What is the treatment for suspected peptic (peptic ulcer disease) ulcer?

From the Guidelines

The treatment of suspected peptic ulcer should begin with a standard triple therapy regimen consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 14 days, as recommended by recent 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. The standard triple therapy regimen includes a PPI standard dose twice a day, clarithromycin 500 mg twice a day, and amoxicillin 1000 mg twice a day, or metronidazole 500 mg twice a day 1. Some key points to consider when treating suspected peptic ulcer include:

• The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community 1
• Sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) should be considered in selected cases, if compliance to the scheduled regimen can be maintained, and if clarithromycin high resistance is detected 1
• If any of these regimens failed, a second-line therapy is represented by a 10-day levofloxacin-amoxicillin triple therapy 1
• Patients should avoid NSAIDs, alcohol, smoking, and spicy foods during treatment as these can exacerbate symptoms and delay healing
• Confirmation of H. pylori eradication should be performed 4 weeks after completing therapy using urea breath test, stool antigen test, or endoscopic biopsy 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Suspected Peptic Ulcer

• The treatment of peptic ulcers often involves the use of proton pump inhibitors (PPIs) such as lansoprazole, which has been shown to be effective in healing gastric and duodenal ulcers 2, 3, 4.
• Lansoprazole has been found to have a high healing rate for gastric and duodenal ulcers, with endoscopic healing rates of 94.2% and 96.2%, respectively, after 8 and 6 weeks of treatment 2.
• The treatment of NSAID-induced ulcers with lansoprazole has also been shown to be effective, with most ulcers reaching scarring stages S1 or S2 after 6 or 8 weeks of treatment 3.
• In addition to its efficacy in healing ulcers, lansoprazole has also been found to be effective in eradicating H. pylori infection, with eradication rates ranging from 71 to 94% when combined with antimicrobial agents 5.

Factors Affecting Ulcer Healing

• Factors such as colonization by H. pylori, the size and depth of the ulcers, pretreatment stage, and ulcer history can affect the healing rates of gastric ulcers 2.
• Cigarette smoking can also delay ulcer healing, and patients who smoke should be encouraged to quit 6.
• The use of NSAIDs can also affect ulcer healing, and platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin 6.

Refractory Peptic Ulcers

• Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment 6.
• The most common causes of refractory ulcers are persistent H. pylori infection and use of NSAIDs, and simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity 6.
• If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered 6.