Medical Therapy for Active Peptic Ulcer Disease

Abstract

Peptic ulcers occur when the damaging effects of acid and pepsin exceed the body's restorative processes that promote mucosal integrity and repair. Several factors have been identified that can contribute to the development of peptic ulcers, including excessive gastric acid secretion, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), infection with Helicobacter pylori, and impaired mucosal bicarbonate secretion. Over time, our understanding of ulcer pathogenesis has increased, leading to the development of various effective therapeutic agents with different mechanisms of action. The aim of this review was to understand the medical therapy for active peptic ulcer disease. The first-line treatment for peptic ulcer disease involves a combination of medications to reduce gastric acid production, protect and repair tissues, and eliminate underlying bacterial infections, particularly Helicobacter pylori. Antibiotics such as doxycycline, metronidazole, clarithromycin, and amoxicillin are prescribed to target and eradicate bacterial infections. Cyto-protective agents, including sucralfate, misoprostol, and bismuth subsalicylate, are used to coat and protect the gastrointestinal lining, aiding in healing. Histamine receptor blockers like famotidine, cimetidine, and nizatidine, as well as proton pump inhibitors such as esomeprazole, dexlansoprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are employed to reduce stomach acid production and foster mucous lining protection for healing. If patients regularly use nonsteroidal anti-inflammatory drugs (NSAIDs), alternative pain relievers like acetaminophen are recommended to mitigate damage to the mucous lining. Treatment approaches may vary depending on complications, such as bleeding or perforation, with minor medical procedures like endoscopy often utilized to address these issues. Overall, a comprehensive treatment strategy is employed to reduce gastric acid, protect and repair tissues, and eliminate the underlying causes of peptic ulcers, with medications playing a central role in effectively managing the condition.