Approximately 25 million Americans have symptoms of a peptic ulcer at some time in their life, according to the Centers for Disease Control and Prevention. Peptic ulcers are open sores in the lining of the stomach or first part of the small intestine, known as the duodenum.
Peptic ulcer pain typically feels like a gnawing or burning sensation in the upper abdomen. It's usually worse between meals, when the stomach is empty.
But pain in the upper abdomen may be due to other causes, including stomach cancer, so see your doctor to determine the diagnosis. There are a number of remedies your doctor may recommend, such as medications, dietary modifications and lifestyle changes.
Medications for Helicobacter pylori
Most peptic ulcers are caused by infection with a bacterium called Helicobacter pylori. Initial treatment for H. pylori usually consists of triple therapy, according to guidelines from the American College of Gastroenterology published in February 2017. Triple therapy typically includes 2 antibiotics plus a proton pump inhibitor (PPI), such as omeprazole (Prilosec) or lansoprazole (Prevacid), which reduces acidity in the stomach.
A systematic review published in the "Cochrane Library" in April 2016 compiled the results of several previous studies. It concluded that successful elimination of H. pylori is definitely beneficial for duodenal ulcers, but not enough studies have been performed to definitely state whether it is effective for gastric ulcers.
When H. pylori infection is not present, peptic ulcers are primarily caused by stomach acid. Parietal cells, located in the lining of the stomach, produce acid and release it into the stomach.
The acid helps digest food, but it may also damage the lining of the stomach and duodenum, producing ulcers. In this situation, the usual treatment is a medication that prevents the release of acid from parietal cells.
Histamine 2 blockers, such as ranitidine (Zantac) or famotidine (Pepcid), and PPIs are the main groups of drugs that act in this manner. PPIs are generally preferred because they are more powerful acid-reducers than histamine 2 blockers.
Less commonly, a protectant medication called sucralfate (Carafate) is used. Sucralfate coats the lining of the stomach and duodenum, preventing acid from reaching the ulcer and allowing the ulcer to heal on its own.
Over-the-counter antacids, such as Tums and Rolaids, are alkaline, so they neutralize acid in the stomach. They temporarily relieve ulcer pain, but the pain returns after 1 to 2 hours as more acid is produced. Antacids may also interfere with the absorption of some drugs, including antibiotics used to treat H. pylori.
Some over-the-counter antacids, such as Alka Seltzer and Bromo Seltzer, also contain Aspirin. The Food and Drug Administration warns that these combination medications may cause serious bleeding in people with stomach ulcers. Consult with your doctor before taking any over-the-counter medications for ulcer pain.
Dietary and Lifestyle Changes
Certain foods, such as chocolate, spicy foods or acidic foods, do not cause ulcers but may make ulcer pain worse. Although doctors used to recommend a bland diet, nowadays the trend is to just avoid foods that worsen symptoms. In the past, milk was encouraged as a treatment for ulcers, but it is no longer recommended, according to the National Institutes of Health.
Cigarette smoking should be stopped, as it can interfere with peptic ulcer healing. Alcohol increases acid release from parietal cells, so avoiding or limiting alcohol consumption is advised.
Although stress is no longer considered the main cause of peptic ulcers, it may delay their healing. An article published in the March 2013 issue of "Applied Psychology: Health and Well-being" explains that eliminating psychological factors, such as stress, is an important part of a comprehensive plan for treating ulcers.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve), can produce stomach inflammation, known as gastritis.
When gastritis is severe, ulcers may develop. In people taking NSAIDs, stopping or reducing the amount of NSAIDs often improves ulcer pain and promotes healing.
In February 2009, the American College of Gastroenterology published guidelines regarding what to do when it is necessary to continue NSAIDs. The guidelines recommend taking a PPI in addition to an NSAID or choosing a specific NSAID called celecoxib (Celebrex). Celecoxib is a Cox-2 inhibitor, which is a special type of NSIAD that is less likely to cause ulcers than other NSAIDs.
Results from laboratory and animal studies indicate that some herbs, such as oregano, sweet marjoram, garlic and ginger, may help heal peptic ulcers. But turmeric/curcumin is the only herb shown to be beneficial in human studies. Turmeric and its active ingredient curcumin have prominent anti-inflammatory and antioxidant effects, which may promote ulcer healing.
A study published in the March 2001 issue of "Southeast Asian Journal of Tropical Medicine and Public Health" examined the effects of turmeric capsules in 25 adults with peptic ulcers. The ulcers healed by 4 weeks in 12 individuals and by 12 weeks in 19 people.
A study published in the August 2016 issue of "Drug Research" reported that adding curcumin to triple therapy for H. pylori ulcers was more effective in eliminating symptoms, including pain, than triple therapy alone.
Warnings and Precautions
See your doctor to determine the cause of your abdominal pain and the appropriate treatment. Be sure to ask about over-the-counter treatments that you may be considering.
Seek immediate medical attention if you have severe abdominal pain, vomit that looks like coffee grounds or bright red blood, or stools that are dark red or look like tar. These symptoms may indicate the presence of a life-threatening ulcer complication, such as bleeding or perforation. Perforation occurs when an ulcer is deep enough to produce a hole through the entire wall of the stomach or duodenum.
- Merck Manual Professional Version: Peptic Ulcer Disease
- Primary Care Medicine: Office Evaluation and Management of the Adult Patient; Allan H. Goroll & Albert G. Mulley
- Applied Psychology: Health and Well-Being: Restoring Psychology's Role in Peptic Ulcer
- American College of Gastroenterology: Prevention of NSAID-Related Ulcer Complications
- Applied and Environmental Microbiology: Inhibition of Helicobacter pylori and Associated Urease by Oregano and Cranberry Phytochemical Synergies
- Herbal Medicine -- Biomolecular and Clinical Aspects. Chapter 13 -- Turmeric, the Golden Spice; Sahdeo Prasad and Bharat B. Aggarwal.
- Centers for Disease Control and Prevention: Helicobacter pylori and Peptic Ulcer Disease -- The Key to Cure
- American Journal of Gastroenterology: American College of Gastroenterology Clinical Guideline: Treatment of Helicobacter pylori Infection
- Drug Research: Adjunctive Therapy With Curcumin for Peptic Ulcer -- A Randomized Controlled Trial
- Southeast Asian Journal of Tropical Medicine and Public Health: Phase II Clinical Trial on Effect of the Long Turmeric (Curcuma longa Linn) on Healing of Peptic Ulcer
- US Food and Drug Administration: FDA Drug Safety Communication: FDA Warns About Serious Bleeding Risk With Over-the-Counter Antacid Products Containing Aspirin
- Journal of Evidence-Based Complementary and Alternative Medicine: Sweet Marjoram -- A Review of Ethnopharmacology, Phytochemistry, and Biological Activities
- National Institutes of Health: Eating, Diet, & Nutrition for Peptic Ulcers (Stomach Ulcers)
- Cochrane Library: Antibiotics for People With Peptic Ulcers Caused by Helicobacter pylori Infection