To treat peptic ulcers, doctors typically recommend medicines to help the ulcer heal. They also look for the cause of ulcers and treat or manage the cause. Talk with your doctor about the best treatment plan for you. Show
Healing peptic ulcersMedicines that doctors recommend or prescribe to treat peptic ulcers include
Treating the causes of peptic ulcersDoctors treat the underlying causes of peptic ulcers to help the ulcers heal and prevent them from coming back. Helicobacter pylori (H. pylori) infectionDoctors treat H. pylori infection with a combination of medicines. These medicines most often include
Your doctor may avoid prescribing antibiotics you’ve taken in the past because the H. pylori bacteria may have developed antibiotic resistance to those antibiotics. If you are given medicines, take all doses exactly as your doctor prescribes. If you stop taking your medicine early, some bacteria may survive and persist in your stomach. In other words, To find out if the medicines worked, your health care professional may recommend testing you for H. pylori at least 4 weeks after you’ve finished taking the antibiotics.2 If you still have an Nonsteroidal anti-inflammatory drugs (NSAIDs) If you have a peptic ulcer caused by taking NSAIDs, your doctor may recommend changing your medicines. Depending on the reason you have been taking NSAIDs, your doctor may suggest stopping NSAIDs, taking a different NSAID, taking a lower-dose NSAID, or taking a different medicine for pain. If you need to keep taking NSAIDs, your doctor may recommend you also take a PPI. Other causesIf your peptic ulcers aren’t caused by H. pylori infection or NSAIDs, doctors will check for uncommon causes. Depending on the cause, doctors may recommend additional treatments. What if an ulcer doesn’t heal or comes back after treatment?Taking medicines and treating the underlying cause heals most ulcers. However, if your ulcer doesn’t heal or comes back after treatment, your doctor may
In rare cases, doctors may recommend surgery to treat peptic ulcers that don’t heal. How do doctors treat the complications of peptic ulcers?Doctors typically treat complications of peptic ulcers in a hospital. In addition to treating the ulcer, doctors may recommend medical procedures, such as an upper GI endoscopy, or surgery to treat ulcer complications. How can I prevent peptic ulcers?If you smoke, quitting smoking can lower your risk for peptic ulcers. If your doctor thinks you have a high risk for developing peptic ulcers caused by taking NSAIDs, your doctor may recommend changes to lower your risk, such as
If you have a peptic ulcer, finding and treating the underlying cause, such as H. pylori infection, can help lower the chance of developing future ulcers. Reference[2] Vakil NB. Peptic ulcer disease: treatment and secondary prevention. UpToDate. Updated April 1, 2020. Accessed October 12, 2021. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not freeze sucralfate liquid. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
The stomach contains cells that secrete different substances as part of the digestive process: parietal cells, chief cells, and surface epithelium cells. See an image of the stomach and these cells in Figure 7.2. are found within the lining of the stomach and secrete mucus as a protective coating. Parietal cells and chief cells are found within the gastric glands. produce and secrete hydrochloric acid (HCl) to maintain the acidity of the environment of a pH of 1 to 4. Parietal cells also secrete a substance called , which is necessary for the absorption of vitamin B12 in the small intestine. Parietal cells are the primary site of action for many drugs that treat acid-related disorders. Chief cells secrete pepsinogen that becomes , a digestive enzyme, when exposed to acid. The stomach also contains enteroendocrine cells (ECL or enterochromaffin-like cells) located in the gastric glands that secrete substances including serotonin, histamine, and somatostatin. G cells in the stomach secrete gastrin that promotes secretions of digestive substances. Although these cells play an important role in the digestive system, acid-related diseases can occur when there is an imbalance of secretions. The most common mild to moderate hyperacidic condition is gastroesophageal reflux disease (GERD), often referred to by patients as heartburn, indigestion, or sour stomach. GERD is caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus. See Figure 7.3 for an illustration of GERD. Peptic ulcer disease (PUD) occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin, in combination with the caustic effects of hydrochloric acid. PUD is the most harmful disease related to hyperacidity because it can result in bleeding ulcers, a life-threatening condition. Stress-related mucosal damage is another common condition that can occur in hospitalized patients leading to PUD. Thus, many post-operative or critically ill patients receive medication to prevent the formation of a stress ulcer, which is also called . See an image of a duodenal ulcer in Figure 7.4. Links to supplementary videos illustrating heartburn and gastric ulcers: Heartburn Gastric ulcer Overall Nursing Considerations for Hyperacidity MedicationsAssessments: Whenever a nurse administers hyperacidity medications, there are common assessments that should be documented, such as an abdominal assessment and documentation of bowel patterns. During therapy, the nurse should continue to assess for potential medication interactions and side effects and be aware that vitamin B12 malabsorption may occur whenever stomach acidity levels are altered. Based on the category of medication, renal and liver function may require monitoring. Additionally, if a patient complains of chest pain, the nurse should perform a complete focused cardiac assessment and not assume it is GI-related because patients may erroneously attribute many cardiac conditions to “heartburn.” Implementation: The nurse should read the drug label information and follow the recommendations for administering hyperacidity medications with other medications or the intake of food. Cultural preferences should also be accommodated when safe and feasible because the patient may believe in alternative methods for treating GI discomfort. A written plan of care with modifications for safe use of medications with these alternative methods may be required. Evaluation: Patients should experience improvement of symptoms within the defined time period; if not, the provider should be notified. Increased pain or new symptoms of coughing/vomiting of blood should be immediately reported because these symptoms can be signs of a life-threatening bleeding ulcer. Hyperacidity Medication ClassesThere are four major classes of medications used to treat hyperacidity conditions: antacids, H2-receptor antagonists, proton pump inhibitors, and mucosal protectants. Each class of medication is further described below. AntacidsAntacids (see Figure 7.5) are used to neutralize stomach acid and reduce the symptoms of heartburn. There are many OTC medications available for this purpose, such as calcium carbonate, aluminum hydroxide, and magnesium hydroxide. Calcium carbonate is the prototype discussed as an example. Be sure to read drug label information regarding antacids as you administer them because each type has its own specific side effects. Many antacids also contain simethicone, an antiflatulent used for gas relief. Simethicone is further described in the medication grid below. Figure 7.5 Antacids Indications Antacids are used to relieve heartburn, acid indigestion, and upset stomach. Mechanism of Action Antacids neutralize gastric acidity and elevate the pH of the stomach. Elevated pH also inactivates pepsin, a digestive enzyme. Specific Administration Considerations Calcium carbonate comes in various formations such as a tablet, a chewable tablet, a capsule, or liquid to take by mouth. It is usually taken three or four times a day. Chewable tablets should be chewed thoroughly before being swallowed; do not swallow them whole. The patient should drink a full glass of water after taking either the regular or chewable tablets or capsules. Some liquid forms of calcium carbonate must be shaken well before use. Do not administer calcium carbonate within 1-2 hours of other medicines because calcium may decrease the effectiveness of the other medicine. Calcium carbonate may be contraindicated in patients with preexisting kidney disease because it may cause . Common side effects of calcium carbonate include constipation and when it is discontinued. Patient Teaching & Education In addition to the information under “Specific Administration Considerations,” patients should be reminded to take OTC meds appropriately as prescribed and to not exceed the maximum dose. Other interventions to prevent hyperacidity can also be recommended, such as smoking cessation and avoiding food and beverages that can cause increased acidity (alcohol, high-fat or spicy foods, and caffeine). ,,, H2-Receptor AntagonistA common H2-receptor antagonist is famotidine. It is available OTC and is also often prescribed orally or as an IV injection in the hospital setting. Other H2-receptor antagonists include cimetidine and ranitidine. Cimetidine has a high risk of drug interactions, especially in elderly patients because of its binding to in the liver, which affects the metabolism of other drugs. Indications Famotidine (see Figure 7.6) is used to treat GERD, peptic ulcer disease, erosive esophagitis, and hypersecretory conditions, or as adjunct treatment for the control of upper GI bleeding. OTC famotidine is also used to treat heartburn or sour stomach. Mechanism of Action H2-receptor antagonists block histamine’s action at the H2 receptor of the parietal cell, thus reducing the production of hydrochloric acid. Specific Administration Considerations To prevent symptoms, oral famotidine is taken 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn. Preexisting liver and kidney disease may require dosage adjustment. Famotidine is supported by evidence as safe for use in pediatric patients younger than 1 year old, as well as in geriatric patients. Patient Teaching & Education Patients taking the oral suspension should be instructed to shake it vigorously for 5 to 10 seconds prior to each use. , The medication may cause constipation so fluids and high-fiber diet should be encouraged. Additionally, smoking interferes with histamine antagonists and should be discouraged., Proton Pump InhibitorsA common proton pump inhibitor (PPI) is pantoprazole (see Figure 7.7). It may be prescribed in various routes including orally, with an NG tube, or as an IV injection in the hospital setting. Other PPIs include esomeprazole, lansoprazole, and omeprazole. PPIs are more powerful than antacids and H2-receptor antagonists. Figure 7.7 OTC Omeprazole Indications Pantoprazole is used to treat damage from gastroesophageal reflux disease (GERD) in adults and children five years of age and older by allowing the esophagus to heal and prevent further damage. It is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome in adults. PPIs may also be given in combination with antibiotics to treat H.Pylori infections, a common cause of duodenal ulcers. Mechanism of Action PPIs bind to the hydrogen-potassium ATPase enzyme system of the parietal cell, also referred to as the “proton pump” because it pumps hydrogen ions into the stomach. PPIs inhibit the secretion of hydrochloric acid, and the antisecretory effect lasts longer than 24 hours. Specific Administration Considerations Packets of delayed-release granules must be mixed with applesauce or apple juice and taken by mouth or given through a feeding tube. Consult the labeling of concomitantly used drugs to obtain further information about interactions because PPIs can interfere with the liver metabolism of other drugs. IV pantoprazole can potentially exacerbate zinc deficiency, and long-term therapy can cause hypomagnesemia, so the nurse should monitor for these deficiencies. Patient Teaching & Education In addition to the considerations above, instruct patients to call their provider if their condition does not improve or gets worse, especially if bleeding occurs., Use of alcohol, NSAIDS, or foods that cause GI irritation should be discouraged., Mucosal ProtectantsSucralfate is a mucosal protectant used to cover and protect gastrointestinal ulcers. Indications Sucralfate is used in the treatment of ulcers. Mechanism of Action Sucralfate locally covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts. It is minimally absorbed by the gastrointestinal tract. Specific Administration Considerations Administer sucralfate on an empty stomach, 2 hours after or 1 hour before meals. Constipation may occur. Sucralfate should be cautiously used with patients with chronic renal failure or those receiving dialysis due to impaired excretion of small amounts of absorbed aluminum that can occur with sucralfate. Patient Teaching & Education In addition to the considerations above, instruct patients to call their provider if their condition does not improve or gets worse. ,,, AntiflatulentSimethicone is an antiflatulent that is commonly found in other OTC antacids (see Figure 7.8). It is also safe for use in infants. Gas commonly occurs in the GI tract due to digestive processes and the swallowing of air. Gaseous distension can also occur postoperatively. Indications Simethicone is used to treat the symptoms of gas such as uncomfortable or painful pressure, fullness, and bloating. Mechanism of Action Simethicone works by altering the elasticity of the mucous-coated gas bubbles, which cause them to break into smaller bubbles, thus reducing pain and facilitating expulsion. Specific Administration Considerations Simethicone is usually taken four times a day, after meals and at bedtime. For liquid form, shake drops before administering. Patient Teaching & Education Patients can be instructed about other measures to assist with gas expulsion such as changing position, ambulation, avoiding the use of straws, and tapering intake of beans and cruciferous vegetables. ,,, Now let’s take a closer look at the medication grids comparing medications used to treat hyperacidity in Table 7.3.,,, Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at Daily Med. On the home page, enter the drug name in the search bar to read more about the medication. Prototype/generic medications listed in the grids below are also hyperlinked directly to a Daily Med page.
Table 7.3 Medication Grid Comparing Hyperacidity Medications
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What drug combination will the nurse normally administer most often to treat a gastric ulcer?
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