Treatment of Peptic Ulcer Disease
Treatment of Peptic Ulcer Disease
The goal of ulcer treatment is to relieve pain and to prevent complications such as bleeding, obstruction and perforation. The first step in treatment involves the reduction of risk factors ( NSAIDs and cigarettes). The next step is medication.
Antacids neutralize existing acid in the stomach. However, the neutralizing action of these agents is shortlived and frequent dosages are required. Ulcers frequently return when antacids are discontinued.
Since many ulcers stem from H. pylori bacteria, doctors use a two-pronged approach :
1. Kill the bacteria
2. Reduce the level of acid in the digestive system to relieve pain and encourage healing.
Accomplishing these two steps requires the use of at least two, and sometimes three or four, of the following medications :
Acid blockers : Histamine antagonists ( H2 blockers) are drugs designed to block the action of histamine on gastric cells, hence reducing acid output. Examples of H2 blockers are cimetidine, ranitidine and famotidine. While H2 blockers are effective in ulcer healing, they have limited role in eradicating H. pylori. Therefore, ulcers frequently return when H2 blockers are stopped. Generally, these drugs are well tolerated and have few side effects even with long term use.
Proton pump inhibitors : Another way to reduce stomach acid is to shut down the 'pumps' within the acid-secreting cells. Proton pump inhibitors like omeprazole, lansoprazole, rabeprazole and esomeprazole reduce acid by blocking the action of these tiny pumps. They also appear to inhibit H. pylori.
Oesophageal ulcers are more sensitive than gastric and duodenal ulcers to minute amounts of acid. Therefore, complete acid suppression, which is accomplished by proton pump inhibitors, is important for oesophageal ulcer healing. The complete shut down of stomach acid does not have any effect on the patient's ability to digest and absorb nutrients.
Cytoprotective agents : These medications protect the tissues that line the stomach and small intestine. Sucralfate and misoprotol are two cytoprotective medications. These drugs strengthen the gut lining against attacks by acid digestive juices. Sucralfate coats the ulcer surface and promotes healing. The medication may have side-effects like constipation and interference with the absorption of other medications.
Antibiotics : Several combinations of antibiotics kill H. pylori and these are equally effective. Antibiotics commonly prescribed include amoxilcillin, clarithromycin or metronidazole.
There is no conclusive evidence that dietary restrictions and bland diets play a role in ulcer healing. No proven relationship exists between peptic ulcer disease and the intake of coffee and alcohol. However, since coffee stimulates gastric acid secretion and alcohol can cause gastritis, moderation in their consumption is often recommended.
Surgery : Surgery used to be a major form of ulcer treatment. Nowadays only an occasional patient needs surgery for the treatment of peptic ulcers.
Ulcers that fail to heal
Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. Not taking medications according to directions is one reason. Some types of H. pylori are resistant to antibiotics. Other factors that can interfere with the healing process include regular use of tobacco, alcohol or NSAID. In rare cases, refractory ulcers may be a result of :
Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with stronger doses of ulcer medications. Surgery is necessary only when the ulcer does not respond to aggressive drug treatment.
Peptic Ulcer Disease
What is Peptic Ulcer Disease
Causes and Symptoms of Peptic Ulcer Disease
Diagnosis and Complication of Peptic Ulcer Disease
Treatment of Peptic Ulcer Disease
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