How Peptic Ulcers Are Treated

A peptic ulcer is a sore or lesion that forms in the lining of the stomach or duodenum, the first part of the small intestine. Peptic ulcers are caused by Helicobacter pylori (H. pylori), a bacterium that lives in the mucous lining of the stomach and intestine. Symptoms of these ulcers include pain, discomfort, heartburn, nausea, or gas, though some people may not experience any symptoms at all.

Treatment of peptic ulcers include antibiotics to clear H. pylori, prescription and over-the-counter medicines to manage symptoms, and lifestyle modifications to help ulcers heal.

A peptic ulcer is one of the most common gastrointestinal tract issues seen by doctors; an estimated 5% to 10% of all people will experience one in their lifetime.

Over-the-Counter (OTC) Therapies

The first line of treatment for many people with ulcers is OTC medications to relieve symptoms. Two common non-prescription medications are:

  • Antacids: Tums, Alka-Seltzer, Milk of Magnesia, Maalox, Mylanta, and Rolaids are over-the-counter antacids that offer temporary relief from ulcer pain by neutralizing stomach acid. They may also have a mucosal protective role.
  • Bismuth subsalicylate: Sold under the brand name Pepto-Bismal, bismuth subsalicylate has both a protective effect and an antibacterial effect against H. pylori. Used to treat digestive disorders since the early 1900s, Pepto-Bismal comes as a liquid, tablet, or chewable tablets.

Prescriptions

There are a few different types of medications your doctor might prescribe.

Antibiotics

If H. pylori is found in your digestive tract (your doctor can test for it), you may be prescribed a short-term course of antibiotics, usually a two-week treatment. Antibiotics are used to kill the bacterium and may vary depending on the current antibiotic resistance rate in your area.

Common antibiotics used to treat peptic ulcers include:

  • Amoxil (amoxicillin)
  • Biaxin (clarithromycin)
  • Flagyl (metronidazole)
  • Tindamax (tinidazole) 
  • Tetracycline HCL (tetracycline) 
  • Levaquin (levofloxacin)

Side effects of antibiotics are typically mild and may include vomiting, nausea, diarrhea, bloating, indigestion, and loss of appetite.

Most ulcers caused by H. pylori do not recur following successful eradication. However, for some patients, their ulcers return, and they must continue maintenance therapy for years.

H2-Blockers

Most doctors treat ulcers (stomach or duodenal) with these acid-suppressing drugs. Examples include Tagamet (cimetidine), Zantac (ranitidine), and Pepcid (famotidine).

They reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion. They reduce pain significantly after several weeks.

For the first few days of treatment, doctors often recommend also taking an antacid to relieve pain. The treatment initially lasts six to eight weeks.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors change the stomach's production of acid by stopping the stomach's acid pump—the final element involved in acid secretion. Prilosec (omeprazole) and has been used for short-term treatment of ulcer disease. Similar drugs, including Prevacid (Iansoprazole), may also be used.

Mucosal Protective Medications

Mucosal protective medications protect the stomach's mucous lining from acid, but these protective medications do not inhibit the release of stomach acid. Instead, they shield the stomach's mucous lining from the damage of the acid.

Two commonly prescribed protective agents are:

  • Carafate (sucralfate): This medication adheres to the ulcer, producing a protective barrier that allows it to heal and inhibits further damage from stomach acid. Sucralfate is approved for short-term treatment of duodenal ulcers and for maintenance treatment.
  • Cytotec (misoprostol): This synthetic prostaglandin, a substance naturally produced by the body, protects the stomach lining by increasing mucus and bicarbonate production and by enhancing blood flow to the stomach. It is approved only for the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers.

Home Remedies and Lifestyle

While medication is likely necessary to heal peptic ulcers, there are a few things you can do at home to help relieve symptoms and help to speed healing.

Reduce Stress

Research shows people who are under stress are more likely to develop peptic ulcers. In fact, a 2016 study published in the journal BMC Gastroenterology tracked 17,525 residents of a community in Denmark and found that people with the highest level of perceived everyday life stress were at greater risk for peptic ulcers.

Learning to manage your stress in healthier ways can help reduce uncomfortable peptic ulcer symptoms and help your body heal. Mind-body exercises, such as deep breathing, meditation, yoga, tai chi, or massage are tools that can help to reduce your stress.

Some people also find that working one-on-one with a therapist can help them to learn better coping mechanisms to alleviate anxieties, worries, and negative thinking, helping ulcers to heal.

Quit Smoking

Smoking has been shown to delay ulcer healing and has been linked to ulcer recurrence. Therefore, if you smoke, you should try to quit.

Avoid Alcohol

Drinking alcohol can inhibit ulcer healing and exacerbate symptoms. That's because alcohol increases the production of stomach acid, which will irritate an ulcer. Alcohol also relaxes the lower esophageal sphincter (LES), allowing stomach contents to reflux back up into the esophagus.

If you still want to consume alcohol, ask your doctor about how and when to do so when you suffer from heartburn.

Modify Your Diet

In the past, doctors advised people with peptic ulcers to avoid spicy, fatty, and acidic foods. However, since the discovery that H. pylori is the underlying cause of ulcers and the advent of effective medications to treat infection, a bland diet is no longer recommended. (It won't cause harm, but it likely won't help either.)

Some people who have peptic ulcers can eat whatever they want with no problems. For many others, however, eating certain foods can cause irritation, excessive acid production, and heartburn. Some common foods that exacerbate ulcer symptoms are coffee, milk, alcoholic beverages, and fried foods.

In general, a diet rich in vitamins and minerals is best. Adding yogurt, kefir, and other fermented foods that contain live bacteria organisms can help make the gut environment conducive to healing your ulcer by fighting H. pylori.

Eating foods rich in flavonoids or polyphenols may also have protective effects. According to a scientific review published in the Journal of Pharmacy & Bioallied Sciences, foods that contain polyphenolic compounds such as quercetin (found in olive oil, grapes, dark cherries, and dark berries such as blueberries, blackberries, and bilberries) and cinnamic acid (found in olive oil, strawberries, and cranberries) can prevent and reduce some ulcers.

Surgeries and Specialist-Driven Procedures

Many times, peptic ulcers can be successfully treated with medication. In some cases, however, ulcers can be severe and cause internal bleeding requiring surgery. Surgical procedures for ulcers include:

  • Vagotomy: The vagus nerve sends messages from the brain to the stomach. A vagotomy cuts part of the nerve that controls acid-secretion, reducing stomach acid.
  • Antrectomy: The antrum is the lower part of the stomach that produces a hormone that stimulates the stomach to secrete digestive juices. An antrectomy removes the antrum. This is typically done along with a vagotomy.
  • Pyloroplasty: The pylorus is the opening to the duodenum and small intestine. This surgery enlarges that opening enabling stomach contents to pass more freely out of the stomach. This may be done along with a vagotomy.

Complementary Alternative Medicine (CAM)

There is limited evidence to support the use of supplements, herbs, homeopathy, and other complementary medicine methods to treat peptic ulcers and relieve symptoms. The following supplements may be effective but speak with your doctor before incorporating them into your treatment plan.

Probiotics

Probiotics, Lactobacillus acidophilus in particular, have been shown to help suppress H. pylori infection. A 2016 review article published in the journal Best Practice & Research in Gastroenterology reports that probiotics can reduce H. pylori by up to 64% and fully eradicate the bacteria in almost a third of cases. The only reported side effect was diarrhea.

While encouraging, the ideal strains, dosage, and treatment duration have not been determined and more research is needed. 

Cranberry Extract

Supplementing with cranberry extract may also help to resolve peptic ulcers and eliminate H. pylori infections. Research published in the Journal of Gastroenterology and Hepatology found cranberry extract inhibited H. pylori in the laboratory. The study authors suggest the effect is due to certain polyphenols in the fruit.

This is promising, but human trials are needed to confirm cranberry can help treat peptic ulcers.

Cranberry supplements contain salicylic acid and should not be used by people who are allergic to aspirin. In addition, cranberry is high in oxalates, which may increase the risk of kidney stones or other kidney disorders and should not be used by people with kidney disease.

Cranberry may interfere with certain medications, including Coumadin (warfarin). If you are taking any medications, talk to your doctor or pharmacist before taking cranberry.

A Word From Verywell

Living with a peptic ulcer can be uncomfortable, but there are things you can do to relieve symptoms and heal. If you think you may have an ulcer, speak to your doctor. With the right treatment plan, reduced stress, and lifestyle modifications, you should be on your way to healing soon.

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Article Sources

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  4. Sumbul S, Ahmad MA, Mohd A, Mohd A. Role of phenolic compounds in peptic ulcer: An overview. J Pharm Bioallied Sci. 2011 Jul;3(3):361-7. doi:10.4103/0975-7406.8443.

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Additional Reading

  • Penn State Hershey Health Information Library. Peptic Ulcer.