Medicine Cabinet: Antibiotics for peptic ulcers

I have peptic ulcer disease and tested positive for H. pylori bacteria. Is there any treatment for H. pylori bacteria other than antibiotics? The ones the doctors put me on produced lots of side effects.

No. The only way to get rid of H. pylori is with antibiotics, which are used along with a type of drug called proton pump inhibitors. (One example is omeprazole.)

At least two antibiotics must be used together. They are taken with the proton pump inhibitor for 10 to 14 days.

Recommended antibiotics include amoxicillin, clarithromycin, metronidazole and tetracycline. Treatment wipes out H. pylori about 80 percent of the time.

If you are sensitive to just one of the antibiotics you tried, your doctor can prescribe another combination. Also, if diarrhea is the major side effect, taking a probiotic (a supplement containing "good" bacteria or yeast) along with the antibiotics might reduce this problem. Probiotics can help bring back a normal bacterial balance in your intestines.

Most people who harbor H. pylori in their stomach lining have no symptoms. If you have a history of a stomach or duodenal ulcer, getting rid of H. pylori becomes very important because this bug most likely caused the ulcer and may later cause another one.

However, if your major problem is dyspepsia (a sense of fullness, pain, burning or bloating in the upper abdomen), the likelihood of feeling better after being treated for H. pylori is quite low. One group of experts estimated that only 1 in 14 people experience substantial benefit over the long term.

Perhaps a more worrisome issue among those who harbor H. pylori is that they may have a slightly higher risk of developing stomach cancer. Treatment might reduce this risk.

Stomach cancer is an uncommon type of cancer in the United States, so the likelihood of ever getting such a cancer is very low. So low, in fact, that I know of no colleagues who subject people with persistent H. pylori to screening endoscopy to try to detect early stomach cancer.