More than a third of gastric and duodenal ulcers (peptic ulcer disease) spontaneously regresses. The healing processes are apparently promoted by a change of the psycho-vegetative constellation of the patient. This assumption is supported by scientific studies, in which nearly half of the patients are cured by placebo (non-active pseudo-drugs). The efficacy of acid-binding drugs (antacids) barely exceeds the "success rate" of placebo. As a result, uncomplicated ulcers are treated on an outpatient basis. A bed rest is not required.
Primary aim of the treatment of an ulcer
The goals of the therapy of peptic ulcer disease are rapid pain relief, ulcer healing and relapse prevention. In the long-term course, the peptic ulcer, however, is characterized by recurrent ulcer disease. Up to 80 percent of patients experience recidive ulcer within one year if only acid secretion-inhibiting drugs were used to heal the previous ulcer. The reason for this is that by acid blocker the infection of Helicobacter pylori underlying the peptic ulcer disease is not restored.
If prevention is carried out without previous rehabilitation of the infection through years of long-term therapy with acid blockers, the gastric inflammation can even get worse. Therefore, the alpha and omega of any treatment is the killing of Helicobacter pylori bacteria. This therapy has received a special name: eradication treatment.
Helicobacter pylori eradication
Both the first appearance of an ulcer, as well as recurrent ulcers rehabilitation of Helicobacter pylori infection is necessary as a primary therapeutic measure. As a result, not only the current ulcer is cured, but also operated an effective prophylaxis.
Conventional treatment with acid secretion inhibitors only slows the current ulcer more slowly than the combination with Helicobacter pylori infection and does not provide protection against the recurrent ulcer, which is expected to be between 60 and 80 percent in the stomach and duodenum within one year after the end of treatment,
For the rehabilitation of Helicobacter pylori infection, the combination of a proton pump inhibitor for the reduction of gastric acid production with two antibiotics is recommended today. The antibiotic used is clarithromycin and either metronidazole or amoxicillin. This can be achieved in 85 to 100 percent of cases, a successful rehabilitation of the infection.
When is a treatment successful?
Successful treatment of gastric ulcer is only possible if the patient consistently complies with eradication treatment. The therapy should always be started with all three drugs at the same time. After seven days the treatment is over. Normally, the healing of duodenal or gastric ulcers is achieved within four or eight weeks. Eight weeks after the beginning of the eradication therapy, a new mirroring of the gastrointestinal tract is performed. At this time, 85 to 90 percent of gastric ulcers are completely healed.
From the ulcer scar biopsies are taken to confirm again the benignness of the ulcer, as even malignant ulcers under acid-inhibiting therapy can simulate a cure according to endoscopic criteria. At the same time tissue samples for the detection of Helicobacter pylori are taken from different gastric mucosal regions. If gastric ulcer is not completely healed in control gastroscopy eight weeks after the start of Helicobacter pylori infection, tissue samples are taken from the edge of the ulcer and from the floor to prevent malignancy.
If the eradication therapy was successful and there is no malignancy, treatment with a proton pump inhibitor continues for four weeks. This is followed by another gastrointestinal reflection. If the infection is not remedied after an eradication attempt, a new attempt is made with the three drugs. Success will be reviewed four to six weeks after completion of this second therapy.
It is gratifying that reinfection with Helicobacter pylori is less than one percent. The rehabilitation of the infection is therefore permanent. Lack of adherence during Helicobacter pylori eradication may worsen the course of the disease and promote the development of severe bleeding.
Anatazida neutralize the already formed stomach acid. They usually contain aluminum or magnesium hydroxide or carbonate compounds. They are available as gel, suspension or tablets in large numbers on the market. Aluminum-containing preparations seem rather clogging, magnesium-containing laxative. The preparations should be taken one to two hours after the meal and, if necessary, again after three hours. Other medicines should be taken at a safe distance of one hour, as otherwise their absorption in the stomach may be affected.
Histamine H2 antagonists
Histamine H2 antagonists are a priority in acute ulcer therapy as well as in relapse prevention. Unlike antacids, they reduce gastric acid production by blocking the parietal cell's histamine H2 receptors. The most important substances are ranitidine, famotidine, nizatidine, roxatidine and cimetidine. It is advantageous that usually a single daily dose is sufficient in the evening. The main side effects of H2 blockers are allergic reactions, gastrointestinal symptoms such as diarrhea, fatigue, headache and dizziness. Rarer are an increase in serum creatinine or liver values as well as prolonged use in men an enlargement of the male breast and libido disorders.
Proton pump inhibitors
The active ingredient omeprazole, for example, is a proton pump inhibitor. They reduce acid secretion by inhibiting a key enzyme responsible for the proton transport of the gastric parietal cell. They are particularly indicated for Helicobacter pylori colonization of the stomach and small intestine, ulcer recurrence or Zoller-Ellison syndrome. The most important side effects are gastrointestinal symptoms such as diarrhea, constipation and flatulence, as well as changes in the blood count. With high dose administration as a syringe visual disturbances up to the blindness by damage of the optic nerve were described.
Protective film-forming agents, such as sucralfate, cover the gastric mucosa with a thin film that protects against the aggressive gastric acid and adheres to the ulcer base for about six hours. The major side effect is an occasional constipation. Protective film-forming agents are preferably taken on an empty stomach one hour before meals. Water can be drunk. Antacids and H2-antagonists should not be taken at the same time as the protective film-forming agents, but should be staggered by about one hour because of possible adverse effects.
Anticholinergics, but especially pirenzepine, inhibit gastric acid secretion by occupying the receptors required by the vagus nerve carrier substance to stimulate the parietal cells of the gastric mucosa. Anticholinergics are primarily used in combination with other ulcer therapeutics. Since they inhibit not only the main nerve of the parasympathetic nervous system but also the other nerves, unpleasant side effects such as dryness of the mouth, bladder emptying disorders, accommodation disorders or rapid heartbeat arise for those affected by higher doses. In patients with increased intraocular pressure (glaucoma) or prostate enlargement, they should not be given.
As Ulkustherapeutika also bismuth preparations are considered, which are usually given today in combination with antibiotics to combat Helicobacter pylori infection. They are taken half an hour to an hour before meals. The affected person must know that the bowel movement turns black and (depending on the preparation), the tongue, gums and dental prostheses may transiently discolour.
Penicillin derivatives such as amoxicillin, but also substances such as metronidazole have gained a greater importance in the control of Helicobacter pylori infection in the context of ulcer therapy.
Prevent an ulcer
The observance of the therapy regulations and the renunciation of alcohol, nicotine and caffeine promote the healing process. An easily digestible diet in several small meals (about 5 times a day) does not overwhelm the stomach excessively, and the stomach may empty at shorter intervals. This prevents excessively high levels of hydrochloric acid from remaining in the stomach for an extended period of time. In principle, all ulcer patients can be recommended psychotherapeutic treatment.