Ulcers (Digestive): Treatment

Most drugs that are currently given to treat ulcers work either by lowering the rate of stomach acid secretion or by protecting the mucous tissues that line the digestive tract.

ANTISECRETORY DRUGS. Medications that lower the rate of stomach acid secretions fall into two major categories:

proton pump inhibitors, which bind an enzyme that secretes stomach acid, and H₂ receptor antagonists, which work by reducing intracellular acid secretion. The proton pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid). The H₂ receptor antagonists include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). Both types of drugs have few serious side effects and appear to be safe for long-term use.

PROTECTIVE DRUGS. The drugs that are currently used to protect the stomach tissues are sucralfate (Carafate), which forms a pastelike substance that clings to the mucous tissues and prevents further damage from stomach acid; and bismuth preparations. A third type of protective drug includes misoprostol (Cytotec), which is often given to patients with ulcers caused by NSAIDs.

Surgical treatment of ulcers is generally used only for complications and suspected malignancies. The most common surgical procedures that are used are vagotomies, in which the connections of the vagus nerve to the stomach are cut in order to reduce acid secretion; and antrectomies, which involve the removal of a part of the stomach (the antrum).

Most doctors presently recommend treatment to eliminate H. pylori in order to prevent ulcer recurrences. Without such treatment, ulcers recur at the rate of 80% per year. The usual regimen used to eliminate the bacterium is a combination of tetracycline, bismuth subsalicy-late (Pepto-Bismol), and metronidazole (Metizol).

— Rebecca J. Frey