Treating a peptic ulcer — a sore on the lining of your stomach or small intestine — depends on what's caused the ulcer. You may need medications that directly address the root cause and others that can help relieve symptoms.
And some common medications you may have been taking for other reasons may need to come out of your medicine chest altogether.
Read more: Remedies for Ulcer Pain
Getting the Right Diagnosis
The two main types of peptic ulcers are gastric ulcers, which form in the lining of the stomach, and duodenal ulcers, which occur at the top part of the small intestine, the duodenum, according to the American College of Gastroenterology.
Helicobacter pylori (H. pylori) bacteria cause most of the ulcers affecting Americans, says Harvard Health Publishing. To a lesser extent, ulcers can be traced to the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. Both H. pylori and NSAIDs can erode the stomach lining or the duodenum, leaving them vulnerable to the stomach's strong, corrosive acids, which then causes an ulcer to form.
Ulcers aren't always obvious. In fact, most people who have ulcers experience no symptoms, according to the Mayo Clinic. However, a burning feeling in the abdomen is the most common sign noted.
To determine whether you have an ulcer, your doctor will order diagnostic tests. Laboratory tests can determine whether you have the H. pylori infection. The tests can be on your blood, stool or breath, according to Mayo. Sometimes an endoscopy, which uses a thin tube with a camera on the end, is needed to visualize the stomach lining or small intestine. If an ulcer is detected, small samples of tissue may be taken for further testing.
Antibiotics for Ulcers
If your ulcer stems from H. pylori bacteria, antibiotics will be the key to your recovery. "We treat the bacteria if it is present in the lining of the stomach of a patient with ulcers," explains Patricia Raymond, MD, a gastroenterologist with Sentara Princess Anne Hospital in Virginia Beach.
The standard approach to treatment is called triple therapy, says Harvard Health. This combines two antibiotics to knock out the infection and a proton pump inhibitor (PPI) to help with healing by reducing stomach acids.
"There are many successful treatment regimens of antibiotics and anti-acid proton pump inhibitors to choose [from]," says Dr. Raymond.
Amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline and levofloxacin are the antibiotics most frequently used for an ulcer treatment plan, according to the Mayo Clinic. Depending on where you live and the local antibiotic resistance rates, your doctor will determine the best combination for you. Usually, you'll need to take antibiotics for one to two weeks, says Harvard Health. But however long the course, it's a must to take all doses, even if your symptoms go away before you finish the medication.
Proton pump inhibitors work by blocking acid production. PPIs include both prescription and over-the-counter medications like omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium). It's important to take your medication and have a meal within the following 30 to 60 minutes — food is needed to activate these drugs, according to the American College of Gastroenterology.
For duodenal ulcers in particular, your doctor might instead recommend an acid reducing drug, called a histamine or H2 blocker, such as famotidine (Pepcid) or cimetidine (Tagamet HB). Note that the U.S. Food and Drug Administration has recalled many generic versions of the well-known H2 blocker Zantac, known as ranitidine, because of impurities. Check on updates before using it.
In addition, antacids such as Tums and Pepto-Bismol may help neutralize stomach acid and give you fast pain relief. Although antacids aren't used to heal ulcers, they can give you a break from symptoms, Mayo Clinic notes.
Read more: Foods That Will Not Irritate Gastric Ulcers
Ulcers and NSAIDs
If your ulcer is from overusing NSAIDs, you'll rely on PPIs or H2 blockers along with avoiding NSAIDs to heal. Switching to acetaminophen (Tylenol) might be an option for you when you need pain relief from a headache or other minor problems, according to Mayo.
Though it's hard to avoid the H. pylori bacteria, it is possible to protect against ulcers from NSAIDs. For instance, don't wait until you have an ulcer to minimize how often you take NSAIDs. Also make sure you take the drugs exactly as directed.
"You can prevent ulcers that are from caustic medications," says Dr. Raymond. "You can do so by buffering with food."
Is This an Emergency?
- American College of Gastroenterology: “Peptic Ulcer Disease”
- Mayo Clinic: “Peptic Ulcer — Symptoms and Causes”
- Harvard Health: “Peptic Ulcer”
- U.S. Food and Drug Administration: “Questions and Answers: NDMA Impurities in Ranitidine (Commonly Known as Zantac)”
- Mayo Clinic: "Peptic Ulcer — Diagnosis and Treatment"