Peptic Ulcers - Treatment for NSAID-Induced Ulcers

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Some people carry a gene that reduces the effectiveness of PPIs. This gene is present in 18 - 20% of people who are of Asian descent.

Standard Brands. Most PPIs are available by prescription as oral drugs. There is no evidence that one brand of PPI works better than another. Brands approved for ulcer prevention and treatment include:

• Omeprazole (generic, Prilosec OTC)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Rabeprazole (Aciphex)

Possible Adverse Effects.

• Side effects of PPIs are uncommon, but may include headache, diarrhea, constipation, nausea, and itching.
• Pregnant women and nursing mothers should avoid taking PPIs. Although recent studies suggest that these drugs do not increase the risk of birth defects, their safety during pregnancy is not yet proven.
• PPIs may interact with certain drugs, including antiseizure medications (such as phenytoin), anti-anxiety drugs (such as diazepam), and blood thinners (such as warfarin).
• Long-term use of high-dose PPIs may cause vitamin B12 deficiency, but more studies are needed to confirm this risk.

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In theory, long-term use of PPIs by people with H. pylori may reduce acid secretion enough to cause atrophic gastritis (chronic inflammation of the stomach), a risk factor for stomach cancer. Long-term use of PPIs may also mask the symptoms of stomach cancer and delay diagnosis. At this time, however, there have been no reports of an increase in the incidence of stomach cancer with long-term use of these drugs.

H2 Blockers

H2 blockers interfere with acid production by blocking histamine, a substance produced by the body that encourages acid secretion in the stomach. H2 blockers were the standard treatment for peptic ulcers until PPIs and antibiotic regimens against H. pylori were developed. H2 blockers cannot cure ulcers, but they are useful in certain cases. They are effective only for duodenal ulcers, however.

Four H2 blockers are currently available over-the-counter in the U.S.:

• Famotidine (Pepcid AC)
• Cimetidine (Tagamet)
• Ranitidine (Zantac)
• Nizatidine (Axid)