Peptic Ulcer Treatments
Once peptic ulcer is diagnosis then treatment options are peptic ulcer home remedies and modern medication to heal an ulcer as well as relieve peptic ulcer symptoms.
Home Remedies Peptic Ulcer
Stop smoking - it can weaken esophageal valve, thereby allowing more acid refluxed into the esophagus. Some studies show that smoking reduces the bicarbonate production, which interferes with the acid-neutralization in the duodenum leads to ulcer formation.
Avoid coffee - it elevates hormones’ cortisol, epinephrine (adrenaline), and norepinephrine, which are accountable for the body’s fight or flight response. It thus increases heart rate, raises blood pressure and activates by shunting away the blood from digestive system causing indigestion. Coffee tends to speed up the gastric emptying process results in highly acidic stomach contents that is being dumped into the small intestine too soon leads to its tissue injury.
Avoid alcohol – low to moderate amount of alcohol can stimulate gastric acid secretion; however, it inhibits the secretion in large quantities. Chronic alcohol consumption shrinks gastric mucosa and decreased secretion, thus fewer abilities to kill bacteria enters with the food. Alcohol also interferes with enzymatic digestion and absorption of nutrients.
Stop aspirin or NSAIDs (non-steroidal anti-inflammatory medications) - are medicines that reduce pain, fever, and inflammation. People who regularly taking these medicines for chronic conditions like arthritis or taking aspirin to prevent heart diseases chances are five times more likely to develop peptic ulcers than others. Try to use Acetaminophen as a substitute for some conditions. If acetaminophen does not help you, consult your doctor for best alternatives.
Ulcer foods - there is no known particular food suitable for ulcer; however, many prefer to avoid spicy, greasy foods. Try to break down foods into many smaller meals, instead of only three meals per day. If you find any food aggravates your symptoms, then try to avoid it.
Use Antacids - to neutralize your stomach acid so that allowing the ulcer to heal.
Commonly available antacid medication:
- Alka-Seltzer – Sodium bicarbonate and/or Potassium bicarbonate,
- Andrews Antacid – calcium carbonate Magnesium carbonate,
- Brioschi – Sodium bicarbonate,
- Equate – Aluminum hydroxide and magnesium oxide,
- Maalox (liquid) – Aluminum hydroxide and magnesium oxide,
- Maalox (tablet) – calcium carbonate,
- Milk of Magnesia – magnesium oxide,
- Pepto-Bismol – Bismuth Subsalicylate,
- Pepto-Bismol Children’s – calcium carbonate,
- Rennie (tablets) – calcium carbonate Magnesium carbonate,
- Rolaids – calcium carbonate and magnesium oxide,
- Tums – calcium carbonate,
- Mylanta – contains Aluminum hydroxide,
- Eno - Sodium bicarbonate, Citric acid, Sodium carbonate,
- Gelusil (available in tablet and syrup form)
Antacid side effects are
- Sodium based antacids may cause fluid retention, hypertension, kidney disease, heart failure.
- Calcium based antacids may cause hypercalcemia, Constipation, and Rebound acid secretion.
- Magnesium based antacids may cause diarrhea, and slightly sedative.
- Aluminum based antacids may cause constipation.
Magnesium and aluminum combination antacids balance both diarrhea and constipation.
Peptic Ulcer Medication
Peptic ulcer treatment options are disinfecting H pyloric bacteria, reducing gastric acidity, and protecting GI tract.
- Gastric acidity reducing medication: Histamine H2 receptor antagonists, Proton pump inhibitors, and Antacids.
- Cytoprotective GI protecting medications are sucralfate, misoprostol, and colloidal bismuth compounds.
Choice of peptic ulcer treatment depends upon the ulcer cause. If the ulcer cause is an infection by H pylori, then the treatment focus will be on killing the bacteria.
Whether it is bacteria caused the ulcer or not; reducing the stomach acid is another important ulcer treatment. Additionally, you get treatment to protect the lining of the stomach and duodenum.
When H. pylori infection is present or suspected, the most effective treatment is the combination of the antibiotic, proton pump inhibitor, sometimes for severe cases together with bismuth compound and protecting the mucus membrane with Sucralfate.
A single antibiotic has no effect against H. pylori, thus a combination of any two antibiotics from Clarithromycin, Amoxicillin, Tetracycline, and Metronidazole. For severe or non-responding for two antibiotic cases, 3 antibiotics can be useful; a common combination is amoxicillin, clarithromycin, and metronidazole.
To help the ulcer to heal and to reduce the peptic ulcer symptoms, your doctor prescribes one proton pump inhibitor sometime additionally with bismuth compound (for severe or treatment-resistive cases). Proton-pump inhibitors are drugs, which can long-lasting reduction of gastric acid production. They are the most effective acid secretion inhibitors available today. Bismuth compounds are often useful to relieve upset stomachs, diarrhea, nausea and heartburn. The exact mechanism of action of bismuth is unknown; however, it is thought to relieve discomfort by coating the digestive tract lining, soothing inflammation, kills bacteria, and suppresses prostaglandin’s action(chemicals causing inflammation).
Bismuth subsalicylate (Pepto-Bismol) will coat ulcers and protecting them from stomach acid. Although bismuth subsalicylate may kill H. pylori, it is useful along with antibiotics in some treatment regimens. Bismuth salicylates can increase the gastrointestinal bleeding ulcer risks. Therefore, it is not advisable to use it as a peptic ulcer treatment on its own or without doctor’s care.
Histamine (H2) receptor antagonist
For younger patients with milder ulcer symptoms without bacterial infection, the first-line treatment will be antacids or H2 antagonist (Ranitidine and famotidine). Which provide relief from peptic ulcers and its symptoms of heartburn, and indigestion additionally limits excess stomach acid.
The H2 receptor antagonists are medication, which block the action of histamine on parietal cells in the stomach, decreasing the stomach acid production by these cells.
H2 receptor antagonists available on the market are:
- Tagamet (cimetidine),
- Pepcid (famotidine),
- Axid (nizatidine),
- Zantac (ranitidine)
H2 receptor side effects are GI discomfort (diarrhea, constipation), breast enlargement and impotence. Elderly patients with renal problems are at most risk.
If your doctor suspects H. pylori infection, subsequently the most effective treatments are combinations of any two antibiotics from this list Clarithromycin, Amoxicillin, Tetracycline, and Metronidazole. The preferable combination is Amoxicillin and Metronidazole, if the ulcer is severe or not responding to the treatment, then a combination of three antibiotics amoxicillin, clarithromycin, and metronidazole.
Along with the antibiotics, your doctor prescribes medication to stop further ulceration due to stomach acid; a proton pump inhibitor such as Pantoprazole will do.
Proton pump inhibitor
Common proton pump inhibitors available on the market are:
- Omeprazole (brand names: Gasec, Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Omez,)
- Lansoprazole (brand names: Prevacid, Zoton, Monolitum, Inhibitol, Levant, Lupizole)
- Dexlansoprazole (brand name: Kapidex, Dexilant)
- Esomeprazole (brand names: Nexium, Esotrex, esso)
- Pantoprazole (brand names: Protonix, Somac, Pantoloc, Pantozol, Zurcal, Zentro, Pan, Controloc)
- Rabeprazole (brand names: AcipHex, Pariet, Erraz, Zechin, Rabecid, Nzole-D, Rabeloc, Razo)
- Ilaprazole (brand names: Ilapro, Lupilla, Adiza)
- Zegarid, a rapid release form of omeprazole
Proton pump inhibitor’s side effects - is GI discomfort such as diarrhea, headache, abdominal pain and CNS problems such as dizziness, headache.
Sucralfate does not affect the amount of acid into the stomach instead it is a gastric mucosal protectant; it can form a protective barrier over ulcer tissue against aggressive factors. This drug is not an acid suppressant. Some common sucralfate side effects include constipation, nausea, flatulence and gastric discomfort. Sucralfate may restrict medication absorption, thus it is preferable to take this medication at least two-hours gap with other medications.
Commonly available sucralfate is:
- Sucramal in Italy
- Carafate in U.S.A
- Pepsigard, Sucral, Sucrafil, Hapifate in India
- Sutra or Musin in parts of South-East Asia
- Sulcrate in Canada
- Ulsanic in South Africa and Israel
- Antepsin in Turkey.
Side effects of Sucralfate - is constipation in 2 to 3% cases and bezoar formation. Other fewer common side effects include flatulence, headache, hypophosphatemia, and dry mouth. Avoid it in the case of chronic renal failure; it might cause them aluminum-induced nephropathy.
Misoprostol reduces stomach acid and replaces protective substances into the stomach that are inhibiting by non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin. Misoprostol is useful to prevent the formation of ulcers in the stomach during treatment with aspirin or an NSAID.
Misoprostol side effects – are mild to moderate diarrhea, stomach cramps, vomiting, flatulence, constipation, headache, menstrual cramps, spotting, increased or irregular menstruation and/or nausea. Stop taking misoprostol and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).
Peptic Ulcer Surgery
Once the peptic ulcer has to start developing complication such as perforation, bleeding, and obstructions then you may require surgical intervention. The types of surgery performed for ulcers are vagotomy, pyloroplasty, and antrectomy.
Vagotomy – is a surgery to cut down of vagus nerve, responsible for transmitting messages from the brain to the stomach, this reduces acid secretion. However, vagotomy produces certain side effects such as severe, persistent abdominal pain, vomiting, diarrhea, and interferes with stomach emptying. The Modified vagotomy surgery involves cutting only the nerves responsible in stimulating the stomach acid-secretion cells. This avoids or limit’s interference with stomach emptying.
Antrectomy – is a surgery to remove the lower part of the stomach (antrum). This stomach section produces a hormone that stimulates it to secrete digestive juices. Sometimes a surgeon may additionally remove the stomach part secretes pepsin and acid. A vagotomy usually performs along with an antrectomy.
Pyloroplasty – is a surgery to enlarge the opening of the duodenum and small intestine (pylorus). This enables stomach contents to move freely out of the stomach. A vagotomy may also perform along with a pyloroplasty.