Peptic Ulcers - Treatment

Treatment

Antibiotic regimens that eradicate H. pylori can cure peptic ulcers and are now the standard agents used for ulcers in infected individuals who are not taking NSAIDs. (Eliminating H. pylori can also cure the rare MALT lymphomas caused by this bacterium.) Other agents, such as proton-pump inhibitors or H2 blockers, are useful for relieving ulcer symptoms.

Test and Treat: Candidates for Antibiotic Therapy and Elimination of H. Pylori

Patients with Clear Evidence of Ulcers. Antibiotics are clearly indicated for patients who have both ulcers and H. pylori infection. In spite of such clear indications, however, European and American studies continue to suggest that many doctors are still only treating symptoms and not curing the ulcers themselves. (Studies also suggest that most doctors are not counseling patients properly on the potential dangers of NSAIDs and other drugs that can cause ulcers.)

---

---

There is considerable debate about whether to test for H. pylori and then treat infected patients who have dyspepsia but who have no signs of ulcers.

Managing Patients with Dyspepsia and No Evidence of Ulcers

The best approach for treating dyspepsia is highly controversial. The options include the following:

• Test and Treat. This approach involves testing for H. pylori and eradicating the bacteria in infected patients.
• Prescribing potent acid-suppressing agents. This approach generally employs a trial of potent acid-suppression drugs called proton-pump inhibitors, such as omeprazole (Prilosec) or esomeprazole (Nexium).

In either case, endoscopy is usually performed if symptoms persist after four weeks. (Some evidence suggests that PPIs may mask ulcers, so patients taking these drugs may need to discontinue them for two weeks before endoscopy.)

Arguments for Testing and Treating Patients with Dyspepsia. The argument supporting testing and treating patients with non-ulcer dyspepsia are as follows:

• Protection against ulcers. Some evidence suggests that antibiotic treatments for infected patients with dyspepsia may prevent ulcers from developing. A study in 2002, for example, found that antibiotic regimens to eradicate H. pylori greatly decreased the likelihood of ulcers in infected patients with nonulcer dyspepsia who were also on long-term NSAIDs.
• Protection against gastric cancer. Some evidence suggests that eradicating H. pylori may prevent or delay the onset of stomach cancer in people with long-term dyspepsia who are infected with the bacteria. For example, a large 2001 study in Japan, where gastric cancer is especially common, found that such cancers developed in about 3% of infected patients with nonulcer dyspepsia. However, none occurred in dyspeptic patients who were treated with antibiotics for H. pylori.