The treatment of gastric and duodenal ulcers had until recently concentrated on neutralizing and reducing gastric acidity. However, attention has now shifted to the eradication of H. pylori. Therefore, antibiotic treatment must be considered in all patients infected with H. pylori with acute ulcers and those who have had gastric or duodenal ulcer in the past diagnosed by endoscopy or barium radiography, even if they are asymptomatic or receiving prolonged treatment for acid suppression. This is particularly important in patients with a history of complications (eg., Bleeding, perforation), because eradication of H. pylori can prevent future complications.
Antibiotic treatment for H. pylori is in development. Simple agents should not be used because no single antibiotic can cure in a predictable way most infections H. pylori. At first it was recommended triple therapy based on bismuth. This approach has been tested with simple patterns of two drugs, which include the use of drugs blocking acid secretion. Whatever treatment is used, antibiotic resistance, the advice of the physician and patient compliance determines its success.
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In duodenal ulcer, the pain tends to be more uniform. The pain is absent when the patient awake, but appears at mid-morning, is relieved by food but recurs 2-3 h after the meal. The pain wakes the patient at night is common and highly suggestive of duodenal ulcer.