What medication should I take if I've been diagnosed with gastric ulcer and ulcerative colitis?

From the Guidelines

For gastric ulcer colitis, the most effective treatment approach is to use biologic agents such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab, as recommended by the AGA guidelines 1.

Treatment Approach

The treatment should be personalized and may include a combination of medications to address both the gastric ulcers and colitis symptoms.

• Proton pump inhibitors (PPIs) like omeprazole (20-40mg daily) or pantoprazole (40mg daily) can be used to reduce stomach acid production and help heal ulcers.
• Anti-inflammatory medications such as mesalamine (800mg three times daily) or sulfasalazine (500mg four times daily) may be prescribed to manage colitis symptoms.
• In severe cases, corticosteroids like prednisone (starting at 40mg daily and tapering) might be needed for short-term inflammation control.
• H2 blockers such as famotidine (20mg twice daily) could be added if PPIs alone aren't sufficient.

Important Considerations

It's essential to avoid NSAIDs like ibuprofen and aspirin as they can worsen ulcers, and to eliminate alcohol and tobacco which can aggravate both conditions.

• Dietary modifications including smaller, more frequent meals and avoiding spicy or acidic foods may help reduce symptoms.
• The treatment approach should prioritize the use of biologic agents, as recommended by the AGA guidelines, to induce and maintain remission in patients with moderate to severe ulcerative colitis 1.

Biologic Agents

The choice of biologic agent should be based on the patient's specific needs and medical history.

• Infliximab or vedolizumab may be preferred for induction of remission in biologic-naive patients 1.
• Tofacitinib may be considered in patients who have failed or are intolerant to TNFα antagonists, but its use should be carefully monitored due to the risk of pulmonary embolism and all-cause mortality at higher doses 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medication for Gastric Ulcer Colitis

• The treatment for gastric ulcer colitis depends on the severity and extent of the disease.
• For gastric ulcers, proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, pantoprazole, or rabeprazole are recommended as the first line of treatment 2.
• These medications have been shown to increase healing rates and improve clinical symptoms.
• In cases of ulcerative colitis (UC), the treatment depends on the extent and severity of the disease.
• For proctitis, topical 5-aminosalicylic acid (5-ASA) drugs are used as the first line agents 3.
• UC patients with more extensive or severe disease should be treated with a combination of oral and topical 5-ASA drugs +/- corticosteroids to induce remission 3.
• Biologic therapies such as TNF-α antagonists, vedolizumab, tofacitnib, or ustekinumab may be used in patients with moderate to severe UC who do not respond to other treatments 4.
• The treatment algorithm for UC should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome 5.

Treatment Options

• PPIs such as omeprazole are effective in treating gastric ulcers and may also be used in combination with other medications to treat UC 2, 6.
• 5-ASA drugs are used to treat UC and may be used in combination with corticosteroids or biologic therapies 3, 4.
• Biologic therapies such as TNF-α antagonists, vedolizumab, tofacitnib, or ustekinumab may be used in patients with moderate to severe UC who do not respond to other treatments 4.
• The choice of treatment depends on the individual patient's needs and the severity of their disease.

Disease Severity and Treatment

• The severity of UC is assessed using the Mayo scoring system, which takes into account the extent of inflammation, disease severity, and prognostic factors of poor outcome 3.
• Patients with severe UC may require hospitalization and treatment with intravenous corticosteroids or biologic therapies 3, 4.
• The treatment goal for UC is to achieve complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy 5.