Principles of treatment for peptic ulcers

Written by Jiang Guo Ming
Gastroenterology
Updated on May 07, 2025
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The principles of treatment for peptic ulcers, if malignant ulcers are present, surgical treatment is preferred. For benign peptic ulcers, it is first necessary to cultivate good dietary and living habits, quit smoking and drinking, avoid excessive fatigue, and adhere to a light diet with regular and measured meals, strictly avoiding overeating and binge eating. Meanwhile, the medication treatment should be determined based on whether there is a Helicobacter pylori infection; if there is an infection, standard antibacterial treatment is required, commonly involving quadruple therapy. If there is no Helicobacter pylori infection, symptomatic treatment usually yields satisfactory results. Proton pump inhibitors are the preferred drugs, such as rabeprazole and lansoprazole, combined with gastric mucosal protectants, prokinetic agents, etc. (Medication use should be conducted under the guidance of a professional doctor.)

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Written by Jiang Guo Ming
Gastroenterology
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Can gastric lavage be performed for peptic ulcer?

Peptic ulcer is one of the common upper gastrointestinal diseases, including gastric ulcer, duodenal bulb ulcer, compound ulcer, etc. In this case, since the ulcer site is often deep, sometimes reaching the base layer, even the serous layer of the gastric mucosa. If gastric lavage is performed too vigorously, gastric perforation may occur. Therefore, generally, gastric lavage is not advocated, but in a few cases, such as organophosphate pesticide poisoning or other drug poisonings, etc. If gastric lavage is not performed promptly, it often leads to serious complications, even life-threatening. Therefore, gastric lavage is still needed in a few cases, and in these situations, the procedure must be gentle and not too prolonged.

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Written by Jiang Guo Ming
Gastroenterology
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Etiology of Peptic Ulcer

Peptic ulcers include gastric ulcers, duodenal bulb ulcers, complex ulcers, and so on. It is currently believed that about 80% of peptic ulcers are related to infection with Helicobacter pylori. Additionally, poor dietary and living habits are closely linked to the formation of peptic ulcers, such as excessive smoking and drinking, overeating cold, greasy, spicy, and irritating foods, as well as strong tea, coffee, etc. Moreover, many medications can cause damage to the gastric mucosa, leading to gastric ulcers, such as non-steroidal anti-inflammatory drugs. Furthermore, emotional excitement and major trauma and other stress responses can also lead to acute gastric mucosal lesions, resulting in peptic ulcers.

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Written by Jiang Guo Ming
Gastroenterology
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Symptoms of peptic ulcer

Peptic ulcers typically include gastric ulcers, duodenal bulb ulcers, and complex ulcers, among others, all of which feature upper abdominal pain. For gastric ulcers, the pain is generally located below the xiphoid process or in the upper left abdomen, primarily occurring after meals and often accompanied by symptoms such as abdominal bloating and acid reflux. Duodenal bulb ulcers usually present as hunger-like pain in the upper abdomen, which can be alleviated by eating and may include nighttime pain, often with significant acid reflux and heartburn. These can be definitively diagnosed via gastroscopy. Additionally, many elderly individuals may develop gastric ulcers after taking nonsteroidal anti-inflammatory drugs, often without significant pain, typically requiring a gastroscopy for accurate diagnosis.

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Written by Jiang Guo Ming
Gastroenterology
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What is peptic ulcer disease?

Peptic ulcer is a common upper gastrointestinal disease, typically caused by the digestive action of stomach acid and pepsin, leading to damage in the mucosal layer of the stomach. Hence, it is called a peptic ulcer, encompassing gastric ulcers as well as duodenal bulb ulcers, complex ulcers, and so forth. The majority of causal factors are due to infection with Helicobacter pylori. Other factors include stimulants such as tobacco and alcohol, poor dietary habits, and medications like non-steroidal anti-inflammatory drugs (NSAIDs) and steroids. In addition, psychological factors can also lead to the development of peptic ulcers.

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Written by Jiang Guo Ming
Gastroenterology
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Can peptic ulcers be cured?

Peptic ulcers include gastric ulcers, duodenal bulb ulcers, complex ulcers, and more. The primary cause is usually Helicobacter pylori infection, particularly in patients with duodenal bulb ulcers. Generally, eradicating Helicobacter pylori can cure the ulcer. However, a small number of patients, due to underlying diseases or irregular medication use, often develop resistance to Helicobacter pylori. In such cases, peptic ulcers are prone to recurrent flares. Additionally, peptic ulcers caused by other factors, such as smoking and alcohol stimulation, poor dietary habits, medication, emotional issues, etc., can generally be cured by removing the triggers. However, it's essential to develop good dietary and living habits and strictly follow medical advice regarding medications.