Peptic Ulcers - Treatment

(Page 3)

In most cases, drug treatment relieves ulcer symptoms. However, symptom relief does not always indicate treatment success, just as persistent dyspepsia does not necessarily mean that treatment has failed. Heartburn and other GERD symptoms can get worse and require acid-suppressing medication.

Failure. Treatment fails in about 10 - 20% of patients, typically when they do not follow their prescribed treatment. Compliance with standard antibiotic regimens may be poor for the following reasons:

• The triple-drug regimens are complicated and require many pills. Helicide and other two-drug combination pills may help offset this problem.
• About 30% of patients experience side effects from the H. pylori regimen. Gastrointestinal problems are very common, and severe diarrhea can occur.

---

---

Treatment may also fail if patients harbor strains of H. pylori that are resistant to antibiotics. When this happens, different drugs are tried.

Re-infection after Successful Treatment. Studies in developed countries indicate that once the bacteria are eliminated, recurrence rates are below 1% per year. Re-infection with the bacteria is possible, however, in areas where the incidence of H. pylori is very high and sanitary conditions are poor. In such regions, re-infection rates are 6 - 15%.

Treatment of NSAID-induced ulcers

If patients are diagnosed with NSAID-caused ulcers or bleeding, they should:

• Get tested for H. pylori and, if they are infected, take antibiotics.
• Possibly use a PPI. Studies suggest that these medications lower the risk for NSAID-caused ulcers, although they do not completely prevent them.

Healing Existing Ulcers. A number of drugs are used to treat NSAID-caused ulcers. PPIs -- omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) -- are used most often. Other drugs that may be useful include H2 blockers, such as famotidine (Pepcid AC), cimetidine (Tagamet), and ranitidine (Zantac). Sucralfate is another drug used to heal ulcers and reduce the stomach upset caused by NSAIDs.