What is the management of gastric ulcers (peptic ulcer disease)?

From the Guidelines

The management of gastric ulcers should prioritize proton pump inhibitors (PPIs) such as omeprazole or lansoprazole, alongside Helicobacter pylori eradication if present, and discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs) if possible, to reduce the risk of rebleeding and promote healing 1.

Key Components of Gastric Ulcer Management

• Medication: PPIs are the cornerstone of treatment, with options including omeprazole (20-40mg daily) and lansoprazole (30mg daily), to reduce stomach acid production and promote healing 1.
• H. pylori Eradication: If H. pylori infection is present, triple therapy consisting of a PPI plus two antibiotics (such as amoxicillin and clarithromycin) for 10-14 days is recommended 1.
• NSAID Management: For NSAID-induced ulcers, discontinuing the offending medication and replacing it with alternative pain management is crucial. If NSAIDs must be continued, the least damaging agent (such as ibuprofen) should be used with a PPI 1.
• Lifestyle Modifications: Avoiding alcohol, tobacco, caffeine, and spicy foods, as well as stress reduction techniques and regular meals, can help alleviate symptoms and promote healing.
• Follow-up Care: Follow-up endoscopy is recommended after treatment to confirm healing, especially for larger ulcers or those with complications, typically around six weeks after discharge from hospital 1.

Rationale for Recommendations

The approach prioritizes reducing gastric acid production, eliminating H. pylori infection if present, and removing irritants to allow the gastric mucosa to heal naturally. PPIs have been shown to be superior to H2-receptor antagonists (H2RAs) and misoprostol in preventing NSAID ulcer recurrence and improving overall symptom control 1. The use of PPIs alongside H. pylori eradication has been demonstrated to be effective in reducing the risk of rebleeding in patients with a history of upper GI bleeding 1.

From the FDA Drug Label

1. Short-term treatment of active, benign gastric ulcer. Most patients heal within 6 weeks and the usefulness of further treatment has not been demonstrated. 5 Maintenance therapy for gastric ulcer patients at reduced dosage after healing of acute ulcers. Concomitant antacids should be given as needed for pain relief to patients with active duodenal ulcer; active, benign gastric ulcer;

• Management of gastric ulcers with ranitidine (PO) includes short-term treatment of active, benign gastric ulcers for up to 6 weeks.
• Maintenance therapy for gastric ulcer patients is also indicated at a reduced dosage after healing of acute ulcers.
• Concomitant antacids may be given as needed for pain relief to patients with active, benign gastric ulcers 2

From the Research

Management of Gastric Ulcers

• The management of gastric ulcers involves the use of proton pump inhibitors (PPIs) such as lansoprazole, which has been shown to be effective in healing gastric ulcers and preventing relapse 3, 4, 5.
• Lansoprazole has been compared to other treatments such as ranitidine and has been found to have a higher healing rate and fewer relapses 3, 5.
• The use of lansoprazole in combination with antibiotics such as amoxicillin and clarithromycin has been shown to be effective in eradicating Helicobacter pylori infection, which is a common cause of gastric ulcers 6, 7.
• Maintenance therapy with lansoprazole has been shown to be effective in preventing ulcer relapse and is a useful treatment option for patients with a history of gastric ulcers 3, 7.

Treatment Options

• Lansoprazole is available in different dosages and can be administered once or twice daily 3, 6.
• The choice of treatment depends on the individual patient and the severity of their condition, as well as the presence of other health conditions such as liver disease 4.
• Other treatment options such as omeprazole and pantoprazole are also available and have been shown to be effective in the management of gastric ulcers 4, 5.

Efficacy and Safety

• Lansoprazole has been shown to be effective in healing gastric ulcers and preventing relapse, with a high healing rate and few adverse events 3, 5, 7.
• The most common adverse events associated with lansoprazole include diarrhea, nausea, headache, and abdominal pain 7.
• Lansoprazole is generally well tolerated and can be used in combination with other medications, including antibiotics 6, 7.