Ulcers Can Now Be Cured Peptic ulcer disease (PUD) is a very common ailment in the United States, affecting

one out of eight persons during their lifetime. Over 25 million Americans are now afflicted with over a half a million new cases diagnosed each year. The annual cost for the care of ulcers in the U.S. is over 3 billion dollars. Clearly, PUD is a major public health problem. However, recent breakthroughs in the cause of ulcers now give your doctor a new way to treat ulcer disease. More importantly, new treatments are now available to help prevent ulcers from ever coming back. The Normal Digestive System To understand how ulcers form, it is first important to understand how the normal stomach and intestines function. The stomach produces acid in response to eating food. This acid serves to start the digestive process by activating the enzyme, pepsin, which can then break down proteins in food. In addition, this acid provides a hostile environment, making it extremely difficult for most bacteria to survive. After the food is mixed up and broken into small particles in the stomach, it is released into the first portion of the small intestine, or duodenum. It is here in the small intestine that the actual process of digestion and absorption of nutrients occur. You may be asking yourself how the lining of the stomach and intestines is spared from being digested by these powerful digestive juices. To avoid digesting itself, the stomach and duodenum have special protective mechanisms. A protective coating of mucus covers the inner lining of the stomach and duodenum. There is always a delicate balance between the destructive forces of acid and the protective forces of the stomach and duodenum. This balance is such that just enough acid is made to digest food, but not enough to overwhelm this protective layer. How Do Ulcers Form? When the delicate balance between acid and the protective forces is interrupted, ulcers may form. This imbalance may be the result of having too much acid in the stomach, but this is relatively uncommon. Most of the time, the imbalance is a result of a disruption of the protective mucus layer. Once this layer has been damaged, the stomach acid and pepsin can eat away at the delicate tissues underneath. This can produce a crater-like hole, known as an ulcer. Therefore, an ulcer is simply the result of the body digesting itself in a weakened area. While acid is generally the final cause of the injury, it is now recognized that there are important factors that permit acid to cause damage. Kinds of Ulcers There are two types of ulcers. Most ulcers are related to acid and pepsin found in the stomach juices and are called "peptic ulcers." A small percentage of ulcers are caused by cancer and are called malignant ulcers. Ulcers are also named by location. Those that occur in the stomach are called gastric ulcers. These generally occur in patients older than 50 years of age. Those that occur in the first part of the intestines are called duodenal ulcers. These occur five times more commonly than gastric ulcers and generally occur in the younger population. Finally, ulcers found in the "food pipe", or esophagus, are named esophageal ulcers. These are usually associated with hiatal hernias and caused by acid splashing upward into the lower esophagus. Helicobacter pylori - the "ulcer bacteria" Peptic ulcers were long believed to be the consequence of too much stress and spicy food. Recent studies have shown that ulcers are most often due to a bacterial infection which is curable with antibiotic treatment. This bacteria named Helicobacter pylori (he-lick-oh-back-ter pie-lorrie) is an unusual acid-resistant germ. It is now believed to be the major cause of ulcer disease accounting for over 90% of cases. Also known as H. pylori, this organism was first reported in the stomach of patients with ulcers in 1982 by Dr. Barry Marshall of Perth, Western Australia, but its significance was not recognized until recently. Surprisingly, while most bacteria cannot survive in the acidic environment of the stomach, H. pylori appear to have no difficulty. This may occur, in part, because of its ability to burrow into the mucous lining of the stomach, thus protecting itself from the acid. In addition, this bacterium produces ammonia, which neutralizes acid in the immediate area. Infection with these bacteria appears to be confined to the lining of the stomach and duodenum and does not spread throughout the body. This infection is very real, however, and causes the body to react by moving infection fighting white blood cells to the area. The body even produces antibodies against H. pylori. These can be measured by special blood tests. Without specific treatment, H. pylori infection can last a lifetime. As H. pylori invades the stomach mucus, it disrupts this protective layer and allows the corrosive stomach acid to come in direct contact with the delicate tissues below. This can lead to peptic ulcers and stomach inflammation called gastritis. In fact, chronic gastritis is the hallmark of H. pylori and is found in nearly all those affected. The real breakthrough is the evidence that Helicobacter infection is the culprit in up to 90% of duodenal ulcers and up to 80% of gastric ulcers. Most of the remaining 10 to 20% of ulcers are caused by aspirin, ibuprofen, and other antiinflammatory drugs used to treat arthritis or pain. Aspirin and Arthritis Medications Aspirin and many other pain medications used to treat arthritis (ibuprofen, Advil, Motrin, and Nuprin, Aleve, Anaprox, Clinoril, Dolobid, Feldene, Indocin, Lodine, Nalfon, Naproxyn, Orudis, Relafen, Tolectin, Toradol, Volteran, and many others) can

also cause ulcers. These medications damage the mucus layer of the digestive tract, thus allowing acid to come in contact with the delicate lining below. On the other hand, acetaminophen (Tylenol) does not cause ulcers and may be used in ulcer patients. What about Stress? Extreme physical stress, such as that associated with major trauma or burns can cause ulcers. On the other hand, while emotional stress and tension can cause an "upset stomach" and may even make an existing ulcer worse, they are no longer felt to be a major cause of ulcers. Certainly, stress management is important in the healing process of an ulcer. Avoiding or reducing pressure at work or home is important, as is getting good nights sleep. Stress management programs are locally available for those who need a little extra help in learning to cope with the stresses of daily life. How Do I Know If I Have An Ulcer? Very often, an ulcer will cause some symptoms that should alert you. These may include a gnawing, burning pain in the upper abdomen between the navel and the breastbone. This may feel similar to a hunger pang. This pain is often worse on an empty stomach and relieved temporarily by food, antacids, or milk. This pain might awaken you at night. Some patients have no pain, but simply present because of nausea, anemia (low blood counts), or the presence of blood in the stool (black tarry looking stools, or microscopic amounts of blood seen on a stool sample). In the past, doctors relied on a barium x-ray of the upper gastrointestinal tract, or Upper GI Series, to diagnose an ulcer. While this study was valuable in diagnosing ulcers, a more accurate diagnostic technique, Gastroscopy, was introduced in the mid 1970's. This technique involves a direct examination of the inner lining of the esophagus, stomach, and duodenum by passing a thin soft flexible tube with a miniature videocamera through the mouth and down into the upper digestive tract. Done under "twilight sleep" sedation, this test is quite simple and painless. Gastroscopy also permits the doctor to take a sample of the lining, called a biopsy, to rule out cancer and to determine if Helicobacter pylori is present. Bleeding Ulcers If you dig too deep in the earth and hit a water pipe,the water gushes forth. It's a mess. It's the same in your stomach. Within the wall of the stomach and intestines are many blood vessels that carry nourishment to the digestive tract itself. An ulcer is like a crater. If it becomes deep enough, it can eat into one of these vessels and begin to bleed. With every heartbeat blood is pumped out of your circulation and into the stomach or intestine. Eventually, the patient either begins to vomit blood or it passes down through the intestines and out the rectum. If the rate of bleeding is rapid, the blood looks fresh and red. At a slower rate of blood loss, the vomit is described looking like "coffee grounds" and the stools are black like tar. A bleeding ulcer is a medical emergency. If enough blood is lost, the body can no longer maintain the blood pressure and dizziness and weakness occurs. As more blood is lost, the pressure drops futher and their is a risk of heart attack, stoke, or death. Bleeding ulcers often require special treatment such as emergency surgery. Some can be treated using gastroscopy to cauterize the vessel and stop the bleeding. Medications are then used to heal the ulcer crater. How Are Ulcers Treated? There are four major goals of ulcer treatment: Relieving pain Preventing complications such as bleeding, perforation and blockage Healing the ulcer Preventing the ulcer from coming back.

While a variety of medicines designed to reduce acid (Tagamet, Zantac, Pepcid, Axid, Prilosec, or Prevacid) or coat the stomach (Carafate) have been very effective in achieving the first three goals, the fourth goal has been difficult to achieve....until now. New research has revealed that if H. pylori infection is cleared by antibiotics, the rate of ulcers returning can be reduced from over 80% to less than 10% in the first year after ulcer healing. This dramatic improvement in ulcer therapy prompted the National Institute of Health to recommend that all ulcer patients who have H. pylori infection be treated with antibiotics in addition to standard acid- reducing medications. Will I Need Surgery? Surgical therapy for ulcer disease is rarely needed. This is generally recommended for ulcers that are complicated by massive bleeding, perforation or blockages. Surgery may also be utilized for gastric ulcers that do not heal with medicine. When acid reflux causes ulcers to form in the esophagus, surgery is sometimes necessary to "tighten" the lower esophageal valve. With the availability of antibiotics to cure ulcer disease, it is expected that the future need for ulcer surgery will continue to decline. What Can I Eat? Not long ago, it was believed that ulcer patients should eat a very strict diet consisting of baby food, milk

products and other bland foods. Since that time, it has been learned that these dietary restrictions are not necessary for the great majority of ulcer patients. Some modifications may be helpful, such as avoiding caffeinated products. However, in general, you should be the judge of which foods to avoid. These would be the ones that predictably cause you pain or don't agree with you. The Future Ulcer disease has plagued mankind for centuries. During the last decade, we have witnessed the changing tides of ulcer treatment. The old motto: "No acid, No ulcer" has now been modified to: "No Helicobacter pylori, No ulcer." Current investigation is actively being performed to develop a vaccine for H. pylori. Elimination of these bacteria may reduce ulcer disease by as much as 80% to 90%. Clearly, this should be the goal for our next generation. At present, our goal should be to educate patients about how most ulcers can now be more readily treated and cured with appropriate antibiotic treatment. For those 25 million Americans afflicted with the disease, this is good news.

Peptic ulcers A peptic ulcer is an area of damage to the lining of either the stomach or the wall of the small bowel. How a peptic ulcer develops Symptoms of peptic ulcers Complications of peptic ulcers Causes of peptic ulcers Diagnosis of peptic ulcers Treatment of peptic ulcers

How a peptic ulcer develops Your stomach produces acid to help you digest food. The lining of your stomach and first part of your small bowel (duodenum) have a layer of mucus that protects them from the acid. If this protection mechanism doesn't work properly, the acid can eat into your stomach lining and cause an ulcer.

Stomach (gastric) ulcers and small bowel (duodenal) ulcers are collectively known as peptic ulcers. Duodenal ulcers are more common. Stomach ulcers usually affect people between the ages of 40 and 80, and duodenal ulcers affect people aged 20 to 60. Peptic ulcers are more common in women than men. The size of peptic ulcers can vary from one millimetre to several centimetres across. They look similar to mouth ulcers. Symptoms of peptic ulcers You may not have any symptoms at all. However, many people have pain in their abdomen (tummy), usually just below the breastbone (sternum). This pain is often described as burning or gnawing and may extend to your back. It usually comes on after eating - 15 to 20 minutes after eating if you have a stomach ulcer and one to three hours after a meal if the ulcer is in your small bowel. The pain may also wake you at night. Other symptoms may include: heartburn a bitter taste in your mouth feeling sick or vomiting regurgitating food

It's important to see your GP if you have:

difficulty swallowing food lost weight without dieting seen blood in your vomit or bowel movements sudden, very painful abdominal pain

These symptoms may be caused by problems other than a peptic ulcer. If you have any of them, visit your GP for advice. Complications of peptic ulcers Most people who have a peptic ulcer don't have any complications. However, possible complications include the following. Bleeding Occasionally ulcers can cause the lining of your stomach or small bowel to bleed. If this happens suddenly, symptoms may include: vomiting blood - it may be bright red or like coffee grains (dark brown bits of clotted blood) dark faeces that look black or like tar - this is because the blood from the bleeding ulcer will have been partially broken down as it makes its way through the bowel

If you have any of these symptoms, see your GP immediately. Anaemia If the bleeding from the ulcer is slow, you might not see blood in your vomit or faeces. However, you may develop anaemia. Anaemia is when there are too few red blood cells or not enough haemoglobin in the blood. Perforation Rarely, the ulcer may eat very deeply into the wall of your stomach or small bowel making a hole into your abdomen. This is called perforation - it causes severe pain and you will need emergency surgery. However, because treatment with medicine is usually successful, it's very unlikely that you will need surgery for a peptic ulcer. Pyloric stenosis Pyloric stenosis can result if you have a peptic ulcer that causes long-term inflammation in the lining of your stomach or small bowel. This is a narrowing of the small passage called the pylorus that links your stomach and the first part of your small bowel. The main symptom of pyloric stenosis is vomiting. Causes of peptic ulcers The most common cause of peptic ulcers is a stomach infection caused by a bacterium called Helicobacter pylori (H. pylori). This infection is quite common - about half of the world's population is infected with the bacterium but it doesn't always cause illness. H. pylori can cause inflammation in the lining of the stomach. Inflammation is when part of the body reacts to an infection or injury causing it to become swollen, hot, red and/or painful. The inflammation reduces the layer of mucus that protects the stomach and small bowel from the stomach acid and causes an ulcer. If the H. Pylori infection is in the upper part of your stomach, it can cause more acid to be produced. This can overload the protective layer of mucus and cause an ulcer. The second most common cause of peptic ulcers is a type of medicine called non-steroidal anti-inflammatory drugs (NSAIDs). Examples of these medicines include aspirin, ibuprofen, naproxen and diclofenac. Most people can take these safely but sometimes if you take NSAIDs over a long period of time, they can damage the mucus lining in your stomach and cause a peptic ulcer. If you're in doubt which painkillers to take, ask your pharmacist. You're more likely to get peptic ulcers if you smoke. You may also be more at risk if other people in your family have had ulcers.

It used to be thought that stress could cause a peptic ulcer. However, stress is now only considered to be important if it's a result of a major operation or trauma. Diagnosis of peptic ulcers Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your GP thinks you may have a peptic ulcer, he or she may recommend some of the following tests to diagnose you and decide what treatment will suit you best. H. pylori test As H. pylori is the most common cause of a peptic ulcer, your GP may test you for the bacterium and, if necessary, prescribe medicines to treat the infection. H. pylori can be detected in a urea breath test. You will be asked to swallow a liquid containing a substance called urea that is broken down by H. pylori to produce water and carbon dioxide. Your breath will then be tested using a machine for the amount of carbon dioxide in it. If the carbon dioxide is over a certain level, H. pylori is present. Alternatively a sample of your blood or your faeces will be sent to a laboratory to test for H. pylori. Endoscopy If you have a suspected peptic ulcer, your GP may arrange a gastro-intestinal endoscopy (also called a gastroscopy). Not everyone who has abdominal pain needs one, so your GP may use one of the other tests first. However, endoscopy is the only way to be certain whether or not you have a peptic ulcer. An endoscopy is a procedure that allows a doctor to look at the inside of your body. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope that is passed through your mouth and into your stomach. The procedure usually lasts a few minutes. Your doctor will be able to see the lining of your stomach and can take a sample of your stomach lining at the same time. This sample is either sent to a laboratory and examined under a microscope, or directly tested for H. pylori. Treatment of peptic ulcers Self-help There are lifestyle changes that you can make to help your ulcers heal and prevent them coming back. These include: not having food and drink that give you more severe symptoms, such as spicy foods and alcohol stopping smoking not taking painkillers that are likely to cause ulcers in the future - your GP or pharmacist can give you advice on other medicines you can take instead

Medicines There are two main groups of medicines available to treat peptic ulcers. These are: proton pump inhibitors, such as omeprazole and lansoprazole H2-blockers - examples include ranitidine and cimetidine

Both types of medicine reduce acid production in the stomach, allowing your ulcer to heal. They can both be used long-term to prevent your ulcer coming back. These medicines will relieve your symptoms and within a few weeks your ulcer will heal. However, once you stop taking the medicine, your ulcer may come back unless the H. pylori has been treated and removed.

Treating H. pylori infection If tests confirm that you have H. pylori, you will be prescribed medicines to treat it. This is usually a combination of a proton pump inhibitor and two antibiotics. Treating the H. pylori infection should allow your ulcer to heal and prevent it from coming back. Your GP will do the tests again after treatment to make sure it has been successful in getting rid of H. pylori.

Peptic ulcer Definition By Mayo Clinic staff Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain. Peptic ulcers that occur on the inside of the stomach are called gastric ulcers. Peptic ulcers that occur inside the hollow tube (esophagus) where food travels from your throat to your stomach are called esophageal ulcers. Peptic ulcers that affect the inside of the upper portion of your small intestine (duodenum) are called duodenal ulcers. It's a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial infection or some medications not stress or diet cause most peptic ulcers. Symptoms Pain is the most common symptom Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may: Be felt anywhere from your navel up to your breastbone Be worse when your stomach is empty Flare at night Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication Disappear and then return for a few days or weeks

Other signs and symptoms Less often, ulcers may cause severe signs or symptoms such as: The vomiting of blood which may appear red or black Dark blood in stools or stools that are black or tarry Nausea or vomiting Unexplained weight loss Appetite changes

When to see a doctor See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If your pain persists, see your doctor. Causes Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus, stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Causes include: A bacterium. A common cause of ulcers is the corkscrew-shaped bacterium Helicobacter pylori. H. pylori bacteria commonly live and multiply within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of your stomach or duodenum, producing an ulcer. It's not clear how H. pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water. Regular use of pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox, others), ketoprofen and others. Peptic ulcers are more common in older adults who take pain medications frequently, such as might be common in people with osteoarthritis. To help avoid digestive upset, take pain relievers with meals. If you have been diagnosed with an ulcer, make sure your doctor knows this when prescribing any pain reliever. The pain reliever acetaminophen (Tylenol, others) doesn't cause peptic ulcers. Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others).

Risk factors You may have an increased risk of peptic ulcers if you: Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori. Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced. Have uncontrolled stress. Although stress alone isn't a cause of peptic ulcers, it's a contributing factor. You may undergo stress for a number of reasons an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury.

Complications Left untreated, peptic ulcers can result in: Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Infection. Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis). Scar tissue. Peptic ulcers can also produce scar tissue that can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

Preparing for your appointment Make an appointment with your family doctor or a general practitioner if you have any signs or symptoms that worry you. If you're thought to have a peptic ulcer, you may be referred to a doctor who specializes in the digestive system (gastroenterologist). It's a good idea to be well prepared for your appointment. Here's some information to help you get ready, and what you can expect from your doctor. What you can do Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Certain medications can affect peptic ulcer tests, so your doctor may want you to stop taking them, and he or she may be able to suggest alternatives to these drugs. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. It's also a good idea to keep written track of your symptoms as well as the food you're eating. People with peptic ulcers often experience more symptoms when their stomachs are empty. Write down key personal information, including any other medical problems, past surgeries, major stresses or recent life changes.

Make a list of all medications, including over-the-counter medications, as well as any vitamins or supplements, that you're taking. It's especially important to note any pain reliever use and the usual dose that you take. Write down questions to ask your doctor.

Preparing a list of questions ahead of time will help you make the most of your limited time with your doctor. List your questions from most important to least important in case time runs out. For peptic ulcers, some basic questions to ask your doctor include: What's the most likely cause of my symptoms? Are there other possible causes for my symptoms? What kinds of tests do I need, and how do I need to prepare for them? Is my condition likely temporary or chronic? What treatment do you recommend? How quickly will I start to feel better? What if my symptoms don't improve? What are the alternatives to the primary approach that you're suggesting? Are there any dietary restrictions that I need to follow? Is there a generic or over-the-counter alternative to the medicine you're prescribing me? Are there any brochures or other printed material that I can take with me? What websites do you recommend? What caused me to develop this ulcer?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something. What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to cover. Your doctor may ask: When did you first begin experiencing symptoms? Have your symptoms been continuous or intermittent? How severe are your symptoms? Are your symptoms worse when you're hungry? Does anything seem to improve your symptoms? What, if anything, appears to worsen your symptoms? Do you take pain relievers or aspirin? If yes, how often? Do you feel nauseated or have you been vomiting? Have you ever vomited blood or black material? Have you noticed blood in your stool or black stools? What, if anything, have you been taking to relieve your symptoms?

What you can do in the meantime While you're waiting to see your doctor, avoiding smoking, alcohol, spicy foods and stress may help lessen your discomfort. Tests and diagnosis In order to detect an ulcer, you may have to undergo diagnostic tests, such as: Tests for H. pylori. Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. Which type of test you undergo depends on your situation. H. pylori may be detected in a blood test, a stool test or a breath test. For the breath test, you drink a small glass of clear, tasteless liquid that contains radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you're infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide. Using a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers. If your doctor detects an ulcer, he or she may remove small tissue samples (biopsy) for laboratory examination. A biopsy can also identify the presence of H. pylori in your stomach lining. Your doctor is more likely to recommend endoscopy if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing.

X-ray of your upper digestive system. Sometimes called a barium swallow or upper gastrointestinal series, this series of X-rays creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.

Treatments and drugs Treatment for peptic ulcers typically involves antibiotics to kill the H. pylori bacterium and other medications to reduce the level of acid in your digestive system to relieve pain and encourage healing. You may take antibiotics for two weeks and acid-reducing medications for about two months. If your peptic ulcer isn't caused by H. pylori, you won't need antibiotics. Instead, your doctor may recommend treatments for your specific situation. For instance, if pain relievers caused your ulcer, your doctor may recommend a different pain reliever or a different dose. Your doctor may also recommend acid-reducing medications to allow your ulcer to heal. You may take these medications for two months or more. Treatments for peptic ulcer can include: Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. Antibiotic regimens are different throughout the world. In the United States, antibiotics prescribed for treatment of H. pylori include amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline. You'll likely need to take antibiotics for two weeks. Medications that block acid production and promote healing. Proton pump inhibitors reduce acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk. Medications to reduce acid production. Acid blockers also called histamine (H-2) blockers reduce the amount of acid released into your digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid). 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. Side effects can include constipation or diarrhea, depending on the main ingredients. 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. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).

Follow-up after initial treatment Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms. If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment. Ulcers that fail to heal Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. These reasons may include: Not taking medications according to directions. The fact that some types of H. pylori are resistant to antibiotics. Regular use of tobacco. Regular use of pain relievers that increase the risk of ulcers.

Less often, refractory ulcers may be a result of: Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome An infection other than H. pylori Stomach cancer Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics. Lifestyle and home remedies You may find relief from the pain of a stomach ulcer if you: Choose a healthy diet. Choose a healthy diet full of fruits, vegetables and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer. Consider switching pain relievers. If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you. Control stress. Stress may worsen the signs and symptoms of a peptic ulcer. Examine your life to determine the sources of your stress and do what you can to address those causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal. Don't smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid. Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.

Prevention You may reduce your risk of peptic ulcer if you: Protect yourself from infections. It's not clear just how H. pylori spreads, but there's some evidence that it could be transmitted from person to person or through food and water. You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely. Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals. Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.