From the Guidelines
The most effective treatment for a gastric (peptic) ulcer involves a combination of medications, including a proton pump inhibitor (PPI) and antibiotics, such as amoxicillin and clarithromycin, for 10-14 days, as recommended by the most recent guidelines 1.
Treatment Overview
The treatment of gastric ulcers typically involves a combination of medications and lifestyle changes. For most patients, a PPI like omeprazole (20-40mg daily), pantoprazole (40mg daily), or esomeprazole (20-40mg daily) should be taken for 4-8 weeks to reduce stomach acid production and allow the ulcer to heal.
Helicobacter pylori Infection
If Helicobacter pylori infection is present, triple therapy is recommended: a PPI plus two antibiotics (usually amoxicillin 1g twice daily and clarithromycin 500mg twice daily, or metronidazole 500mg twice daily if penicillin allergic) for 10-14 days, as supported by the guidelines 1.
NSAID-Induced Ulcers
For NSAID-induced ulcers, the offending medication should be discontinued if possible. Antacids can provide quick symptom relief but don't heal ulcers effectively.
Lifestyle Modifications
Lifestyle modifications include:
- Avoiding alcohol, tobacco, caffeine, and spicy foods that may worsen symptoms
- Stress reduction, which is also beneficial These treatments work by either neutralizing stomach acid, reducing acid production, eliminating H. pylori infection, or protecting the stomach lining, allowing the damaged tissue to heal naturally.
Follow-up Endoscopy
Most gastric ulcers heal within 4-8 weeks with appropriate treatment, but follow-up endoscopy may be needed to confirm healing, especially for larger ulcers or those suspicious for malignancy, as recommended by previous guidelines 1.
Potassium-Competitive Acid Blockers (P-CABs)
Although P-CABs, such as vonoprazan, have shown promise in treating peptic ulcer disease, the current evidence does not support their routine use as first-line therapy, as stated in the recent review 1. However, they may be useful in PPI treatment failures or for secondary ulcer prophylaxis.
From the FDA Drug Label
1.3 Treatment of Active Benign Gastric Ulcer Omeprazole delayed-release capsules are indicated for short-term treatment (4 to 8 weeks) of active benign gastric ulcer in adults. The treatment for a gastric (peptic) ulcer is omeprazole delayed-release capsules for short-term treatment (4 to 8 weeks) in adults 2.
- The dosage is not specified in the provided text, so it should be determined based on other clinical guidelines or recommendations.
- Alternative treatments may be considered, but omeprazole is a specified treatment option for gastric ulcers.
From the Research
Treatment Options for Gastric (Peptic) Ulcer
- The treatment for gastric (peptic) ulcer often involves a combination of medications, including proton-pump inhibitors (PPIs), antibiotics, and acid suppressants 3, 4, 5, 6, 7.
- For patients with Helicobacter pylori infection, treatment typically includes a PPI and antibiotics, such as amoxicillin and clarithromycin, to eradicate the infection 3, 4, 6, 7.
- The use of triple therapy with omeprazole, amoxicillin, and clarithromycin has been shown to be effective in curing H. pylori infection in gastric ulcer patients 3.
- In cases where the patient is allergic to beta-lactam antibiotics, a fluoroquinolone may be used as an alternative 6, 7.
- Long-term therapy with a PPI may be useful in patients with H. pylori-negative ulcers, which are more aggressive and have higher recurrence rates 4.
- Acid suppressants, such as PPIs, may also have a role in the initial treatment of patients with bleeding ulcers, including those associated with nonsteroidal anti-inflammatory drug (NSAID) use 4.
Specific Treatment Regimens
- A 7-day course of a PPI + clarithromycin + amoxicillin combination has been shown to be effective in eradicating H. pylori infection in about 70% of cases 6.
- Prolonging treatment with a PPI + amoxicillin + clarithromycin or a PPI + amoxicillin + metronidazole to 10 or 14 days may improve the rate of H. pylori eradication by 5% to 10% 6.
- A combination therapy with a PPI + amoxicillin + clarithromycin + metronidazole for 5 days has been shown to eradicate H. pylori in about 90% of cases 6.
- Sequential treatment with amoxicillin for 5 days, followed by clarithromycin + metronidazole for 5 days, has also been shown to be effective in eradicating H. pylori infection 6.