From the Guidelines
The best treatment for a stomach ulcer is a standard triple therapy regimen consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin, taken for 14 days, as recommended by the latest guidelines 1. This approach is based on the strong recommendation from the World Journal of Emergency Surgery, which suggests that in patients with bleeding peptic ulcer and positive tests for HP infection, eradication therapy is recommended to avoid recurrent bleeding 1.
Key Components of Treatment
- A PPI, such as omeprazole, taken at a standard dose twice a day
- Amoxicillin, 1000 mg twice a day
- Clarithromycin, 500 mg twice a day
Alternative Therapies
If clarithromycin resistance is high, a 10-day sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) may be considered, with the recommended doses being:
- PPI standard dose twice a day
- Amoxicillin 1000 mg twice a day
- Clarithromycin 500 mg twice a day
- Metronidazole 500 mg twice a day
Second-Line Therapy
If first-line therapy fails, a 10-day levofloxacin-amoxicillin triple therapy is recommended, with the suggested doses being:
- PPI standard dose twice a day
- Levofloxacin 500 mg once a day or 250 twice a day
- Amoxicillin 1000 mg twice a day It is essential to note that the choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, as the response to eradication therapy is significantly related to the prevalence of primary resistance in the population 1.
From the FDA Drug Label
Lansoprazole delayed-release capsules are indicated in adults for short-term treatment (up to eight weeks) for healing and symptom relief of active benign gastric ulcer [see Clinical Studies ( 14.4)]. Ranitidine tablets USP are indicated in: 4. Short-term treatment of active, benign gastric ulcer. Most patients heal within 6 weeks and the usefulness of further treatment has not been demonstrated.
The best treatment for stomach ulcer is short-term treatment with lansoprazole or ranitidine.
- Lansoprazole is indicated for short-term treatment (up to eight weeks) for healing and symptom relief of active benign gastric ulcer.
- Ranitidine is indicated for short-term treatment of active, benign gastric ulcer, with most patients healing within 6 weeks 2 3.
From the Research
Treatment Options for Stomach Ulcer
The treatment for stomach ulcer, particularly those associated with Helicobacter pylori infection, often involves a combination of medications to eradicate the infection and heal the ulcer.
- Triple Therapy: Studies have shown that triple therapy with a proton pump inhibitor (PPI) such as omeprazole, amoxicillin, and clarithromycin is effective in eradicating H. pylori infection and healing stomach ulcers 4, 5.
- Dual Therapy: Dual therapy with a PPI and one antibiotic has been found to be less effective than triple therapy in eradicating H. pylori infection 4, 5.
- Quadruple Therapy: A quadruple therapy regimen including omeprazole, amoxicillin, metronidazole, and bismuth has also been shown to be effective in eradicating H. pylori infection 6.
- Treatment Duration: The duration of treatment can vary, but most studies have used a 7- to 14-day treatment regimen 4, 7, 5, 6.
- Antibiotic Resistance: The choice of antibiotics may be influenced by the presence of antibiotic resistance, particularly to clarithromycin 7.
- Side Effects: The side effects of these treatment regimens are generally mild and well-tolerated, but may include gastrointestinal disorders and other adverse effects 4, 7, 5, 6.
Eradication Rates
The eradication rates of H. pylori infection with different treatment regimens have been reported as follows:
- Omeprazole, Amoxicillin, and Clarithromycin: 82.2% to 94% 4, 6
- Omeprazole, Amoxicillin, and Metronidazole: 86% to 93% 5, 6
- Omeprazole, Amoxicillin, Metronidazole, and Bismuth: 97.3% 6
- Lansoprazole, Clarithromycin, and Amoxicillin: 94% 8
Patient Compliance
Patient compliance with these treatment regimens is generally high, with most studies reporting compliance rates of over 90% 5, 6.