According to the American Academy of Family Physicians (AAFP), healing stomach ulcers can take 4 to 12 weeks. In the process, symptomatic ulcers negatively impact quality of life and sense of well-being. A multifaceted treatment approach that uses a variety of therapeutic modalities can speed up the healing process and prevent the formation of future ulcer recurrence.
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Proven Medical Treatments for Stomach Ulcers
Stomach, or gastric, ulcers are painful sores most commonly caused by a Helicobacter pylori (H. pylori) bacterial infection or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. The fastest way to treat an ulcer is by successfully identifying and eliminating the underlying cause. Medications that protect the stomach's lining and encourage mucosal healing also play a role in treatment.
How Antibiotics Can Cure Stomach Ulcers
H. pylori is a spiral-shaped bacteria that can cause infection in the stomach and duodenum (the first segment of the small intestine). H. pylori infections cause up to 80% of all gastric ulcers. All patients with stomach ulcers should be tested for H. pylori, and those infected should undergo antibiotic eradication therapy.
Treating H. pylori infection can be difficult due to high rates of antibiotic resistance and poor success rates with single- and dual-agent protocols. Therefore, antibiotic treatment requires using three or four prescription agents simultaneously. (36)
The following regimens have been found to have eradication rates of 90 percent or higher (36):
- Clarithromycin Triple Therapy: proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole for 14 days
- Bismuth Quadruple Therapy: PPI, bismuth, tetracycline, and metronidazole or tinidazole for 10-14 days
- Concomitant Therapy: PPI, clarithromycin, amoxicillin, and metronidazole or tinidazole for 10-14 days
- Sequential Therapy: PPI and amoxicillin for 5-7 days followed by a PPI, clarithromycin, and nitroimidazole for 5-7 days
- Hybrid Therapy: PPI and amoxicillin for seven days followed by a PPI, amoxicillin, clarithromycin, and nitroimidazole for seven days
- Levofloxacin Triple Therapy: PPI, levofloxacin, and amoxicillin for 10-14 days
- Fluoroquinolone Sequential Therapy: PPI and amoxicillin for 5-7 days followed by a PPI, fluoroquinolone, and nitroimidazole for 5-7 days
Using OTC Medications to Block Acid Production
PPIs are medications that reduce stomach acid production by blocking an enzyme required to make it. They are available over-the-counter (OTC) and by prescription. (42)
Examples include:
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Prilosec)
Compared to other antisecretory therapies, PPIs are more effective in suppressing stomach acid and produce longer-lasting effects (20). They are also better at healing ulcers, preventing complications (like bleeding), and palliating ulcer symptoms (40). A systematic review found that PPIs dosed for eight weeks resulted in ulcer healing in 80-90% of patients.
Side effects of PPIs, especially when used longer than 4-8 weeks, include:
- Abdominal pain
- Changes in bowel movements
- Dizziness
- Dry mouth
- Headaches
- Rash
- Clostridioides difficile (C. diff) infection
- Bone fracture
- Chronic kidney disease (CKD)
- Vitamin B12, folic acid, iron, zinc, calcium, and magnesium deficiencies
The Benefits of OTC Acid Reducers for Ulcer Relief
Histamine-2 receptor antagonists (H2RA), or H2 blockers, reduce stomach acid secretion by up to 70% in a 24-hour period by blocking the binding of histamine to H2 receptors in the stomach.
H2 blockers are also available OTC or by prescription. Examples include:
- Cimetidine (Tagamet)
- Famotidine (Pepcid)
In April 2020, the Food and Drug Administration (FDA) recalled ranitidine (Zantac) from the market because of concerns over the cancer-causing contaminant N-nitrosodimethylamine (NDMA).
Because H2 blockers are not as strong as PPIs, they take longer to heal stomach ulcers. Studies indicate that H2 blockers result in 70-80% ulcer healing at four weeks and 87-94% healing at eight weeks.
Neutralizing Stomach Acid with Antacids
Antacids do not reduce stomach acid production but instead neutralize it. They can quickly reduce ulcer symptoms, such as pain, but they aren't generally recommended for ulcer healing.
The FDA warns against using aspirin-containing antacids, such as Alka-Seltzer Original and Bromo Seltzer, which can increase the risk of ulcer bleeding. Instead, opt for an antacid that does not contain aspirin, such as:
- TUMS
- Mylanta
- Pepto-Bismol
- Rolaids
Antacids can reduce the absorption of other medications and supplements, reducing their effectiveness. Take antacids at least one hour before or two hours after other medications. (38)
Avoiding NSAIDs to Prevent Worsening Ulcers
NSAIDs reduce inflammation by inhibiting cyclooxygenase (COX) enzymes and the production of pro-inflammatory chemicals called prostaglandins. Examples include:
- Diclofenac
- Ibuprofen
- Naproxen
- Indomethacin
- Aspirin
- Celecoxib
NSAIDs are the second leading cause of stomach ulcers after H. pylori infection. NSAIDs can decrease intestinal mucus secretion and mucosal blood flow, leading to gastritis (inflammation of the stomach lining) and ulcer formation. Stomach ulcer complications, such as bleeding, occur up to five times more often in patients regularly taking NSAIDs. (49)
Acetaminophen (Tylenol) or antacids are better pharmaceutical alternatives to NSAIDs for ulcer pain management (29).
Complementary and Integrative Therapies for Ulcer Treatment
Complementary and integrative medicine (CIM) therapies can be used with or as alternative therapeutic options to pharmaceutical medications for ulcer healing.
Herbal Remedies for Stomach Ulcer Relief
Demulcent herbs are plants that contain mucilage, a gel-like substance, which creates a temporary protective barrier and soothes irritated and inflamed mucous membranes. Examples include:
- Licorice can stimulate gastrointestinal blood flow and mucus production, helping to speed up the healing process. It also possesses antimicrobial properties against H. pylori.
- Slippery Elm contains anti-inflammatory antioxidants and increases gastrointestinal mucus production (48).
- Aloe Vera: Limited human research supports the use of aloe vera gel in treating stomach ulcers and reducing H. pylori load (7, 8).
Mastic is a resin obtained from the Pistacia lentiscus tree. For thousands of years, mastic gum has been used to treat various gastrointestinal conditions, including stomach ulcers. Given the evidence that supports its ability to eradicate infection, it is commonly utilized in natural H. pylori treatment protocols.
Probiotics for Stomach Health
Probiotics are live beneficial microorganisms that balance the gastrointestinal microbiome. Probiotics protect the integrity of the gastric mucosa through various mechanisms. Probiotic supplementation has been shown to prevent the formation and expedite the healing of gastric ulcers. (28)
Lactobacillus spp. and Saccharomyces boulardii probiotics make antibiotic therapy more effective against H. pylori infection and can prevent antibiotic-associated diarrhea.
Acupuncture for Pain Relief and Healing
Acupuncture has been explored as a complementary treatment for gastric ulcer management. It involves inserting thin needles into specific points on the body to stimulate healing and reduce symptoms. Studies suggest that acupuncture may help alleviate pain, reduce inflammation, and promote healing of gastric ulcers by enhancing gastric mucosal blood flow and modulating the autonomic nervous system. While promising, more rigorous clinical trials are needed to fully establish its efficacy and understand the underlying mechanisms. (30, 50, 64)
Mind-Body Therapies for Stress Reduction
Mental and emotional stress can aggravate stomach ulcers. When stressed, the stomach produces more stomach acid, and people may try to cope with unhealthy behaviors known to underlie ulcer formation, such as drinking alcohol and smoking.
Mind-body medicine focuses on the interactions between the mind, body, and behavior to promote mental and physical well-being. Examples include meditation and yoga, which are used to manage stress and improve quality of life.
Dietary and Lifestyle Changes to Heal Stomach Ulcers
Implementing specific dietary and lifestyle changes plays a role in the healing process of stomach ulcers, offering a complementary approach to medical treatments and promoting overall gastrointestinal health.
Adjusting Your Diet to Promote Ulcer Healing
Diet and nutrition play an important role in treating stomach ulcers.
Avoiding the following foods can reduce stomach ulcer symptoms:
- Fried foods
- Acidic foods, such as tomatoes and citrus fruits
- Ultra-processed foods
A whole-food, anti-inflammatory diet will help you meet nutritional requirements to fight infection, reduce inflammation, and support tissue healing. Nutrients of particular importance include:
Many patients with stomach ulcers are reported to eat diets low in dietary fiber. A high-fiber diet (at least 20-30 grams daily) may help prevent ulcer formation and recurrence.
How to Stop Smoking for Better Stomach Health
Smoking is a major risk factor for stomach ulcer formation and delays ulcer healing time because it induces gastrointestinal inflammation.
If you smoke, stop. The following tips can make efforts to quit more successful:
- Use nicotine replacement therapies, such as patches or gums
- Chantix and Zyban are prescription medications that are FDA-approved for smoking cessation
- Join a support group
The Centers for Disease Control and Prevention (CDC) provides a list of resources to help people quit smoking.
Avoiding Alcohol to Prevent Ulcer Aggravation
Excessive alcohol consumption can cause gastritis, weaken the stomach lining, and cause an ulcer. Alcohol also interacts with the hypothalamic-pituitary-adrenal (HPA), influencing cortisol production and putting the body under more stress.
These steps can help cut down on drinking:
- Establish mental health support
- Find ways to socialize that don't involve alcohol
- Avoid triggers
- Set limits
- Drink festive, non-alcoholic beverages
Monitoring and Follow-Up for Effective Ulcer Management
The recommendations discussed in this article are not meant to replace formal medical care. Patients with stomach ulcer symptoms should see their doctor for a definitive diagnosis. Patients being treated for an ulcer should always follow their doctor's advice and check in regularly to ensure they are on the right path toward healing.
If you begin to experience any of the following symptoms, speak to your doctor:
- Nausea and vomiting
- Vomiting blood
- Black or tarry stools
- Difficulty breathing
- Dizziness
- Unexplained weight loss
- Changes in appetite
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Key Takeaways:
- Stomach ulcers are most commonly caused by H. pylori infection or chronic NSAID use. Successful ulcer healing requires identifying and treating the cause.
- Various prescription, over-the-counter, and natural medications and supplements are available to expedite ulcer treatment.
- Successful ulcer treatment and prevention protocols should also include lifestyle modifications, including a healthy diet, stress management, and smoking cessation, which are considered common aggravating factors for ulcers.
- Ulcers take an average of one to two months to heal. Ultimately, following your doctor's advice is the fastest way to heal a stomach ulcer.
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