Peptic Ulcer Disease Treatment

Peptic ulcer disease treatment focuses on reducing acid production that leads to peptic sores and lesions, healing damage to the lining of the stomach or duodenum (the first part of the small intestine), and tempering symptoms like pain, gas, and others.

This requires both medical and lifestyle approaches. For example, antibiotics are used to treat cases caused by the bacterium Helicobacter pylori (H. pylori). Antacids are used to neutralize acid and proton pump inhibitors (PPIs) can be used to suppress it.

Some cases are cured, while others may recur after treatment.

This article details each of these and other peptic ulcer treatment options, as well as when cases are too serious to benefit from them, instead requiring surgery.

Over-the-Counter (OTC) Therapies

For many people, the first line of peptic ulcer treatment is OTC medication to relieve symptoms. Two common non-prescription medications are:

• Antacids: Tums, Alka-Seltzer, Milk of Magnesia, Maalox, Mylanta, and Rolaids are over-the-counter antacids that offer temporary relief from ulcer pain by neutralizing stomach acid. They may also have a mucosal protective role.
• Bismuth subsalicylate: Sold under the brand name Pepto-Bismal, bismuth subsalicylate has both a protective effect and an antibacterial effect against H. pylori. Used to treat digestive disorders since the early 1900s, Pepto-Bismal comes as a liquid, tablet, or chewable tablets.

Prescription Medications

There are a few different types of medications your healthcare provider might prescribe.

Antibiotics

If H. pylori is found in your digestive tract (your healthcare provider can test for it), you may be prescribed a short-term course of antibiotics, usually a two-week treatment. Antibiotics are used to kill the bacterium and may vary depending on the current antibiotic resistance rate in your area.

Common antibiotics used to treat peptic ulcers include:

• Amoxil (amoxicillin)
• Biaxin (clarithromycin)
• Flagyl (metronidazole)
• Tindamax (tinidazole) 
• Achromycin V (tetracycline) 
• Levaquin (levofloxacin)

Side effects of antibiotics are typically mild and may include vomiting, nausea, diarrhea, bloating, indigestion, and loss of appetite.

Most ulcers caused by H. pylori are cured with treatment and do not recur. However, for some patients, their ulcers return, and they must continue maintenance therapy for years.

H2-Blockers

Most healthcare providers treat ulcers (stomach or duodenal) with these acid-suppressing drugs.

Examples include:

• Tagamet (cimetidine)
• Zantac 360 (famotidine)
• Pepcid (famotidine)

They reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion. They reduce pain significantly after several weeks.

For the first few days of treatment, healthcare providers often recommend also taking an antacid to relieve pain. The treatment initially lasts six to eight weeks.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors change the stomach's production of acid by stopping the stomach's acid pump—the final element involved in acid secretion.

Prilosec (omeprazole) has been used for short-term treatment of ulcer disease. Similar drugs may also be used, including Konvomep (omeprazole and sodium bicarbonate) and Prevacid (lansoprazole).

Mucosal Protective Medications

Mucosal protective medications protect the stomach's mucus lining from acid, but these protective medications do not inhibit the release of stomach acid. Instead, they shield the stomach's mucus lining from the damage of the acid.

Two commonly prescribed protective agents are:

• Carafate (sucralfate): This medication adheres to the ulcer, producing a protective barrier that allows it to heal and inhibits further damage from stomach acid. Sucralfate is approved for short-term treatment of duodenal ulcers and for maintenance treatment.
• Cytotec (misoprostol): This synthetic prostaglandin, a substance naturally produced by the body, protects the stomach lining by increasing mucus and bicarbonate production and by enhancing blood flow to the stomach. It is approved only for the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers.

Anticholinergics

Anticholinergics such as Gastrozepin (pirenzepine) and Dartisla ODT (glycopyrrolate) may be used as an adjunct treatment for peptic ulcers to prevent spasms in the muscles of the gut and bladder while reducing the excess production of stomach acid.

Combination Medications

In May 2022, the FDA approved two treatments for H. pylori infection in adults:

• Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin)
• Voquezna Dual Pak (vonoprazan, amoxicillin)

Vonoprazan is a potassium-competitive acid blocker (P-CAB), and amoxicillin and clarithromycin are antibiotics used to kill the bacterium.

Lifestyle Modifications

While medication is likely necessary to heal peptic ulcers, there are a few things you can do at home to help relieve symptoms and help to speed healing.

Reduce Stress

Research shows people who are under stress are more likely to develop peptic ulcers. In fact, a 2016 study published in the journal BMC Gastroenterology tracked 17,525 residents of a community in Denmark and found that people with the highest level of perceived everyday life stress were at greater risk for peptic ulcers.

Learning to manage your stress in healthier ways can help to reduce uncomfortable peptic ulcer symptoms and help your body heal. Mind-body exercises, such as deep breathing, meditation, yoga, tai chi, or massage are tools that can help to reduce your stress.

Some people also find that working one-on-one with a therapist can help them to learn better coping mechanisms to alleviate anxieties, worries, and negative thinking, helping ulcers to heal.

Quit Smoking

Smoking has been shown to delay ulcer healing and has been linked to ulcer recurrence. Therefore, if you smoke, you should try to quit.

Avoid Alcohol

Drinking alcohol can inhibit ulcer healing and exacerbate symptoms. That's because alcohol increases the production of stomach acid, which will irritate an ulcer. Alcohol also relaxes the lower esophageal sphincter (LES), allowing stomach contents to reflux back up into the esophagus.

Changing Your Diet

In the past, healthcare providers advised people with peptic ulcers to avoid spicy, fatty, and acidic foods. However, since the discovery that H. pylori is the underlying cause of ulcers and the advent of effective medications to treat infection, a bland diet is no longer recommended. (It won't cause harm, but it likely won't help either.)

Some people who have peptic ulcers can eat whatever they want with no problems. For many others, however, eating certain foods can cause irritation, excessive acid production, and heartburn. Some common foods that exacerbate ulcer symptoms are coffee, milk, alcoholic beverages, and fried foods.

In general, a diet rich in vitamins and minerals is best. Adding yogurt, kefir, and other fermented foods that contain live bacteria organisms can help make the gut environment conducive to healing your ulcer by fighting H. pylori.

Eating foods rich in flavonoids or polyphenols may also have protective effects. These foods include olive oil, grapes, dark cherries, and a wide range of berries. Some research suggests that banana is good for ulcer healing, too.

Surgeries

Many times, peptic ulcers can be successfully treated with medication. In some cases, however, ulcers can be severe and cause internal bleeding requiring surgery.

Surgical procedures for ulcers include:

• Vagotomy: The vagus nerve sends messages from the brain to the stomach. A vagotomy cuts part of the nerve that controls acid-secretion, reducing stomach acid.
• Antrectomy: The antrum is the lower part of the stomach that produces a hormone that stimulates the stomach to secrete digestive juices. An antrectomy removes the antrum. This is typically done along with a vagotomy.
• Pyloroplasty: The pylorus is the opening to the duodenum and small intestine. This surgery enlarges that opening enabling stomach contents to pass more freely out of the stomach. This may be done along with a vagotomy.

Complementary Alternative Medicine (CAM)

There is limited evidence to support the use of home remedies, supplements, herbs, homeopathy, and other complementary medicine methods to treat peptic ulcers and relieve symptoms.

The following supplements may be effective, but speak with your healthcare provider before incorporating them into your treatment plan.

Probiotics

Probiotics, Lactobacillus acidophilus in particular, have been shown to help suppress H. pylori infection. A 2016 review reported that probiotics can reduce H. pylori by up to 64% and fully eradicate the bacteria in almost a third of cases. The only reported side effect was diarrhea.

While encouraging, the ideal strains, dosage, and treatment duration have not been determined and more research is needed. 

Cranberry Extract

Supplementing with cranberry extract may also help to resolve peptic ulcers and eliminate H. pylori infections, due to polyphenols found in the fruit. However, studies are needed to confirm cranberry can help treat peptic ulcers disease.

Cranberry supplements contain salicylic acid and should not be used by people who are allergic to aspirin. In addition, cranberry is high in oxalates, which may increase the risk of kidney stones or other kidney disorders and should not be used by people with kidney disease.

Cranberry may interfere with certain medications, including Coumadin (warfarin). If you are taking any medications, talk to your healthcare provider or pharmacist before taking cranberry.

A Word From Verywell

Living with a peptic ulcer can be uncomfortable, but there are things you can do to relieve symptoms and heal. If you think you may have an ulcer, speak to your healthcare provider. With the right treatment plan, reduced stress, and lifestyle modifications, you should be on your way to healing soon.