Proton pump inhibitors are the preferred treatment for ulcers: because PPIs relieve pain and heal peptic ulcers more rapidly than [H.sub.2]-receptor blockers, they are generally the treatment of choice.(Drug Class Overview)

Publication: Managed Healthcare Executive

Publication Date: 01-APR-04

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PEPTIC ULCERS can produce a wide variety of symptoms or may present no symptoms at all until complications such as perforation occur. Left untreated, many ulcers heal on their own, but they often recur.

Peptic ulcer disease frequently is caused by an infection with Helicobacter pylori (H. pylori) bacteria, so the first step in managing ulcers is diagnosis and treatment of this bacteria. Eliminating the infection speeds healing of the ulcer and makes it much less likely to come back.

Various combinations of antibiotics have been tried to combat H. pylori, including Amoxil and other forms of amoxicillin, Biaxin (clarithromycin), Flagyl and other forms of metronidazole, Achromycin V and other forms of tetracycline. In clinical trials, antibiotic treatment is generally successful in about 70% to 90% of patients, but in practice eradication rates have been lower. Cure rates are better with 14-day regimens compared with 7-day treatments. The greatest potential cost savings in H. pylori treatment comes from not using Biaxin, an expensive drug. At the same time, formulaties must include Biaxin for use in patients who haven't responded to less expensive antibiotics.

Some ulcers are caused by use of nonsteroidal anti-inflammatory drugs (NSAIDs), and...

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