Some peptic ulcers go away without treatment after 2 to 3 months. But they often come back.
Gastric ulcers and duodenal ulcers are treated with a type of medication known as proton pump inhibitors (PPIs), for instance with omeprazole or pantoprazole. PPIs reduce the production of stomach acid and are taken for 4 to 8 weeks.
If the ulcer was caused by painkillers, it can be a good idea to stop taking the painkillers for a while 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),
- one antibiotic drug containing the active ingredient clarithromycin, and
- another antibiotic drug containing the active ingredient metronidazole or amoxicillin.
Sometimes quadruple therapy is used instead. This approach involves taking all four drugs: the three antibiotic drugs and a proton pump inhibitor. It is a treatment option if the bacteria are resistant to some antibiotics. People who are allergic to the antibiotic penicillin can use metronidazole instead of amoxicillin. In both triple and quadruple therapy, the drugs are taken together over a period of 1 to 2 weeks. 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 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.
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.