Medicines

Long-term healing of most peptic ulcers can be achieved rapidly by eradicating H. pylori. It is recommended that the presence of H. pylori is confirmed before starting eradication treatment.

Drug		Action		Effect
Antibiotics		Kills H pylori
Proton pump inhibitors Histamine2-receptor antagonists		Reduce the amount of acid produced by the stomach		Protects ulcers from stomach acid and allows tissue to heal
Antacids		Neutralise stomach acid
Prostaglandin analogues		Reduce the amount of acid produced by the stomach, protects the stomach lining
Stomach liner protectors		Protect the stomach lining

Modern-day treatment of H. pylori peptic ulcers will normally include a combination of medicines designed to clear the body of H. pylori, reduce stomach acid, and protect the stomach lining.

Regimes to treat Helicobacter pylori

The medicines used may vary, but generally include: 

• Two antibiotics to kill H. pylori, eg amoxicillin, clarithromycin or metronidazole. 
  
  
• An acid-suppressing medication (normally a proton pump inhibitor) or a stomach-liner protector.

The medicines are normally taken for 1–2 weeks and prevent the ulcer coming back in 90% (9 out of every 10) of patients.


Regimes to treat peptic ulcers associated with the use of NSAIDs or aspirin

• If possible, treatment with NSAIDs or aspirin may be stopped or a different painkiller used (eg paracetamol), to remove the source of irritation and enable the ulcer to heal. 
  
  
• Acid-suppressing medication (a proton pump inhibitor or a histamine2-receptor antagonist) can be used to reduce stomach acid and lessen the acid-related damage caused by the NSAID or aspirin. 
  
  
• A prostaglandin analogue can be prescribed to improve protection of the lining of the stomach and intestine.

Acid-suppressing medication and prostaglandin analogues can heal peptic ulcers even when given along with the NSAID or aspirin – although proton pump inhibitors are more effective than histamine2-receptor antagonists.
If you need to continue to take an NSAID and your doctor thinks you are at risk of developing a peptic ulcer, you may be prescribed an acid-suppressing drug or prostaglandin analogue to protect your stomach.


Proton pump inhibitors
Proton pump inhibitors are a group of medicines that includes esomeprazole, omeprazole, lansoprazole, pantoprazole, and rabeprazole.

• Proton pump inhibitors are the most effective medicines currently available for the treatment of ulcers.
  
  
• They block the action of the stomach’s proton pump, which pumps hydrogen ions into the stomach, making the stomach acidic. They will, therefore, reduce the acidity of the stomach.
  
  
• Proton pump inhibitors are used in combination with antibiotics to treat H. pylori-related ulcers.
  
  
• Proton pump inhibitors are available from your doctor on prescription, and in some countries, can be bought over the counter. 

Histamine2-receptor antagonists
Histamine2-receptor antagonists are a group of medicines that includes cimetidine, ranitidine and nizatidine.

• These medicines work by stopping (blocking) the action of histamine (a chemical released by the stomach).
  
  
• The presence of histamine in the stomach results in the release of hydrogen ions into the stomach, making the stomach contents more acidic.
  
  
• Histamine2-receptor antagonists heal peptic ulcers by reducing gastric acid output.

Stomach-liner protectors
Stomach-liner protectors are a group of medicines that includes bismuth salts and sucralfate.

• Bismuth salts and sucralfate help protect the stomach lining from acid.
  
  
• Bismuth salts also eradicate H. pylori. 

Prostaglandin analogues
Prostaglandin analogues are a group of medicines that includes misoprostol.

• Misoprostol has similar action to prostaglandin, a substance which occurs naturally in the body.
  
  
• It prevents the release of stomach acid and protects the intestinal wall, promoting peptic ulcer healing.
  
  
• Misoprostol increases the risk of abortion, and should, therefore, not be used in women of child-bearing age unless effective contraceptive measures are being taken. 

Antacids
Use of an antacid will normally bring pain relief to people with only occasional symptoms. These medicines can be bought over the counter, at chemist shops. Antacids provide relief by neutralising the stomach acid. There is a wide range of antacids available. The main ingredients of antacids are:

• Aluminium hydroxide
  
  
• Magnesium salts
  
  
• Calcium carbonate
  
  
• Sodium bicarbonate
  
  
• Potassium bicarbonate
  
  
• Bismuth salts