Treatment regimens for peptic ulcers have changed since the identification of Helicobacter pylori (H. pylori) bacteria as the cause of most ulcers. As a result, most peptic ulcers today are relatively easy to cure with medications.

Medications are used to treat the bacterial infection and neutralize or reduce the amount of stomach acids to help healing. Neutralizing or reducing stomach acid helps peptic ulcers heal regardless of their cause. Ulcers caused by medication use generally heal when the medications are discontinued. However, in some cases, symptoms may continue for a while after ulcers are healed.

When peptic ulcers are caused by H. pylori bacteria, antibiotics are used. Two different antibiotics are generally required for one to two weeks. They are usually combined with other medications such as proton pump inhibitors (PPIs), which decrease acid production and aid in healing of the ulcer. According to the American College of Gastroenterology, antibiotics can cure 80 to 90 percent of peptic ulcers. Antibiotics must be taken for the full prescribed period to ensure that the infection is completely gone. Otherwise, recurrence is likely.

Other medications treat symptoms and the lining damage caused by the ulcer. Most medications are used for four to eight weeks. When symptoms are mild, antacids may suffice. These medications neutralize the hydrochloric acid in the stomach. Most are available without a prescription. They need to be taken several times a day and may cause diarrhea or constipation in some people. Although antacids may help reduce symptoms, they do not help to actually heal the ulcer.

Medications that reduce the production of stomach acid are typically taken once or twice a day and can rapidly heal ulcers. These include H2 blockers, which work by blocking histamine, a chemical that stimulates acid secretion. PPIs block the action of the “pumps” in the cells that secrete acid. They are stronger than H2 blockers and may also inhibit the activity of the H. pylori bacteria. Research suggests that PPIs may also reduce bleeding related to peptic ulcers as well as a patient’s need for surgery. However, studies show that use of PPIs may result in increased risk of infection with another bacterium (Clostridium difficile) and increased risk of hip fracture.

Cytoprotective agents are medications that protect the stomach lining. They generally work by forming a protective coat over the base of an ulcer to help ease symptoms and promote healing. These medications are generally taken two to four times per day.

Patients who have peptic ulcers caused by medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) should stop taking those medications. In addition, H2 blockers, PPIs and cytoprotective agents may also be used. If the NSAIDs cannot be discontinued, a physician can treat the ulcer with medications and monitor any further damage caused by the NSAIDs.

Physicians (often gastroenterologists) may recommend a bland diet for patients with peptic ulcers. Foods that irritate the stomach lining may need to be identified and eliminated from the diet, especially those that are spicy, acidic, fried or fatty. However, these measures may not actually help speed healing of ulcers.

It is important for patients with peptic ulcers to avoid other irritants, as well. Medication therapies for other conditions that irritate the gastrointestinal lining may need to be altered. Patients are advised to avoid alcohol and those who smoke are encouraged to quit. Cigarette smoking slows the healing of ulcers and is linked to recurrence.

The bleeding that may accompany ulcers usually stops on its own. However, if it persists, it can often be treated during endoscopy, either by cauterizing (heat-sealing) the bleeding site or injecting a clotting agent into it.

Surgery is rarely used for peptic ulcers today. It may be used in cases of severe, repeated episodes, to treat complications or as therapy for cancerous ulcers. When peptic ulcers perforate the organ wall and cause peritonitis, immediate surgery is required. In some cases, ulcers may recur even after they have been surgically treated. Possible surgeries for peptic ulcers include:

• Ulcer surgery. Ulcers can be closed and patched in either a standard, open surgical procedure or by using a laparoscope. This involves several small incisions to insert delicate tools instead of a single large incision.
  
  
• Vagotomy. In rare cases, this surgery is used to cut a specific nerve that stimulates the production of stomach acid, resulting in a decrease of such acid. This reduces the chance of developing peptic ulcers.
  
  
• Partial gastrectomy. Part of the stomach is surgically removed. This removes the sites of frequent ulcer formation. It may be used when an ulcer does not respond to medical treatment or for complications such as an obstruction or perforation.