Treatment of Peptic Ulcers

Peptic ulcers are painful sores that develop in the lining of the stomach, small intestine, or esophagus. These ulcers result from the erosion of the protective mucosal layer by stomach acid, often triggered by bacterial infections, certain medications, or lifestyle factors. If left untreated, peptic ulcers can lead to serious complications, including bleeding, perforation, and obstruction. Fortunately, modern medicine offers several effective treatment options that not only relieve symptoms but also promote complete healing.

Peptic ulcers are a common yet often misunderstood digestive condition that affects millions of people worldwide. Characterized by open sores that form in the lining of the stomach, upper small intestine, or esophagus, these ulcers can lead to a range of uncomfortable symptoms from mild indigestion and burning pain to severe complications like internal bleeding or even perforation of the stomach wall.

What is Peptic Ulcers?

Peptic ulcers are primarily classified into three types :-

1. Gastric ulcers, which occur in the stomach.

2. Duodenal ulcers, located in the upper part of the small intestine.

3. Esophageal ulcers, found in the esophagus.

The most common causes of peptic ulcers include Helicobacter pylori (H. pylori) infection, long-term use of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or aspirin, excessive alcohol consumption, smoking, and chronic stress.

Symptoms often include a burning stomach pain, bloating, nausea, and sometimes vomiting or weight loss. However, some ulcers remain “silent” and go undetected until complications arise.

Diagnosis of Peptic Ulcers

If a peptic ulcer is suspected, doctors typically recommend a combination of the following diagnostic tests :-

1. Upper endoscopy (EGD) :- A thin, flexible tube with a camera is inserted through the throat to examine the stomach and upper small intestine.

2. Urea breath test, stool antigen test, or blood test :- These are used to detect H. pylori infection.

3. Barium swallow X-ray :- Used occasionally to highlight ulcers on an X-ray image.

Accurate diagnosis is crucial to determine the appropriate course of treatment and prevent complications.

Medical Treatment of Peptic Ulcers

1. Antibiotics to Eliminate H. pylori

   When H. pylori infection is the root cause, the primary treatment is a combination of antibiotics. This is known as triple therapy and typically includes :-

   • Amoxicillin
   • Clarithromycin
   • A proton pump inhibitor (PPI)

   This regimen is usually followed for 10 to 14 days. In some cases, a quadruple therapy is prescribed, adding a bismuth-containing medication for better results.

   Eradicating H. pylori not only heals the existing ulcer but also prevents recurrence.

2. Acid-Reducing Medications

   Lowering stomach acid helps ulcers heal faster and reduces pain. There are several categories of medications used :-

   Proton Pump Inhibitors (PPIs)

   PPIs are the most effective drugs for reducing stomach acid. Common PPIs include :-

   1. Omeprazole
   2. Esomeprazole
   3. Pantoprazole
   4. Lansoprazole

   These medications are typically prescribed for 4 to 8 weeks depending on ulcer size and severity.

   H2-Receptor Antagonists

   These are another class of acid-reducing drugs, including :-

   1. Ranitidine (withdrawn in some countries)
   2. Famotidine
   3. Nizatidine

   Though not as potent as PPIs, H2 blockers can be effective for mild ulcers or as maintenance therapy.

3. Antacids and Protective Agents

   Over the counter antacids can provide quick relief from ulcer pain by neutralizing stomach acid. However, they don’t promote healing.

   Sucralfate and misoprostol are protective agents that form a coating over the ulcer or enhance mucus production, respectively. These are especially useful in patients who must continue NSAID use despite ulcer risk.

Lifestyle Modifications for Better Healing

Medical therapy is crucial, but long-term ulcer management requires positive lifestyle changes. Key modifications include :-

1. Avoiding NSAIDs and aspirin unless prescribed with a PPI.

2. Limiting alcohol and caffeine, which can irritate the stomach lining.

3. Quitting smoking, as it delays healing and increases recurrence risk.

4. Reducing stress through yoga, meditation, or counseling.

5. Eating smaller, more frequent meals to ease digestion and reduce acid buildup.

These adjustments not only help heal the ulcer but also improve overall digestive health.

When Surgery Is Needed?

Surgery for peptic ulcers is rare today, thanks to effective medications. However, in severe cases where complications arise, such as :-

1. Perforation (a hole in the stomach or duodenum)

2. Uncontrollable bleeding

3. Obstruction due to swelling or scar tissue

…surgical intervention may become necessary.

Surgical options include vagotomy (cutting the vagus nerve to reduce acid), antrectomy (removal of part of the stomach), or pyloroplasty (widening the duodenum). These are typically reserved for life-threatening or non-healing ulcers.

Can Peptic Ulcers Be Prevented?

Yes, many peptic ulcers can be prevented with the right measures. If you’re prone to ulcers or have a history of H. pylori, your doctor may recommend routine screenings and long-term use of PPIs if you need NSAIDs for arthritis or heart disease.

Eating a balanced diet rich in fruits, vegetables, and whole grains supports gut health. Probiotic-rich foods like yogurt or supplements may also help in preventing recurrence after H. pylori treatment.

Natural Remedies: Are They Safe?

Some people turn to natural remedies like honey, licorice root (DGL), probiotics, and cabbage juice to ease ulcer symptoms. While there is some evidence supporting their role in symptom relief, these should never replace prescribed medical treatment.

Always consult your healthcare provider before trying herbal or natural supplements, as they may interfere with medications or worsen the condition.

Conclusion

Peptic ulcers are not only treatable but also preventable with early intervention and the right approach. Modern treatment focuses on eliminating the root cause often H. pylori infection while reducing stomach acid and protecting the stomach lining. Combined with healthy lifestyle choices, patients can expect full recovery and a significantly reduced risk of recurrence.