The goal is to remove the source of the problem and heal the ulcer. Gastric ulcers may take longer to heal.
Some medications block or reduce acid production. Some coat the ulcer to protect it. If H pylori caused the ulcer, you will need to take a combination of drugs to kill the bacteria. This usually consists of antibiotics and a proton-pump inhibitor. It is very important to take these drugs as directed. The doctor may order tests 6-12 months after treatment. This is done to check that the bacteria are gone.
Medications may include:
- Antacids—may provide some relief from heartburn ; do not heal ulcers
- Antibiotics (eg, amoxicillin , tetracycline , and clarithromycin )
- Bismuth-containing drug (Pepto-Bismol)
- Proton pump inhibitors—to decrease stomach acid production (eg, omeprazole , lansoprazole )
- H 2 blockers—to decrease stomach acid production (eg, famotidine , ranitidine , cimetidine , nizatidine )
- Medications to coat ulcer (eg, sucralfate )
- Medications to protect stomach against NSAID damage (eg, misoprostol )
- If you smoke, quit . Smoking interferes with ulcer healing.
- Do not drink alcoholic beverages.
- Avoid NSAIDS. This includes over-the-counter drugs like aspirin and ibuprofen .
- Spicy or fatty foods may worsen symptoms. You can temporarily stop eating them. Keep in mind they did not cause the ulcer. They probably do not affect ulcer healing.
- If stress increases ulcer pain, learn and practice stress-management techniques .
Surgery and Endoscopy
You may need surgery if you have bleeding, a perforation, or an obstruction. Surgical options include:
- Highly elective vagotomy—This is a technique that cuts only part of the vagus nerve. This surgery does not require extra drainage.
- Vagotomy with antrectomy—This involves cutting the vagus nerve combined with removing the lower part of the stomach (antrum). The antrum makes a chemical that promotes acid production. Without that chemical, acid production drops.
This may be done to stop bleeding. A thin, lighted tube is inserted down the throat into the stomach or intestine. Then, heat, electricity, epinephrine, or a substance called “fibrin glue” can be applied to the area. This should stop the blood flow.
Vagotomy and Drainage
Vagotomy is the cutting of parts of the vagus nerve. This procedure can greatly reduce acid production. Cutting the entire nerve can also create problems with stomach. In this case, drainage must be created. Drainage may be done with one of the following:
- Pyloroplasty —widening the opening between the stomach and the duodenum, allowing stomach contents to flow more easily into the intestine
- Gastroduodenostomy—creating a new opening to connect the stomach and the duodenum
- Gastrojejunostomy—creating a new opening to connect the stomach and the jejunum (the second part of the small intestine)
Two other forms of vagotomy include:
- Highly elective vagotomy—cuts only part of the vagus nerve; does not require extra drainage
- Vagotomy with antrectomy—the vagus nerve is cut and the lower part of the stomach (antrum) is removed; the antrum makes a chemical that promotes acid production