What Are the Four Main Medications Used in Treating Gastric Ulcers?

Gastric ulcers are commonly caused by Helicobacter pylori (H. pylori) infection, which is present in 80%-90% of cases. In fact, nearly all cases of duodenal ulcers—up to 95% or even 100%—are also linked to this bacterial infection. Therefore, the primary treatment approach involves using a quadruple therapy regimen to effectively eradicate H. pylori.

The standard four-drug combination typically includes two different antibiotics, a bismuth-based compound, and a proton pump inhibitor (PPI). Below is a detailed breakdown:

Antibiotics: The first line of defense involves using two antibiotics to target and eliminate the bacteria. For patients who are not allergic to penicillin, options include Amoxicillin capsules or dispersible tablets, Augmentin (Amoxicillin-Clavulanate), or Clarithromycin. Alternative choices may involve fluoroquinolones like Levofloxacin, Metronidazole, or Furazolidone. Two of these antibiotics are selected for the treatment course.

Bismuth Compound: A bismuth-containing agent helps protect the stomach lining while also enhancing the antibacterial effects of the antibiotics. Commonly used medications in this category include Colloidal Bismuth Pectin capsules, Compound Bismuth Aluminate, or Bismuth Subcitrate Potassium. Only one of these is used during the treatment period.

Proton Pump Inhibitors (PPIs): These medications reduce gastric acid production, allowing the ulcer to heal more effectively. Examples include Omeprazole, Rabeprazole, Pantoprazole, and Esomeprazole. One PPI is chosen and administered at double the standard dose for optimal effect.

It's important to note that medication dosages are often doubled during this therapy. Patients must follow medical advice closely, as the full course usually lasts between 10 to 14 days. Moreover, if a confirmed gastric ulcer is present, extended PPI therapy may be recommended for 6 to 8 weeks, sometimes even up to 12 weeks, depending on the severity and individual patient response.