Peptic Ulcer (cont.)
What treatments are available for peptic ulcers?
The goal of ulcer treatment is to relieve pain and to prevent
ulcer
complications, such as bleeding, obstruction, and perforation.
The first
step in treatment involves the reduction of risk factors
(NSAIDs and
cigarettes). The next step is medications.
Antacids neutralize existing acid in the stomach. Antacids
such as Maalox, Mylanta, and Amphojel are safe and effective
treatments. However,
the neutralizing action of these agents is short-lived, and
frequent
dosages are required. Magnesium containing antacids, such as Maalox and Mylanta, can cause diarrhea, while aluminum agents like
Amphojel can cause
constipation. Ulcers frequently return when antacids are
discontinued.
Studies have shown that a protein in the stomach called
histamine
stimulates gastric acid secretion. Histamine antagonists (H2
blockers) are
drugs designed to block the action of histamine on gastric
cells, hence
reducing acid output. Examples of H2 blockers are cimetidine (Tagamet),
ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid). While H2
blockers are effective in ulcer healing, they have limited role
in
eradicating H. pylori without antibiotics. Therefore, ulcers
frequently
return when H2 blockers are stopped. Generally, these drugs are
well
tolerated and have few side effects even with long term use. In
rare
instances, patients report headache, confusion, lethargy, or
hallucinations. Chronic use of cimetidine may rarely cause
impotence or breast swelling. Both cimetidine and ranitidine can interfere
with body's
ability to handle alcohol. Patients on these drugs who drink
alcohol may
have elevated blood alcohol levels. These drugs may also
interfere with
the liver's handling of other medications like Dilantin, Coumadin, and
theophylline. Frequent monitoring and adjustments of the
dosages of these
medications may be needed.
Proton-pump inhibitors such asomeprazole (Prilosec),
lansoprazole
(Prevacid), pantoprazole
(Protonix), esomeprazole
(Nexium), and rabeprazole
(Aciphex) are more potent than H2 blockers in suppressing acid
secretion. Different proton-pump
inhibitors are very similar in action and there is no evidence that one is more
effective than another in healing ulcers.
While proton-pump inhibitors are comparable to H2 blockers in
effectiveness
in treating gastric and duodenal ulcers, it is superior
to
H2 blockers in treating esophageal ulcers. Esophageal ulcers are
more
sensitive than gastric and duodenal ulcers to minute amounts
of
acid. Therefore, more complete acid suppression accomplished by proton-pump
inhibitors are
important for esophageal ulcer healing. Proton-pump inhibitors are well tolerated. Side effedcts are
uncommon; they include headache, diarrhea, constipation, nausea and rash. Interestingly, proton-pump
inhibitors do not
have any effect on a person's ability to digest and absorb nutrients. Proton-pump
inhibitors have
also been found to be safe when used long term, without serious
adverse health effects reported.
Sucralfate (Carafate) and misoprostol (Cytotec)
are agents that strengthen the gut lining against attacks by acid digestive
juices. Carafate coats the ulcer surface and promotes healing. The medication
has very few side effects. The most common side effect is constipation and the
interference with the absorption of other medications. Cytotec is a
prostaglandin-like substance commonly used to counteract the ulcer effects of
NSAIDs. Studies suggest that Cytotec may protect the stomach from ulceration in
those who take NSAIDs on a chronic basis. Diarrhea is a common side effect.
Cytotec can cause miscarriages when given to pregnant women, and should be
avoided by women of childbearing age.
Many people harbor H. pylori
in their stomachs without ever having pain
or ulcers.
It is not completely clear whether these patients should be
treated with
antibiotics. More studies are needed to answer this question.
Patients with
documented ulcer disease and H. pylori infection should be
treated with
antibiotic combinations. H. pylori can be very difficult to
completely eradicate.
Treatment requires a combination of several antibiotics,
sometimes
in combination with a proton-pump inhibitor, H2
blockers or Pepto-Bismol. Commonly used antibiotics are tetracycline,
amoxicillin,
metronidazole (Flagyl), clarithromycin (Biaxin),
and levofloxacin (Levaquin).
Eradication of H.
pylori prevents the return of ulcers (a major problem with all
other ulcer
treatment options). Elimination of this bacteria may also
decrease the
risk of developing gastric cancer in the future. Treatment with
antibiotics carries the risk of allergic reactions, diarrhea,
and
sometimes severe antibiotic-induced colitis (inflammation of
the colon).
There is no conclusive evidence that dietary restrictions and
bland
diets play a role in ulcer healing. No proven relationship
exists between
peptic ulcer disease and the intake of coffee and alcohol.
However, since
coffee stimulates gastric acid secretion, and alcohol can cause
gastritis,
moderation in alcohol and coffee consumption is often
recommended.
Next: Summary »
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From the Doctors at MedicineNet.com  |
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- omeprazole, Prilosec, Zegerid - Describes the medication omeprazole (Prilosec, Zegerid ) a drug used for treating acid-induced inflammation and ulcers of the stomach and duodenum, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome. Article includes descriptions, uses, drug interactions, and side effects. Source:MedicineNet
- rabeprazole, Aciphex - Clarifies the medication rabeprazole (Aciphex), a drug used for treating ulcers of the stomach and duodenum, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome. Source:MedicineNet
- Upper Endoscopy (EGD) - Learn about the endoscopy procedure which examines the esophagus, stomach and duodenum to detect gastrointestinal and digestive disorders on MedicineNet.com Source:MedicineNet
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