Treatment of Peptic Ulcer
Peptic ulcers are open sores that develop on the inner lining of the stomach or the upper part of the small intestine. H. pylori infection and long-term NSAID use are the most common causes. They cause burning stomach pain, especially when the stomach is empty.
Managing Peptic Ulcer effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Peptic Ulcer can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓PPI as cornerstone for acid-related disorders (GERD, peptic ulcer, H. pylori eradication regimens)
- ✓H. pylori eradication: PPI + clarithromycin + amoxicillin (7–14 days); bismuth quadruple if resistance suspected
- ✓IBD: 5-ASA for mild UC; corticosteroids for induction; biologics (anti-TNF, anti-integrin) for moderate-severe
- ✓Hepatitis B/C: antiviral therapy (tenofovir/entecavir for HBV; DAAs for HCV with >95% SVR rate)
- ✓Cirrhosis: treat underlying cause + complications (ascites, varices, HE) systematically
What to Do Now
- Learn your personal risk factors for Peptic Ulcer (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Peptic Ulcer
- Use our AI symptom checker to assess whether your symptoms fit an early Peptic Ulcer pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Peptic Ulcer-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Medications Used in Peptic Ulcer
Omeprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
Lansoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
Esomeprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
Rabeprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
Famotidine is an H2 receptor antagonist that reduces stomach acid by blocking histamine receptors on parietal cells.
Ranitidine is an H2 receptor antagonist that reduces stomach acid by blocking histamine receptors on parietal cells.
Cimetidine is an H2 receptor antagonist that reduces stomach acid by blocking histamine receptors on parietal cells.
Non-Pharmacological Management
- •Dietary modification: low-FODMAP for IBS; gluten-free diet for coeliac disease; low-fat for pancreatitis
- •Alcohol cessation: critical in alcoholic liver disease, pancreatitis, GERD
- •Weight loss: reduces GERD symptoms and improves NAFLD (5–10% weight loss reduces hepatic steatosis)
- •Elevate bed head; avoid late meals; avoid trigger foods in GERD
- •Regular meals; avoid NSAIDs and aspirin (gastric mucosal damage); no smoking
- •Endoscopic surveillance: Barrett's oesophagus, IBD colon cancer screening, cirrhosis for HCC
- •Vaccination: hepatitis A and B for unvaccinated at-risk patients
Treatment Goals
Monitoring Parameters
- ◆LFTs, bilirubin, albumin, INR: liver function — monthly in acute liver disease, every 3–6 months in chronic
- ◆FBC: anaemia (GI bleeding, malabsorption), leucopenia (azathioprine toxicity)
- ◆Faecal calprotectin: non-invasive IBD disease activity monitoring
- ◆Colonoscopy: IBD dysplasia surveillance every 1–5 years depending on duration and extent
- ◆H. pylori test of cure: UBT or stool antigen 4 weeks after eradication therapy
- ◆Hepatic elastography (FibroScan): assess fibrosis progression in chronic liver disease
- ◆Alpha-fetoprotein + ultrasound: HCC surveillance in cirrhosis every 6 months
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Peptic Ulcer — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Peptic Ulcer combined with new relevant symptoms
- ⚠Sudden worsening of Peptic Ulcer symptoms despite established treatment
Escalation Criteria
- →Acute GI bleeding: upper GI endoscopy within 24h; resuscitation, IV PPI, haemostatic therapy
- →Acute severe UC (Truelove-Witts criteria) → hospitalisation, IV steroids; escalate to biologics/surgery if no response at 72h
- →Hepatic encephalopathy: lactulose, rifaximin; identify precipitant; assess for transplant listing
- →Acute-on-chronic liver failure: specialist gastroenterology/transplant centre referral
Special Populations
Clinical Insights
Compare With Similar Conditions
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