Treatment of peptic ulcer

Abstract

The current therapy of choice for all Helicobacter pylori-associated ulcer disease is eradication therapy. Although adequate therapeutic regimens are currently available, often still ineffective therapies are tried. Cure of the infection essentially eliminates the ulcer diathesis. Cure of the infection is especially indicated in complicated/recalcitrant ulcer disease. Sadly, at present only a minority of peptic ulcer disease patients receive adequate eradication therapy. Cure of the infection does not equal full resolution of dyspeptic symptoms. A variable percentage of patients continues acid suppressant therapy for ongoing or newly developed dyspeptic or reflux symptoms. Acid-suppressant therapy, both for healing and for maintenance, remains the cornerstone of peptic ulcer therapy in all other circumstances (H. pylori-negative ulcer, aspirin/NSAID-induced ulceration, hyperacidity related ulcer etc.). Proton pump inhibitors are superior to H2RAS both for healing and for maintenance. Whether higher doses are occasionally necessary in H. pylori-negative ulcers, requires further study. Acid-suppressant therapy, even when prolonged, so far appears safe and well tolerated.