Diet therapy and lifestyle modification
The foundation of conservative patient management remains proper meal planning and cessation of bad habits. These measures are aimed at reducing the functional load on the stomach.
- Elimination of dietary irritants. Foods capable of provoking dyspepsia or enhancing gastric secretion are completely removed from the diet. Any spicy condiments, canned foods, fried meat, as well as strong tea, coffee, and alcoholic beverages are prohibited.
- Frequent small meals. Food must be taken in small portions every 3–4 hours. This is because the intake of large volumes of food mechanically stretches the stomach walls, which is a powerful stimulus for excessive acid secretion. Small portions help avoid this reflex.
- Smoking cessation. Patients are strongly advised to completely quit smoking or sharply limit the number of cigarettes smoked, as this directly affects the mucosal healing processes.
Eradication therapy
If a patient is found to have a Helicobacter pylori infection, its elimination (eradication) becomes the primary task. This is what allows not only for the ulcer to scar over, but also prevents its recurrence (relapse prevention).
To eradicate the bacterium, strictly standardized protocols including three or four components are used. Such regimens include:
- Antibacterial drugs (specifically, amoxicillin, clarithromycin, and metronidazole).
- Bismuth preparations.
- Proton pump inhibitors (e.g., omeprazole).
With strict adherence to the prescribed regimen, treatment success is achieved in 85–90% of patients, and cases of reinfection are extremely rare.
Antisecretory and supportive pharmacotherapy
For rapid healing of the ulcer defect, it is necessary to reliably suppress hydrochloric acid production. Several groups of drugs are used for this purpose.
Proton pump inhibitors (PPIs) These are first-line drugs. A typical representative is omeprazole.
- Mechanism of action: they directly block the proton pump ($H+, K+$-ATPase enzyme) in mucosal cells.
- Efficacy: they possess the most potent and prolonged antisecretory action.
- Application: they lead in all acid-dependent conditions (gastroesophageal reflux disease, Zollinger–Ellison syndrome, peptic ulcer disease).
Second-line drugs and adjuncts
- H2-receptor antagonists (e.g., ranitidine). Despite being noticeably inferior to PPIs in both potency and duration of action, these drugs are still widely used in clinical practice.
- Non-absorbable antacids (magnesium oxide, aluminum hydroxide, calcium carbonate). Their task is the short-term neutralization of already secreted acid. They are used as symptomatic therapy to relieve dyspepsia, as an adjunct to the main course of treatment, or for maintenance therapy.
- Symptomatic agents. As indicated, the physician may add coating agents, antispasmodics for pain relief, and sedatives.
Correction of concomitant treatment It is extremely important to review the intake of ulcerogenic drugs, primarily nonsteroidal anti-inflammatory drugs (NSAIDs). Their intake must be discontinued or minimized. If discontinuation is impossible for life-saving reasons, the patient is mandatorily prescribed parallel anti-ulcer (supportive) therapy.
Surgical treatment
In modern gastroenterology, surgical intervention is used only when conservative (medical) therapy proves ineffective, or when life-threatening conditions develop.
Absolute indications for emergency or urgent surgery include the following complications:
- Perforation of the stomach or intestinal wall at the ulcer site.
- Profuse gastrointestinal bleeding.
- Malignancy — the process of malignant transformation of an ulcer defect.
- Cicatricial pyloric stenosis, in which food evacuation from the stomach is impaired due to narrowing of the lumen.
Briefly: answers to topical questions
What bismuth preparations are used in Helicobacter pylori eradication regimens?
In Helicobacter pylori eradication regimens, bismuth subcitrate potassium is used. This drug functions as a gastroprotector and cytoprotector, helping to create a protective film on the ulcer surface.
In clinical practice, the following is used:
- Bismuth subcitrate potassium (colloidal bismuth subcitrate) is an obligatory basic component of classical quadruple therapy (second-line quad therapy) and modified sequential therapy. In addition, this drug can potentiate the standard first-line triple therapy regimen.
What is the recommended duration of Helicobacter pylori eradication therapy?
The recommended duration of a standard eradication therapy course is from 10 to 14 days.
This rule applies to any of the chosen pharmacological treatment regimens (including first- and second-line therapy, as well as sequential therapy). During the specified period, medications are taken twice a day. When using standard triple therapy in certain regions, the course may be prescribed for 14 days provided proven efficacy.
What specific antispasmodics are prescribed to relieve pain in ulcers?
In the complex treatment of peptic ulcer disease, hyoscine preparations are prescribed to eliminate smooth muscle spasms of the gastrointestinal tract.
Specific representatives of this group of antispasmodics include:
- Hyoscyamine sulfate — used to relieve symptoms.
- Hyoscine butylbromide (Buscopan) — used to relieve spasms.
These drugs belong to symptomatic therapy agents and are added to the patient's treatment regimen strictly according to clinical indications.
For quick memorization of indications for surgery, use the BLEDS mnemonic: Bleeding, Leak (perforation), Emerging malignancy, Duodenal obstruction (pyloric stenosis).
Class and exam questions
Why is eating every 3–4 hours recommended for peptic ulcer disease?
Large volumes of food mechanically stretch the stomach and strongly stimulate the secretion of digestive juices. Frequent meals in small portions minimize this load and reduce acid production.
What should be done if a patient with an ulcer needs to take NSAID painkillers?
Nonsteroidal anti-inflammatory drugs have a pronounced ulcerogenic (damaging) effect. If their withdrawal is absolutely impossible, concomitant anti-ulcer therapy is mandatorily prescribed in parallel to protect the mucosa.
What is the main advantage of proton pump inhibitors over H2-blockers?
Proton pump inhibitors block the final stage of acid production — the H+, K+-ATPase enzyme itself. Due to this, they provide the most powerful and prolonged effect of secretion suppression compared to H2 histamine blockers.
What else to study on this topic
- Mechanism of action of the H+, K+-ATPase enzyme (proton pump) at the cellular level
- Specifics of triple and quadruple Helicobacter pylori eradication regimens
- Pharmacological differences of non-absorbable antacids (aluminum, magnesium, calcium)
- Pathogenesis of ulcer development during the intake of nonsteroidal anti-inflammatory drugs
- Features of the clinical course of Zollinger–Ellison syndrome
Master the entire topic in the "Propaedeutics" course
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