Peptic Ulcers - Medications

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Side Effects.

• Diarrhea and other gastrointestinal problems are severe enough to cause 20% of patients to stop taking the drug. Taking misoprostol after meals should minimize these effects. One study indicated that taking the drug two or three times a day instead of the standard regimen of four times may prove to be just as effective and cause fewer side effects.
• Misoprostol can induce abortion or cause birth defects and should not be taken by pregnant women. If pregnancy occurs during treatment, the drug should be discontinued at once and the doctor contacted immediately.

Proton-Pump Inhibitors (PPIs)

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Actions Against Ulcers. PPIs are the drugs of choice for managing patients with peptic ulcers from any cause. They suppress the production of stomach acid. These drugs work by blocking the gastric acid pump – the molecule in the stomach glands that is responsible for acid secretion.

PPIs can be used as part of a multidrug regimen for H. pylori or used alone for preventing and healing NSAID-caused ulcers. They are also useful in the treatment of ulcers caused by Zollinger-Ellison syndrome. Some people carry a gene that reduces the effectiveness of proton-pump inhibitors. This gene may be present in 18% and 20% of people of Asian descent.

Standard Brands. Most PPIs are available by prescription. They can all be taken by mouth. 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 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.
• PPIs may interact with certain drugs, such as antiseizure agents (e.g., phenytoin), antianxiety drugs (e.g., diazepam), and blood thinners (e.g., warfarin).
• Long-term use of high-dose PPIs may produce vitamin B12 deficiencies, but studies are needed to confirm this risk.
• Long-term use of PPIs by people with H. pylori may, in theory at least, reduce acid secretion enough to cause atrophic gastritis (chronic inflammation of the stomach). This condition, in turn, is a risk factor for stomach cancer. Long-term use of PPIs may also mask symptoms of stomach cancer and delay diagnosis. At this time, however, there have been no reports of an increased risk of stomach cancer with long-term use of these drugs.

Sucralfate

Sucralfate (Carafate) seems to work by adhering to the ulcer crater and protecting it from further damage by stomach acid and pepsin. It also promotes the defensive processes of the stomach. Sucralfate has an ulcer-healing rate similar to that of H2 blockers. Other than constipation, which occurs in 2.2% of patients, the drug has few side effects. Sucralfate does interact with a wide variety of drugs, including warfarin, phenytoin, and tetracycline.

Review Date: 07/14/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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