What are the treatments for a stomach ulcer?
A 4- to 8-week course of a medicine that greatly reduces the amount of acid that your stomach makes is usually advised. The most commonly used medicine is a proton pump inhibitor (PPI). PPIs are a group (class) of medicines that work on the cells that line the stomach, reducing the production of acid. They include esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole and they come in various brand names. Sometimes another class of medicines called H2 blockers is used. These are also called histamine H2-receptor antagonists but are commonly called H2 blockers. H2 blockers work in a different way on the cells that line the stomach, reducing the production of acid. They include cimetidine, famotidine, nizatidine and ranitidine and they come in various brand names. As the amount of acid is greatly reduced, the ulcer usually heals. However, this is not the end of the story.
If your ulcer was caused by H. pylori
Most stomach ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection. If this infection is not cleared, the ulcer is likely to return once you stop taking acid-suppressing medication. Two antibiotics are needed to clear H. pylori. In addition, you need to take an acid-suppressing medicine to reduce the acid in the stomach. This is needed to allow the antibiotics to work well. You need to take this 'combination therapy' (sometimes called 'triple therapy') for a week. One course of combination therapy clears H. pylori infection in up to 9 in 10 cases. If H. pylori infection is cleared, the chance of a stomach ulcer returning is greatly reduced. However, in a small number of people H. pylori infection returns at some stage in the future.
If your ulcer was caused by an anti-inflammatory medicine
If possible, you should stop taking the anti-inflammatory medicine. This allows the ulcer to heal. You will also normally be prescribed an acid-suppressing medicine for several weeks. This stops the stomach from making acid and allows the ulcer to heal. However, in many cases, the anti-inflammatory medicine is needed to ease symptoms of arthritis or other painful conditions, or aspirin is needed to protect against blood clots. In these situations, one option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid made by the stomach and greatly reduces the chance of an ulcer forming again.
What about surgery?
In the past, surgery was commonly needed to treat a stomach ulcer. This was before it was discovered that H. pylori infection was the cause of most stomach ulcers, and before modern acid-suppressing medicines became available. Surgery is now usually only needed if a complication of a stomach ulcer develops, such as severe bleeding or a hole (perforation).
What happens after treatment?
A repeat gastroscopy (endoscopy) is usually advised a few weeks after treatment has finished. This is mainly to check that the ulcer has healed. It is also to be doubly certain that the 'ulcer' was not due to stomach cancer. If your ulcer was caused by H. pylori then a test is advised to check that the H. pylori infection has gone. This is done at least four weeks after the course of combination therapy has finished. In most cases, the test is 'negative' meaning that the infection has gone. If it has not gone then a repeat course of combination therapy with a different set of antibiotics may be advised.
Further reading and references
Dyspepsia - proven peptic ulcer; NICE CKS, July 2015 (UK access only)
Cai S, Garcia Rodriguez LA, Masso-Gonzalez EL, et al; Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005. Aliment Pharmacol Ther. 2009 Nov 1530(10):1039-48. Epub 2009 Aug 26.
Sachs G, Scott DR, Wen Y; Gastric infection by Helicobacter pylori. Curr Gastroenterol Rep. 2011 Dec13(6):540-6. doi: 10.1007/s11894-011-0226-4.
Niv Y; H. pylori/NSAID--negative peptic ulcer - the mucin theory. Med Hypotheses. 2010 Nov75(5):433-5. Epub 2010 May 4.
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