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Peptic Ulcer Disease Treatment

Peptic ulcers are often caused by an overproduction of gastric acid. Many treatment options focus on reducing or suppressing gastric acid production. If your doctor determines that you have an H. pylori infection, you will need treatment for that as well.

The goal of treatment for peptic ulcer disease is to:

  • Relieve symptoms

  • Heal lesions

  • Prevent recurrences

  • Prevent complications

Treatments for peptic ulcer disease include:

Sometimes, treatment leads to complications. Learn more about peptic ulcer disease complications.

Peptic Ulcer Disease Treatment: Medication

Several different medication therapies are available to help reduce gastric acid and coat the ulcers:

  • Antacids neutralize gastric acid. The disadvantage is that you need to take a relatively large dose for them to be effective, and they can cause unwanted side effects such as diarrhea.

  • Histamine (H2) blockers reduce gastric acid by blocking the H2 receptors. These medications decrease acid secretion and are a relatively safe treatment option.

  • Proton pump inhibitors, or PPIs, are drugs that block the three major pathways for acid production. PPIs suppress acid production much more effectively than H2 blockers. PPIs are the gold standard in medication therapy of peptic ulcer disease.

  • Medications to protect and strengthen the mucous lining of the stomach.

  • Antibiotics to treat H. pylori, if that is detected.

See animation: Mechanism of normal acid production, H2 blockers, and proton pump inhibiting drugs.

Peptic Ulcer Disease Treatment: Surgery

Due to the effectiveness of H2 blockers and PPIs, surgery for peptic ulcer disease is rarely needed. The most common reason for surgery for benign (noncancerous) gastric ulcers is if the ulcer fails to heal completely after a regimen of medication.

Duodenal ulcers can also require surgery. Usually, your surgeon performs one of three procedures:

  • Vagotomy . This surgery cuts parts of the vagus nerve (the nerve that sends messages from the brain to the stomach), leading to reduced acid secretion.

    Selective vagotomy
    Selective vagotomy (Click to Enlarge)

  • Antrectomy . During this procedure, your surgeon removes the lower part of your stomach, the antrum. The antrum produces the hormone that tells the stomach to secrete digestive juices. Vagotomy is sometimes performed at the same time.

    Antrectomy and truncal vagotomy for duodenal ulcer with Billroth I anastomosis
    Antrectomy and truncal vagotomy for duodenal ulcer with Billroth I anastomosis (Click to Enlarge)

  • Pyloroplasty . Your surgeon enlarges the opening into the duodenum and small intestine, which allows contents to pass more freely from the stomach.

    Surgical technique of pyloroplasty and truncal vagotomy
    Surgical technique of pyloroplasty and truncal vagotomy (Click to Enlarge)

Peptic Ulcer Disease Complications

The three major complications of peptic ulcer disease treatment are:

  • Hemorrhage (excessive bleeding)

  • Perforation/penetration, due to the ulcer burning through the stomach wall

  • Gastric outlet obstruction, or pyloric stenosis, occurs when the pylorus narrows. The pylorus is the opening from the stomach into the small intestine.

There are a number of options available to treat these complications, including endoscopic therapy.

See illustration: Endoscopic therapy procedure

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