Peptic Ulcers - Treatment

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Patients who test positive for H. pylori infection will receive an antibiotic to treat H. pylori. Those who have an ulcer are more likely to respond to antibiotic treatment. Because an endoscopy is not done before treatment in the test and treat strategy, patients who do not have an ulcer are also treated with antibiotics. Even if they test positive for H. pylori, patients who do not have an actual ulcer are less likely to have a full response to antibiotics.

When the test and treat approach is used, patients who do not respond to treatment, or whose symptoms return relatively quickly will often need an endoscopy.

There is considerable debate about whether to test for H. pylori and treat infected patients who have dyspepsia but no clear evidence of ulcers, in part because H. pylori in the intestinal tract protects against GERD and possibly other conditions. There is also concern about the overuse of antibiotics, which can contribute to the emergence of antibiotic-resistant bacteria.

Antibiotic and Combination Drug Regimens for the Treatment of H. pylori

Reported cure rates for H. pylori range from 70 - 90% after antibiotic treatment. The standard treatment regimen uses two antibiotics and a PPI:

PPIs. These drugs include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and rabeprazole (Aciphex). PPIs are important for all types of peptic ulcers, and are a critical partner in antibiotic regimens. They reduce acidity in the intestinal tract, and increase the ability of antibiotics to destroy H. pylori.

Antibiotics. The standard antibiotics are clarithromycin (Biaxin) and amoxicillin. The antibiotic metronidazole (Flagyl) may be used instead of amoxicillin in patients who are allergic to penicillin.

Patients typically take this combination treatment for at least 14 days. A 7-day regimen is another option, but some research suggests that 14 days of therapy with antibiotics and PPIs is more effective at eradicating H. pylori.

Follow-Up. Follow-up testing to check that the bacteria have been eliminated should be done no sooner than 4 weeks after therapy is completed. Test results before that time may not be accurate.