Treatment of Peptic Ulcers

The symptoms of peptic ulcers may be relieved by reducing the amount of acid in the stomach. This may be done in one of two ways: by neutralising the acid that is already there by the use of antacids (alkalis or similar chemicals) or by inhibiting the secretion of acid in the first place. Two major groups of medicines are available to do this. The first of these is known as Proton Pump Inhibitors (PPIs), and includes drugs such as lansoprazole (e.g. Zoton), pantoprazole (Protium), esomeprazole (Nexium) and omeprazole (e.g. Zanprol). These fast-acting drugs are an extremely effective and powerful way to reduce the production of stomach acid. An older form of acid reducing medicine is known as an H2-antagonist, and includes such drugs as cimetidine (e.g. Tagamet) and ranitidine (eg Zantac). It is now more common to treat peptic ulcers with PPIs than H2-antagonists.

Sufferers are also advised to take small, light meals, avoiding foods that may irritate the stomach or duodenal lining such as spicy food, caffeine, fatty foods and alcohol. If possible, non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided, using paracetamol instead. If this is not possible, the doctor should be able to prescribe a suitable alternative pain-relief medication.

If the patient tests positive for H. pylori, then they will probably be prescribed a course of drugs to eradicate the bacteria. The treatment (often known as 'triple therapy') usually consists of 3 drugs taken daily for one week: two high dose antibiotics and a Proton Pump Inhibitor (PPI) to reduce the amount of acid produced by the stomach. In the majority of cases, getting rid of the H. pylori infection allows the ulcer to heal and prevents it from recurring.

Surgery

If the ulcer shows no sign of healing after treatment, or if there is serious or persistent bleeding (perforation), then surgical treatment may be necessary. Procedures may include:

• Pyloroplasty: the opening to the duodenum and small intestine is made larger, which enables the stomach contents to move on more easily.
• Vagotomy: the nerve that links the stomach to the brain (the vagus nerve) is cut, which reduces the stimulation of acid production.
• Antrectomy: the lower part of the stomach (the antrum ) is removed. This portion of the stomach is responsible for producing gastrin, which stimulates the production of stomach acid. Its removal therefore lowers the level of acid secretions in the stomach.

Side effects from surgery may include vomiting, diarrhoea, a feeling of fullness and faintness after taking food. These usually pass fairly quickly. Some patients may develop anaemia, caused by poor absorption of vitamin B12. However, this may be treated by regular vitamin injections.