Peptic Ulcers - Treatment

Arguments Against Testing and Treating Patients with Dyspepsia. The arguments against testing and treating are as follows:

Lack of significant effect on symptoms. Studies are mixed on whether antibiotics have much effect on dyspepsia symptoms. For example, in a 2003 study, overall symptom scores after a year where not significantly different between dyspeptic patients who were treated for H. pylori and patients who were maintained on PPIs.
Lower rates of H. pylori in the US. The numbers of people with H. pylori infection is declining in the US, possibly making the test-and-treat approach too expensive considering the number of people it helps.
Increased risk for gastroesophageal reflux disease (GERD). A number of studies suggest that H. pylori in the intestinal tract protects against gastroesophageal reflux disease (GERD), which in severe cases, can be a risk factor for cancer in the esophagus. Eliminating H. pylori may also have other adverse effects.
Overuse of antibiotics. Concern that such treatments without clear evidence of ulcers will lead to unnecessary antibiotic prescriptions, increasing the risk for side effects. Overuse may also contribute to a growing public health problem--the emergence of bacteria that are resistant to antibiotics.

text continues below

Antibiotic and Combination Drug Regimens for Patients with Clear Evidence of Ulcers

The standard treatment regimen for H. pylori uses two or three antibiotics and a proton-pump inhibitor. Cure rates after antibiotic treatment range from 70 - 90%. A typical regimen contains three drugs:

A proton-pump inhibitor. These drugs include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and rabeprazole (Aciphex). Proton-pump inhibitors are important for all types of peptic ulcers and a critical partner of antibiotic regimens. They reduce the acidity in the intestinal tract, and increase the ability of antibiotics to destroy H. pylori.
Two antibiotics. Standard antibiotics are clarithromycin (Biaxin) and amoxicillin. (Some doctors substitute the antibiotic metronidazole (Flagyl) for clarithromycin or amoxicillin.)

This combination treatment is typically taken for at least 14 days. Many studies, however, suggest that a 7-day treatment may work just as well.

Follow-Up. Follow-up testing for the bacteria should be done no sooner than four weeks after therapy is completed. Test results before that time may not be accurate.

In most cases, drug treatment relieves symptoms of ulcers. However, symptom relief after treatment does not always indicate success, nor does persistence of dyspepsia necessarily mean that treatment has failed. Heartburn and other symptoms from gastroesophageal reflux disease (GERD), for example, sometimes worsen and require acid-suppression agents.