Peptic Ulcers - Treatment

Treatment

Deciding which treatment is best for patients with symptoms of dyspepsia or peptic ulcer disease depends on a number of factors.

An endoscopy to identify any ulcers and test for H. pylori probably gives the best guidance for treatment. However, dyspepsia is such a common reason for a doctor's visit that many people are treated initially based on their symptoms and blood or breath H. pylori test results. This approach (called test and treat) is considered an appropriate option for most patients. Patients who have evidence of bleeding or other alarm symptoms, or who are over age 50 should have an endoscopy performed first.

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Approach to Patients Who Are Not Taking NSAIDs

If an endoscopy is performed soon after the patient first visits a doctor for symptoms, treatment is based on the results of the endoscopy:

• If an ulcer is seen and the patient is infected with H. pylori, treatment for the infection is started, followed by 4 - 8 weeks of treatment with a proton pump inhibitor (PPI). Most patients will improve with this treatment.
• If an ulcer is seen but H. pylori are not present, patients are usually treated with PPIs for 8 weeks.
• If no ulcer is seen and the patient is not infected with H. pylori, the first treatment attempt will usually be with PPIs. These patients do not need antibiotics to treat H. pylori. Other possible causes of their symptoms should also be considered.

Most patients who do not have risk factors for complications are treated without first having an endoscopy. The type of treatment is decided based on a patient's symptoms, and on the results of H. pylori blood or breath tests.

Patients who are not infected with H. pylori are given a diagnosis of functional (non-ulcer) dyspepsia. These patients are most commonly given 4 - 8 weeks of a PPI. If this dose is not effective, doubling the dose will occasionally relieve symptoms. If there is still no symptom relief, patients may have an endoscopy. However, it is unlikely that an ulcer is present. In this group of patients, symptoms may not fully improve.