What is the treatment for peptic ulcers? Medicines for stomach ulcers and surgery.

The choice of treatment depends on whether the ulcer is caused by H. pylori infection or not. A correct diagnosis is the key to whether treatment is successful or not. If bacteria are the cause, treatment focuses on the infection.

Regardless of whether bacteria are the cause, another important focus of treatment is to reduce the acid in the stomach.

For ulcers, we have the following recommendations:

• lifestyle changes: stop smoking, avoid alcohol, aspirin and NSAIDs.
• taking acid-blocking drugs (histamine receptor blockers - famotidine, ranitidine, cimetidine, proton pump inhibitors - omeprazole, pantoprazole, esomeprazole, lansoprazole).
• "triple therapy" or "dual therapy" regimens for ulcers caused by H pylori.

• Triple therapy: the combination of bismuth and the antibiotics tetracycline and metronidazole is effective in 80%-95% of people and represents the current standard of care. All are taken in tablet form. 
• Dual therapy: this therapy was developed in response to the complexity and side effects of triple therapy. It includes 2 antibiotics - amoxicillin and metronidazole (or clarithromycin), taken as tablets 3 times a day; and a proton pump inhibitor (omeprazole, pantorazole, esomeprazole,...). This simplified schedule is preferred by many people, which is why it is most commonly indicated.
• Treatment with dual and triple therapy usually lasts two weeks.
• Once H pylori bacteria are eradicated from a person's digestive tract, they usually do not return. The ulcers usually heal completely and do not come back.

Treatment of bleeding ulcers depends on the severity of blood loss and includes:

• fluids and drugs that reduce the acidity of the stomach into the vein.
• Intestinal rest: bed rest and clear liquids without food for several days. This gives the ulcer a chance to start healing without irritation.
• nasogastric probe: insertion of a thin, flexible tube through the nose and down into the stomach. This also relieves pressure on the stomach and helps it to heal.
• urgent endoscopy or surgery if indicated: damaged, bleeding blood vessels can usually be stopped during an endoscopic examination.

Surgical treatment of peptic ulcer

With the success of medical therapy, surgery has a very limited role in the treatment of peptic ulcer disease. In general, 5% of bleeding ulcers eventually require surgical management. Urgent surgery is required for these conditions:

• inability to achieve endoscopic cessation of bleeding.
• recurrent bleeding despite endoscopic attempts to achieve cessation of bleeding (most often after two unsuccessful attempts).
• perforation of the ulcer.

The appropriate surgical procedure depends on the location and nature of the ulcer.