Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.

The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.

Pharmacological management

The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication regime, antibiotics, PPIs, and sometimes bismuth salts to suppress or eradicate H. pylori.

For patients on aspirin and nonselective NSAIDs, a pause of 4 to 6 weeks is recommended. When aspirin continuation is essential, co-administration with a proton pump inhibitor (PPI), H2 receptor blocker, or misoprostol may be advised.

Antibiotic therapy: The recommended combination drug therapy for peptic ulcers is commonly administered over 10 to 14 days. It may involve triple therapy, incorporating two antibiotics (metronidazole or amoxicillin and clarithromycin) and a proton pump inhibitor (For example, omeprazole or rabeprazole). Alternatively, quadruple therapy may be prescribed, including two antibiotics (metronidazole and tetracycline), a proton pump inhibitor, and bismuth salts. This strategic combination effectively aims to combat Helicobacter pylori and promote healing within a specified treatment period.

Cytoprotective drug therapy: Sucralfate is a cytoprotective drug therapy for short-term ulcer treatment. It offers mucosal protection to the esophagus, stomach, and duodenum. Unlike antacids, sucralfate does not neutralize acid. To maximize its effectiveness at a low pH, administer sucralfate at least 60 minutes before or after taking an antacid.

Adjunct drugs: H2 receptor blockers and antacids may be adjunct therapy to promote ulcer healing. Antacids increase gastric pH by neutralizing hydrochloric acid. As a result, they reduce the acid content of chyme reaching the duodenum. Some antacids (aluminum hydroxide) can bind to bile salts, decreasing the damaging effects of bile on the gastric mucosa.

Synthetic prostaglandin analog: Misoprostol is a synthetic prostaglandin analog prescribed to prevent gastric ulcers caused by NSAIDs and LDA. People who need chronic NSAID therapy, such as those with osteoarthritis, may benefit from its use.

In cases of Zollinger-Ellison Syndrome (ZES), characterized by gastrin hypersecretion, proton pump inhibitors effectively control gastric acid release, while octreotide, a medication suppressing gastrin levels, may be prescribed.

Lifestyle management

Smoking cessation is crucial, as it reduces pancreatic bicarbonate secretion into the duodenum, contributing to increased acidity and delayed ulcer healing.

Dietary modification advises against acid oversecretion and hypermotility, with specific caution about irritating foods and beverages, such as pepper, carbonated drinks, broth, spicy foods, and caffeine-containing items. Patients are educated to avoid stress and abstain from alcohol.

This comprehensive approach ensures a thorough and effective management strategy for peptic ulcers, addressing symptomatic relief and underlying causes.