After peptic ulcer disease is diagnosed, the goal of treatment is to heal the ulcer while relieving pain and preventing complications and recurrence. Traditional ulcer therapy heals, relieves pain, and prevents complications but does not prevent recurrence. Treatment of H. pylori infection, when present, dramatically decreases the recurrence rate.9 If NSAID-associated ulcers are present, the offending agent must be stopped to reduce the recurrence rate.

Traditional therapy includes histamine (H 2) receptor antagonists (H2RAs), proton pump inhibitors (PPIs), sucralfate, and antacidsl,1,5 (Table^S-l). H2RAs decrease acid production by blocking the actions of histamine on the parietal cell H 2 receptor. All four drugs heal ulcers approximately equally and are available in over-the-counter preparations.115 Side effects are uncommon, but cimetidine has more significant drug interactions than do the other three due to inhibition of cytochrome P-450 activity.15 PPIs decrease acid production by blocking hydrogen ion secretion by the parietal cell. PPIs generally heal ulcers faster than do H 2RAs and also have some in vitro inhibitory effect against H. pyloriM5 Side effects are also rare, but omeprazole has some activity against cytochrome P-450, and both PPIs inhibit absorption of drugs that rely on gastric acidity.15 Sucralfate appears to protect the ulcer from acid exposure and heals about as well as do H ^As.1,!5 Sucralfate has few side effects but does inhibit absorption of a number of medications.15 Antacids heal ulcers by buffering gastric acid and are as effective as H 2RAs.1 Due to the simplicity of H2RAs, PPI, and sucralfate dosing requirements, antacids now are used mainly on an as-needed basis for ulcer pain until healing occurs.

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