Diagnosis

To detect an ulcer, your doctor will have to take your medical history and conduct a physical examination. Diagnostic tests for H. pylori will be carried out to determine whether the bacterium H. pylori is present in your body. A blood or stool specimen may be used. A breath test is carried out in some climes.

If you are taking an antacid prior to the testing for H. pylori, make sure to let your doctor know. Depending on which test is used, you may need to discontinue the medication for a period of time because antacids can lead to false-negative results.

Endoscopy

Your doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.

If your doctor spots an ulcer, a small tissue sample (biopsy) may be removed for examination in a lab. A biopsy can also identify whether H. pylori is in your stomach lining.

Your doctor is more likely to recommend endoscopy if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing. If the endoscopy shows an ulcer in your stomach, a follow-up endoscopy should be performed after treatment to show that it has healed, even if your symptoms improve.

Treatment

Treatment for peptic ulcers depends on the cause. Usually treatment will involve eliminating the H. pylori bacterium if present, stopping or reducing use of NSAIDs if possible, and helping your ulcer to heal with medication.

Medications can include:

Antibiotic medications to destroy H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline and levofloxacin.

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and perhaps bismuth subsalicylate (Pepto-Bismol).

Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole and esomeprazole.

Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — decrease the amount of stomach acid released into your digestive tract, which relieves ulcer pain and boosts healing. Available by prescription or over the counter, acid blockers include the medications cimetidine and nizatidine.

Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.

Antacids can provide symptom relief but generally aren’t used to heal your ulcer.

Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.

Follow-up after initial treatment

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

Ulcers that fail to heal

Peptic ulcers that don’t heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:

• Not taking medications according to instructions
• Some types of H. pylori are resistant to antibiotics
• Consistent use of tobacco
• Consistent use of pain relievers; such as NSAIDs — that increase the risk of ulcers

Lifestyle and home remedies

You may find relief from the pain of a stomach ulcer if you:

• Regulate stress. Stress may worsen the signs and symptoms of a peptic ulcer. Study the sources of your stress and address them.
• Don’t smoke/Quit smoking
• Limit or avoid alcohol.
• Use alternative medicine

Preparing for your appointment

Make an appointment with your regular doctor if you have signs or symptoms that worry you. Your doctor may refer you to a gastroenterologist (a specialist in the digestive system). On visiting your doctor, ensure to ask questions regarding the signs/symptoms you are experiencing. Your doctor will ask you a couple of questions, be open with him/her.