        Important: Take full antibiotic medication as prescribed to maximize the chances of completely eradicating the infection. Some people stop taking their antibiotics when they feel better before the end of treatment. The bacteria is not completely eliminated, it can start to multiply again. It is difficult to get rid of the bacteria H. pylori because it lodge deep in the lining of the stomach and duodenum. Eradication therapy has a dual antibiotic therapy combined with antisecretory. The best associations are validated: PPI, a unit dose twice daily, amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily for 7 days. Metronidazole at a dose of 500 mg twice daily may be used instead of clarithromycin or amoxicillin.

       Eradication, defined by the absence of the bacteria in the stomach at least 4 weeks after the end of any treatment is obtained in 70 to 80% of cases. The failures are due to poor adherence and / or primary resistance to macrolides or imidazole. Control of eradication is needed in cases of frequently recurring ulcer disease or in history of complications. It is best achieved by doing an indirect test.

What is the possible development of a duodenal ulcer?

        Duodenal ulcer may heal and recur (60% at 1 year), and can became complicated: bleeding, perforation and stenosis. It never turns into cancer.

Is the treatment effective?

        The healing rates at 4 weeks was 90 to 95%. The endoscopic control of healing is not necessary unless symptoms persist. Control of eradication of H. pylori when it is decided, is made 4 weeks after treatment, preferably by an indirect test.

        Antisecretory therapy may be proposed in case of failure of eradication of H. pylori.