Peptic ulcer disease
Mucosal defect of stomach or duodenum extending beyond the muscularis mucosae. Main causes: Helicobacter pylori infection (70–90% of duodenal ulcers, 60–80% of gastric) and NSAIDs. ACG 2017 and Spanish AEG 2024 base therapy on proton pump inhibitors for 4–8 weeks plus H. pylori eradication when the test is positive. H2-blockers (famotidine) are used as an alternative to PPIs in intolerance or for nocturnal acidity.
ICD-10 K276 drugs
Also known as: Gastric ulcer, Duodenal ulcer
Drugs used for this condition
- ALansoprazoleFirst line · Proton pump inhibitor (PPI)First-line for gastric and duodenal ulcer per ACG 2017. Dose 30 mg once daily for 4–8 weeks within H. pylori eradication (with amoxicillin, clarithromycin, or metronidazole for 10–14 days) or as monotherapy in HP-negative ulcer.
- ARabeprazoleFirst line · Proton pump inhibitor (PPI)First-line for gastric and duodenal ulcer, including H. pylori eradication (rabeprazole 20 mg twice daily + amoxicillin + clarithromycin or metronidazole for 10–14 days).
- BFamotidineSecond line · H2-histamine receptor antagonistUsed in gastric and duodenal ulcer when PPIs are intolerable, or as maintenance after ulcer healing. Dose 40 mg once daily at bedtime for 4–8 weeks. ACG 2017 sets PPIs plus H. pylori eradication as first-line; H2-blockers remain an alternative.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CDeglycyrrhizinated licorice (DGL)Not recommended · Over-the-counter botanical supplement, an extract of Glycyrrhiza glabra root with glycyrrhizin removed (to eliminate the mineralocorticoid effect); marketed for peptic ulcer, functional dyspepsia and H. pyloriDGL is an over-the-counter botanical supplement. In peptic ulcer disease the evidence base is limited to small old RCTs. Morgan (Gut 1985) compared Caved-S (DGL plus antacids) with cimetidine in 169 patients over 2 years: gastric ulcer recurrence rates were comparable. Tewari (Practitioner 1989) in 874 duodenal ulcer patients compared DGL with cimetidine: efficacy was similar. These trials predate the H. pylori eradication era and proton pump inhibitors and do not translate to modern care. NICE CG184 and ACG 2017 recommend a 4–8 week PPI course in peptic ulcer disease plus mandatory H. pylori testing and eradication per Maastricht VI 2022. AEMPS and AESAN classify DGL as a complemento alimenticio without therapeutic indication. No Cochrane review on DGL in peptic ulcer exists. DGL may be a mild adjunct alongside core therapy but is NOT a replacement for PPIs and eradication – ulcers do not heal durably without acid suppression and H. pylori removal. If DGL was bought «instead of omeprazole», discuss the treatment plan with a gastroenterologist – the DGL evidence base in ulcer disease is weak and outdated.
- DEnoxoloneNot recommended · Plant-derived anti-inflammatory agent, a liquorice root derivativeLiquorice derivatives have a long ulcer history: in the 1960s and 1970s carbenoxolone, a close relative of enoxolone, was prescribed for gastric ulcer until it was displaced first by H2 blockers and then by proton pump inhibitors. Today's ulcer management rests on two things: acid suppression and eradication of Helicobacter pylori. Enoxolone does neither. The EMA HMPC monograph on liquorice root permits only traditional use for stomach discomfort, without antiulcer promises, and keeps the 4 to 6 week limit. The price of long use is known: sodium retention, edema, rising blood pressure, potassium loss. If liquorice or enoxolone was offered as ulcer treatment instead of gastroscopy and a Helicobacter pylori test, consider seeking a second opinion.
- DSodium alginateNot recommended · Anti-reflux agent forming a protective raftAlginate is often taken for months «to protect the stomach», meaning ulcer treatment. It does not treat an ulcer. The gel covers the stomach contents from above and reduces reflux into the esophagus, but it does not affect healing of a mucosal defect and does not touch Helicobacter pylori. Peptic ulcer management has two parts: acid suppression with a proton pump inhibitor and eradication of Helicobacter pylori when the test is positive. Alginate may sit on top of that for quick heartburn relief. The danger is delay: the symptom is muffled while bleeding or perforation develop on the same ground. Warning signs are black stool, vomiting blood, weight loss, difficulty swallowing and pain that wakes you at night. If alginate was offered as ulcer treatment instead of gastroscopy, consider seeking a second opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit