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Peptic ulcer healing drugs

 
 
 

Preface


Peptic ulcers are open sores that develop on the inside lining of the esophagus (esophageal ulcer), stomach (gastric ulcer) and the upper portion of your intestine (duodenal ulcer). There is a mucous lining coating the digestive tract which protects against acid. An ulcer could develop if the amount of acid is increased or the amount of mucus is decreased, so that acid eats away at the inner surface of the digestive tract, creating painful open sore. Patient may develop complications such as bleeding, obstruction, or perforation.

  Contraception

The most common symptom of a peptic ulcer is abdominal pain. Typically, the pain may be felt anywhere from your navel up to your breastbone, and may be worse when your stomach is empty and flare at night. Other less common symptoms may include indigestion, heartburn, nausea, vomiting of blood, black-colored stools, loss of appetite and unexplained weight loss.

Peptic ulcers are usually caused by either infection by Helicobacter pylori (H. pylori) bacteria or regular use of non-steroidal anti-inflammatory drugs (NSAIDs), a kind of pain killers. Besides, there are many factors that may increase the risk of developing peptic ulcers, such as smoking, alcohol consumption, undesirable eating habits and uncontrolled stress.

 

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Treatment


Lifestyle advice
Lifestyle factors such as diet and stress may worsen the symptoms of ulcers. On the contrary, healthy lifestyle and good dietary habits may help to accelerate ulcer healing, such as,:

  1. Take small but frequent meals and eat at regular time;
  2. Avoid spicy or excessively rich foods that are irritable to the gut;
  3. Do not smoke and avoid drinking alcoholic and stimulating beverages, such as coffee and strong tea;
  4. Drink milk and eat milk-based food that may help to relief the pain;
  5. Avoid situations causing stress and anxiety; and
  6. Do regular exercises to help you relax.
 
 

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Peptic ulcer healing drugs



You should consult doctors or other health care professionals for appropriate treatment of peptic ulcers. In general, the treatment of peptic ulcers mainly depends on whether the cause is H. pylori infection, NSAIDs or both. If it is caused by H. pylori infection, eradication therapy involves taking a combination of a course of antibiotics and an antisecretory drug such as proton pump inhibitor (PPI) will be used. In case if it is caused by the use of NSAIDs, the NSAIDs should be withdrawn if possible, and a one-to two-month course of an antisecretory drug such as PPI or Histamine-2 receptor antagonist is recommended. Whereas, if the peptic ulcer is caused by a combination of using NSAIDs and H. pylori infection, two-month course of a PPI and a course of eradication therapy will be given. Other medications used for treating peptic ulcers include antacid and cytoprotective agents.

1. Antibiotics

For ulcers caused by H. pylori infection, you will be asked to take two or three antibiotics together with a PPI. There is good evidence that such eradication therapy has benefits both in healing ulcers and preventing recurrence, especially for duodenal ulcer. Commonly used antibiotics are amoxicillin, clarithromycin, metronidazole and tetracycline. They are prescription-only medicines and are available in many dosage forms such as tablets and capsules.

 

2. Proton pump inhibitors (PPIs)

PPIs directly suppress gastric acid production by blocking the proton pumps of the gastric parietal cell that is responsible for acid secretion, and thereby promoting the ulcer healing. Their effect on suppressing gastric acid production is stronger than that of Histamine-2 receptor antagonists. These include the pharmacy only medicine omeprazole, and the pharmacy only medicines lansoprazole, rabeprazole, esomeprazole, pantoprazole and aripiprazole. They are available in various dosage forms such as tablets, capsules and injections.

3. Histamine-2 receptor antagonists

Histamine-2 receptor antagonists suppress the secretion of gastric acid by blocking the actions of histamine, a protein produced by the body that stimulates gastric acid secretion. Examples include cimetidine, famotidine and ranitidine. They are over-the-counter medicines and are available in forms of tablets, capsules, syrups or injections.

4. Antacids

Antacids cannot heal ulcer, but neutralise existing acid in the stomach, thereby relieving or eliminating the irritation and erosion to the stomach wall and the ulcer sites and provide rapid pain relief. Antacids are normally given between meals and at bedtime when symptoms of gastric hyperacidity usually occur. Common over-the-counter examples are aluminium hydroxide, magnesium trisilicate, calcium carbonate and sodium bicarbonate, and they are taken orally in forms of chewable pills and liquids.

5. Cytoprotective agents

Cytoprotective agents help protect the tissues that line your stomach and small intestine. They include the prescription-only medicines prostaglandin analogues, which inhibit gastric acid secretion by a direct action on the parietal cell and promoting healing of gastric and duodenal ulcers. Misoprostol is one of the examples and is taken orally in form of tablets. Besides, the over-the-counter medicines chelates and complexes also belong to this class. Chelates and complexes coat the ulcer surface by forming an adherent complex with proteins, thus protecting it from further damage by gastric acid and promoting healing. Sucralfate is one of the examples and is available in forms of tablets and suspensions.

 

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Common Side Effects and Precautions of peptic ulcer healing drugs:

Types of Drugs
 
Common side effects
 
Precautions
 
1. Antibiotics
Amoxicillin
  • Skin rashes
  • Gastrointestinal adverse effects such as diarrhea, nausea and vomiting
  • Stop medicine if rash occurs
  • Use with caution in patients with glandular fever, lymphatic leukaemia or HIV infection
  • Avoid use in patients with penicillin hypersensitivity
Clarithromycin
  • Mild gastrointestinal disturbance such as nausea, vomiting, abdominal discomfort and diarrhoea
  • Smell and taste disturbance
  • Stomatitis
  • Glossitis
  • Headache
  • Use with caution in patients with myasthenia gravis, renal or hepatic impairment
  • Avoid use in pregnancy
Metronidazole
  • Gastrointestinal disturbance such as nausea and vomiting
  • Unpleasant metallic taste
  • Furred tongue
  • Oral mucositis
  • Anorexia
  • Avoid drinking alcohol beverages
  • Use with caution in patients with blood dyscrasias, central nervous system disease and severe hepatic impairment
  • Avoid use in pregnancy
Tetracycline
  • Gastrointestinal adverse effects such as diarrhea, nausea and vomiting
  • Dysphagia
  • Oesophageal irritation
  • Photosensitivity
  • Hypersensitivity reactions
  • Skin pigmentation
  • Take medicine with sufficient water to prevent oesophageal ulceration
  • Take antacids, minerals such as calcium and iron and milk separately, with an interval of 2 to 3 hours
  • Should not be given to pregnant or breastfeeding women and children under 12 years
  • Avoid use in patients with acute porphyria
  • Use with caution in patients with renal or hepatic impairment, myasthenia gravis and systemic lupus erythematosus
  • Avoid exposure to direct sunshine
2. Proton pump inhibitors (PPI)
  • Gastrointestinal disturbances such as nausea, vomiting, diarrhoea and constipation
  • Headache
  • Rash
  • Pruritus
  • Dizziness
  • Fatigue
  • Dry mouth
  • Peripheral oedema
  • Use with caution in patients with hepatic impairment
  • Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D
3. Histamine-2 receptor antagonists
  • Diarrhoea
  • Dizziness
  • Tiredness
  • Headache
  • Rashes
  • Avoid using cimetidine when breastfeeding
  • Use cimetidine with caution in patients with hepatic impairment
  • Cimetidine may reduce absorption of certain drugs (e.g. ketoconazole) and inhibit the hepatic metabolism of many drugs (e.g. phenytoin, oral anticoagulants). Combination of these drugs should be avoided or used with caution
4. Antacids
  • Aluminium salts tend to produce constipation, while magnesium salts tend to cause diarrhoea
  • Take antacids and other medications 2 to 3 hours apart to minimize interactions
  • Avoid use of sodium bicarbonate in patients who must control sodium intake (e.g. in heart failure, hypertension, renal failure, cirrhosis, or pregnancy)
5. Cytoprotective agent
Misoprostol
  • Diarrhoea
  • Other gastrointestinal effects include abdominal pain, dyspepsia, flatulence, and nausea and vomiting
  • Increased uterine contractility and abnormal vaginal bleeding
  • Rash
  • Headache
  • Dizziness
  • Avoid use in pregnant and in those who plan to become pregnant
  • Use with caution in patients with inflammatory bowel disease
Sucralfate
  • Constipation
  • Other gastrointestinal effects such as diarrhoea, nausea, indigestion, flatulence
  • Dizziness
  • Headache
  • Use with caution in patients with renal impairment
 

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General advice on taking peptic ulcer healing drugs


  • There are many factors that may affect ulcer healing. Healthy lifestyle and good dietary habits may accelerate ulcer healing.

  • Peptic ulcer healing drugs should preferably be used according to medical directions and patient should adhere to the treatment regimen.

  • For peptic ulcer disease caused by H. pylori infection, testing (preferably urea breath test) should be performed at least 4 weeks after treatment to confirm eradication.

  • Be familiar with the name and dosage of the drugs you are taking. Taking the drugs in accordance with the using instruction on the label or package insert. Be cautious about their possible side effects and if persists, ask doctors for advices.

  • If pain persists despite treatment, discuss with your doctor for other appropriate treatment.

 
 

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Communication with your doctor


  • Always seek your doctor’s advice on the best treatment option. Your doctor will use the most appropriate drugs after considering your condition and your response to the taken drugs.

  • Inform your doctor of your medical history and the drugs you are taking because other drugs may interact with peptic ulcer drugs and some diseases may warrant special precautionary measures.

  • Seek medical advice as soon as possible if you experience any serious side effects suspected to be related to your peptic ulcer drugs.

  • Don’t manage peptic ulcer disease by self-medication with health products according to the product claims unless advised by healthcare professionals.

 

 

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Storage of drugs

Drugs should be stored in a cool dry place. Unless specified on the label, medicines should not be stored in refrigerators. Furthermore, drugs should be kept properly in places unreachable by children to prevent accidental ingestion.

 

 

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More information about managing your peptic ulcer

Please refer to the following link for more information about managing your peptic ulcer:
http://www.cheu.gov.hk/eng/info/otherdiseases_02.htm

 

 

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Acknowledgement: The Drug Office would like to thank the Professional Development and Quality Assurance (PD&QA) and the Central Health Education Unit (CHEU) for their valuable contribution to the preparation of this article.
 



Drug Office
Department of Health
Feb 2013

 

 

 

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