Most peptic ulcers can be cured and prevented from returning by eliminating Helicobacter pylori (H. pylori) infections and avoiding use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Medicines are used to:

• Treat peptic ulcer disease by reducing the amount of acid produced by the stomach.
• Kill H. pylori bacteria when it is determined that they are infecting the stomach lining.
• Prevent NSAID-related peptic ulcer disease by helping protect the lining of the stomach and upper small intestine (duodenum) from injury caused by NSAIDs.

Medication Choices

Medicines to reduce acid production

Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.

• Proton pump inhibitors (PPIs) (for example, Prilosec, Prevacid, Aciphex, Protonix, Nexium) reduce the amount of acid produced by the stomach (and are more potent than H2 blockers).
• H2 blockers (for example, Tagamet, Zantac, Pepcid, Axid) also reduce the amount of acid produced by the stomach.
• Antacids neutralize stomach acid. They are not as strong as PPIs or H2 blockers.

Proton pump inhibitors may be taken with antibiotics if the ulcer is caused by an H. pylori infection.

Medicines to kill H. pylori bacteria

Doctors prescribe combination drug therapy to cure infection with H. pylori bacteria. Combination drug therapy usually includes at least two antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.

Medicines to prevent ulcers

Certain medicines are used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs. These medicines are called prostaglandin analogs (such as misoprostol). They are sometimes used to prevent NSAID ulcers.

What To Think About

Ulcers in the stomach (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).

For people who have peptic ulcer disease and are known to be infected with H. pylori, doctors recommend combination therapy that includes at least two antibiotics, an acid reducer (usually a proton pump inhibitor), and sometimes a bismuth compound. These combination regimens cure infections 80% to 90% of the time.^{4, 5} Successful treatment of the infection greatly reduces the chances that the ulcer will come back.

You can get some H2 blockers and PPIs without a prescription (over-the-counter or OTC). If you are using OTC acid reducers (such as Prilosec OTC or Pepcid AC) to help with your symptoms for more than 10 to 14 days at a time, or if your symptoms are very bad, it is important that you see your doctor.