Some peptic ulcers go away without treatment after two to three months. But they often come back.
Gastric ulcers and duodenal ulcers are treated with proton pump inhibitors (PPIs), for instance with omeprazole or pantoprazole. PPIs reduce the production of stomach acid and are taken for four to eight weeks.
If the ulcer was caused by painkillers, it may be a good idea to stop taking the painkillers for a while (if possible) so the lining of the stomach can recover. There may be alternatives that are more gentle on the stomach.
If a peptic ulcer is being caused by a Helicobacter pylori infection, a combination of three medications (triple therapy) is generally used to treat it:
- One proton pump inhibitor (PPI)
- Bismuth – a non-toxic heavy metal that slows the growth of bacteria and forms a protective film over the damaged area
- An antibiotic drug containing the active ingredient tetracycline
- Another antibiotic drug containing the active ingredient metronidazole
In this quadruple therapy, all four drugs are taken at the same time for at least ten days. If you still have symptoms after that, treatment with the proton pump inhibitor can be continued.
After four weeks at the earliest, a special breath test, a stool test or (sometimes) gastroscopy is done to see whether the treatment worked. If it wasn't effective, it can be repeated using a different combination of antibiotics and a proton pump inhibitor. The testing is often carried out beforehand to see whether the bacteria are resistant to one or more antibiotics.
If the ulcer causes heavy bleeding, it is treated using a minimally invasive (endoscopic) procedure. Various approaches can be used. These include injecting epinephrine (adrenaline), placing a small clip to clamp off the bleeding vessel, or cauterizing it (burning the bleeding vessel to close it off). Sometimes open surgery is needed instead.