• If you have been diagnosed with a peptic ulcer caused by infection with Helicobacter pylori (H. pylori) bacteria, you will need treatment with antibiotic medicines to kill the bacteria.
• If your ulcer is caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), stop using them. NSAIDs slow or prevent the healing of an ulcer.
• Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. These include H2 blockers and proton pump inhibitors (PPIs).
• Lifestyle changes, such as quitting smoking and not drinking too much alcohol, are important for helping ulcers heal. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
• Ulcers that do not respond to treatment may have developed complications or may actually be cancer. You may need an endoscopy so that your doctor can look at the inside of your stomach and your upper small intestine to check for H. pylori or can collect a tissue sample (biopsy) that can be tested for cancer. But sometimes when symptoms do not get better with treatment, they are caused by something else that may or may not be a serious problem. Make sure you talk with your doctor to get to the bottom of your symptoms.
• If an ulcer eats through the wall of the stomach or intestine into the abdominal cavity (perforation), or if your ulcer continues to bleed despite therapy, you may require surgery. But these complications are rare.

Most cases of peptic ulcer disease are caused by an infection with H. pylori bacteria or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. If an H. pylori infection is present, antibiotics to cure the infection are used in combination with these medicines.

Because the medicines now used to treat peptic ulcer disease are so effective, surgery is rarely used to treat peptic ulcer disease. Surgery generally is reserved for people who develop a life-threatening complication of an ulcer, such as severe bleeding, perforation, or obstruction. In some cases, even these complications can be treated without surgery.

Initial treatment

Initial treatment of peptic ulcer disease depends on its cause.

• H. pylori infection. Treatment to eliminate Helicobacter pylori (H. pylori) bacteria usually involves combining two antibiotics with an acid reducer such as a proton pump inhibitor or sometimes a bismuth compound. Curing the infection speeds the healing of an ulcer and makes the ulcer less likely to recur. It is important to take all the medicine your doctor prescribes so that the bacteria are killed and do not come back. Do not stop taking the medicine just because you feel better. If the bacteria are not eliminated by the antibiotics, they may become even more difficult to kill later (resistant).
• NSAIDs. If at all possible, you will need to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs). If you must continue taking an NSAID, other medicines may be used to protect the stomach. For more information, see the Medications section of this topic.
• Hypersecretory condition. Acid reducers are most often used to treat an ulcer caused by a hypersecretory condition (a condition in which your stomach produces excessive acid). In addition, your doctor may want to conduct other tests to determine whether there is another cause for the ulcer.
• Unknown cause. If no cause can be found (idiopathic ulcer), your ulcer will usually be treated with an acid reducer. Long-term treatment depends on the severity of the ulcer and other factors, such as the size of the ulcer, whether you have had complications, and what other treatments have been used.