Treatment of Peptic Ulcer

The treatment of peptic ulcers is different depending on whether the patient has Helicobacter pylori infection or not, and whether the bacteria has resistance to antibiotics.

First-line therapy

1. β-lactam antibiotic with bacteriolytic properties with a moderate-spectrum of action. It has to be combined with clavulanic acid, which makes it more powerful against bacteria that produce β-lactamase.
2. Nitroimidazole antibiotic – which is used to fight against protozoa and anaerobic bacteria.
3. Proton pump inhibitor (of the latest generation) - causes a substantial decrease in the secretion of gastric acid by irreversibly blocking hydrogen and potassium adenosine triphosphate enzyme system.
4. Bismuth compound – has a number of properties which includes a decrease in the acidity of stomach acid and protection of the stomach’s mucous layer.

Treatment of antibiotic-resistant Helicobacter pylori

In cases when the Helicobacter pylori infection is treatment-resistant, an additional macrolide antibiotic should be added to the aforementioned combination of drugs. Macrolide antibiotics produce a bacteriostatic and bactericidal effect on a number of bacteria through interference with their protein synthesis. Treatment of peptic ulcers not caused by Helicobacter pylori.

Treatment of patients that do not have Helicobacter pylori includes proton pump inhibitors (e.g. pantoprazole) over an extended period of time. Also, patients that currently undergo treatment using nonsteroidal anti-inflammatory drugs should be taking a synthetic prostaglandin E1 (e.g. Misoprostol) in order to prevent the ulcerogenic effect of NSAIDs. This drug is used to prevent gastric ulcers in cases such as this (other uses include inducing of labor or abortion).

Treatment of treatment-resistant ulcers

Currently, a number of modern techniques were developed to combat treatment-resistant peptic ulcers:

• Hyperbaric oxygen therapy – involves a therapeutic administration of the oxygen to decrease the inflammation caused by the peptic ulcer and to promote its healing.
• Low-intensity laser irradiation – studies have shown that this method, in combination with conventional treatment, allows for almost complete eradication of Helicobacter pylori. Also, the frequency of complications in the late follow-up period was much lower than in control group.
• Laser chromoendoscopy eradication of Helicobacter pylori – this original technique employs a laser in the wave length of 660 nanometers. This method allows for a much faster healing of the inflammation and destructive changes in the mucous layer of the stomach and duodenum, while eradicating Helicobacter pylori.
• Endoscopic laser photocoagulation of the peptic ulcers – produces a hemostatic effect (stops bleeding) on ulcers that are bleeding. Though some studies have shown that this procedure may delay the process of reepithelialization of the ulcer.
• Using endoscope for topical treatment of the ulcer – by using the endoscope, doctor can treat the ulcer using a number of methods:
  • Mechanical cleaning of the base and edges of the peptic ulcer
  • Rinsing of the peptic ulcer using collargol, ethyl alcohol, solcoseryl, and numbing agents (e.g. procaine)
• Electrophoresis of procaine into the epigastric region to relieve the pain.

Surgical treatment of peptic ulcers

If all other methods fail and if the size of the peptic ulcer is more than 2 cm (or if it’s located on the greater curvature of the stomach), then surgical treatment is recommended to the patient in order to prevent the malignization of the ulcer. Also, if the ulcer is bleeding despite all efforts of the doctors to stop it, then operation may be in order.

Perforated peptic ulcer – is a surgical emergency which should be addressed immediately to save the life of the patent. Also, if the peptic ulcer has penetrated into a nearby organ, operation will be in order, though usually it is less of an emergency than perforation.