Sunday, August 20, 2006

Peptic Ulcer - Prevention and Treatment

Prevention: Because no one knows exactly how people become infected with H. pylori or why it causes ulcers, there is no way to prevent most cases of peptic ulcers. The only precaution is to wash your hands thoroughly before eating and after using the bathroom. You may help to prevent peptic ulcers not related to H. pylori by eliminating or limiting the use of NSAIDs and tobacco.

Treatment: For ulcers caused by H. pylori, treatment requires a combination of medications. The goals are to kill H. pylori bacteria in the body, reduce the amount of acid in the stomach, and protect the lining of the stomach and intestines. Most patients are treated with "triple therapy," which requires taking two antibiotics and one acid-suppressing medication for one to two weeks. A variety of antibiotics and acid-suppressing medications may be used.

Typically, the acid-suppressing medication will be either an H2 blocker, such as ranitidine (Zantac) or cimetidine (Tagamet) or a proton pump inhibitor, such as omeprazole (Prilosec) or lansoprazole (Prevacid). Your doctor will prescribe a specific regimen based on convenience, cost and any allergies you have.

Triple therapy requires taking as many as 8 to 12 pills every day, and it can cause side effects such as nausea, vomiting, diarrhea, headache and yeast infection in women. However, the treatment is 80% to 90% effective. Ulcers caused by H. pylori won't heal completely or may heal and then return if the bacteria are not killed.

Typically, you will take antibiotics and other medication for two weeks, then may take acid-suppressing medication for another four to eight weeks. Gastric ulcers tend to heal more slowly than duodenal ulcers. Uncomplicated gastric ulcers take up to two or three months to heal completely, while duodenal ulcers take about six weeks.

The H. pylori infection can return and cause another ulcer, particularly if the first infection is not eliminated completely. If your symptoms don't go away completely, your doctor may suggest re-testing for H. pylori after your treatment is completed. People whose ulcers are caused by NSAIDs or other drugs should stop using these drugs.

Healing will begin almost immediately. Doctors also may recommend medications to reduce acid damage during healing. These may include antacids to neutralize gastric acids or medications that decrease the amount of acid produced by the stomach, such as an H2 blocker or proton pump inhibitor. Ulcers caused by a medication should begin healing as soon as you stop taking the drug. Antacids or medications that limit the amount of acid your stomach produces may be used for two to six weeks to help healing and relieve pain.

Emergency treatment may be needed if an ulcer causes serious bleeding. Usually, this treatment is done through an endoscope using special clips or probes. Acid-blocking medications may be given intravenously (injected into a vein), and blood transfusions may be necessary if the bleeding is severe.

In extremely rare circumstances, surgery may be needed to treat a perforated or bleeding peptic ulcer. The surgery, which usually requires an abdominal incision, involves sewing normal tissue over the ulcer to seal it. However, it is rarely done now because treatments for H. pylori infections are so successful.

From Health A-Z, Harvard Health Publications. Copyright 2006

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