See also: natural remedies against gastritis
Medical therapy
To learn more: Medicines to cure ulcers
It is used to achieve the following objectives: resolution of symptoms, healing of ulcerative lesion and prevention of recurrences and complications.
Although dietary measures do not by themselves produce significant effects on ulcer healing, it is advisable to reduce the intake of xanthine-containing foods (coffee, tea, coca-cola) and alcohol. The patient should be asked to have regular nutrition with light snacks in the intervals between meals.
In most cases the peptic ulcer heals after therapies with drugs that buffer or inhibit gastric acid secretion (antacids, H2 histamine receptor antagonists, proton pump inhibitors) or with drugs with direct protective activity on the mucosa (sucralfate, tricitrate of potassium bismuth).
Antacids perform their action by neutralizing gastric acidity and inhibiting the activation of pepsinogen. This implies that the effectiveness of antacids is obtained only with the systematic and frequent use of drugs (on average 4 times a day) and in high doses. The intake of antacids can hinder the absorption of other drugs: anticoagulants, digitalis, antibiotics, quinidine, steroid hormones, anticholinergics, barbiturates, salicylates, vitamins, trace elements; to avoid drug interactions it is advisable to distance the administration of these drugs from that of antacids by at least 2 hours.
Long-term medical therapy
Although peptic ulcers can quickly heal thanks to the efficacy of the drugs mentioned above, ulcerative recurrence is frequent if therapy is stopped; about 80% of relapses are observed one year after treatment interruption.
In an attempt to prevent ulcerative relapses, patients are subjected to maintenance therapies with drugs that inhibit gastric acid secretion (H2-antagonists and proton pump inhibitors): low dosages of these drugs, taken continuously, have proven to be effective in reducing the frequency of recurrences and the incidence of complications.
The discovery of the clinical importance of gastric infection with Helicobacter pylori, due to its high prevalence in patients suffering from ulcer disease, has provided the opportunity to modify the natural history of the disease since, when the infection is eradicated, the relapse of ulcer, both duodenal and gastric, is less than 2% after one year. At the same time, eradication also reduces complications of peptic pathology, including bleeding.
Since it has been shown that most ulcers are due to chronic Helicobacter infection, a peptic ulcer therapy that does not include eradication of the infection is not considered complete. There is consensus on the need to subject all patients suffering from ulcer and infected by that bacterium to eradication therapy, regardless of whether the ulcer is in an active form or in a healing phase. Currently the therapy of choice is considered the association of an acid-suppressor drug (proton pump inhibitor, or ranitidine, or bismuth citrate), with two antibiotic drugs chosen among amoxicillin, clarithromycin and metronidazole, administered twice a day for a week .
Surgical therapy
Surgical intervention is indicated in the presence of therapy-refractory ulcers, especially if arising in the stomach, or relapsing, which involve severe pain symptoms and severely limit the patient's quality of life; or if there is even a slight suspicion of an malignant nature of the ulcer, even in the case of negative histological findings; or again if the patient demonstrates a poor acceptance of medical treatment.
Furthermore, serious complications are indicated for intervention: conspicuous or recurrent hemorrhage, perforation, occlusion due to adhesions between ulcer scars. The overall post-operative mortality rate in interventions in election is 1%, but reaches 10-20% in the case of emergency interventions performed for bleeding or perforative complications.
The aims of the interventions performed for the treatment of peptic ulcer are:
- remove the ulcer by resetting the last portion of the stomach and the duodenal bulb (see gastrectomy )
- reduce gastric acid secretion by severing the gastric branches of the vagus nerve
Surgery in conditions of choice for the treatment of peptic ulcers has decreased greatly over the past 20 years, since the use of H2-blocker and omeprazole drugs began.
