Stomach ulcer - Treatment

If you have a stomach ulcer, your treatment will depend on whether the cause is an H. pylori infection, non-steroidal anti-inflammatory drugs (NSAIDs) or both.

If your stomach ulcer is caused by an H. pylori infection, a course of antibiotics is recommended. This is known as eradication therapy because it will kill the bacteria.

If your stomach ulcer is caused by NSAIDs and you don't have a H. pylori infection, a one-to two-month course of proton pump inhibitors (PPIs) are recommended. Your use of NSAIDs will also need to be reviewed and an alternative painkiller, such as paracetamol, may be recommended.
If it is thought that your stomach ulcer is caused by a combination of NSAID use and an H. pylori infection, you will be given a two-month course of PPIs and a course of eradication therapy.

An alternative type of medication, known as H2-receptor antagonists, are sometimes used instead of PPIs.

Eradication therapy

Eradication therapy involves taking a combination of two or three different antibiotics and a proton pump inhibitor (PPI), all at the same time. Taking one antibiotic alone is insufficient to kill the germ.You will usually be asked to take each antibiotic twice a day for 7-14 days. The antibiotics most commonly used in eradication therapy are:

• amoxicillin
• clarithromycin
• metronidazole

The side effects are usually mild and include:

• feeling sick
• diarrhoea
• a metallic taste in your mouth
• grey colouring of saliva or your stools

Try to persist with treatment if you only have mild side effects. Stop if you have severe watery diarrhoea or an obvious allergic reaction.

You will be re-tested at least four weeks after eradication therapy has been completed to see whether there are any H. pylori bacteria left in your stomach. If there is, you will be given a further course of eradication therapy using different antibiotics in combination with PPIs.

Proton pump inhibitors (PPIs)

Proton pump inhibitors (PPIs) work by blocking the actions of proteins called proton pumps, which are partially responsible for producing stomach acid. Reducing the amount of stomach acid prevents any further damage to your stomach ulcer, allowing it to heal naturally.

Lansoprazole and omeprazole are the two PPIs most commonly used to treat stomach ulcers. Side effects of these are usually mild but include:

• headache
• diarrhoea
• nausea
• abdominal pain
• constipation 
• dizziness
• skin rashes

These should pass once treatment has been completed.

H2-receptor antagonists

H2-receptor antagonists work by blocking the actions of a protein called histamine, which is also responsible for stimulating the production of acid.

Ranitidine is the most widely used H2-receptor antagonist for treating stomach ulcers.

Side effects are uncommon but may include:

• diarrhoea
• headaches
• dizziness
• skin rashes
• tiredness

Antacids and alginates

All of the treatments discussed above can take several hours before they start to work, so it is likely that your GP will recommend some additional medication to help provide short-term symptom relief..

Two types of medication that can be used are:

• antacids – to help neutralise stomach acid on a short-term basis
• alginates – which produce a protective coating on the lining of your stomach

Both antacids and alginates are available to buy over the counter at pharmacies. Your pharmacist will be able to advise you about the types of antacid and alginate most suitable for you.

Antacids are best taken when you experience symptoms or when you expect them, such as after meals or at bedtime. Alginates are best taken after meals.

Don't take these medications within an hour of taking proton pump inhibitors or ranitidine as they may block the effects.

Side effects for both medications are uncommon but include:

• diarrhoea
• vomiting
• wind (flatulence)

Bananas are also thought to provide a protective effect against stomach acid, so you may want to consider eating these as an alternative way to relieve your symptoms, if you don't want to take antacids or alginates.

Reviewing NSAID use

If your stomach ulcer has been caused by taking NSAIDs, your GP will want to review your use of them.

You will usually be advised to use an alternative painkiller that is not linked to stomach ulcers, such as paracetamol or a low-dose opiate-based painkiller.

If you are taking low-dose aspirin to reduce your risk of getting blood clots, your GP will help you decide whether you need to continue taking it. In most cases it is continued or only stopped for a few days.

In these cases a PPI is given as well as the aspirin to try to prevent further ulceration, and this is usually very effective. If you or your GP feel that the continued used of NSAIDs is absolutely necessary, you will be prescribed a long-term course of a PPI or H2-receptor antagonist.

It is important that you understand the potential drawbacks and risks associated with continued NSAID use. You are more likely to develop another stomach ulcer and the risks of experiencing serious complications, such as internal bleeding, are higher.