Some of the peptic ulcers may heal without treatment, spontaneously. But if they complicate the whole situation is severe, there may appear ulcer bleeding, ulcer perforation, and gastric obstruction. Ulcer bleeding manifests as: melena or black stools, weakness, orthostatic syncope, hematemesis meaning blood vomiting. Treatment may be the rapid replacement of the lost fluids on venous line, even blood transfusion in more severe cases. To establish the exact portion of the affected mucous and the bleeding spot upper endoscopy is performed and the bleeding may be stopped with the aid of heated instruments.

If the ulcer is perforated the gastric contents are leaked in the peritoneal cavity and results in acute peritonitis. Those cases are very severe and surgery is required immediately, because the abdomen muscles become rigid and any motion determines extreme abdominal pain.

If gastric obstruction occurs near the pyloric canal which joins the stomach to the duodenum the patient reports increasing abdominal pain, diminished appetite, vomiting of undigested or partially digested food and weight loss. Upper endoscopy is recommended to exclude the gastric cancer as a cause of obstruction. If the gastric contents are evacuated from the stomach and cimetidine and ranitidine are administered intravenously the gastric obstruction is resolved. Patients with persistent obstruction require surgery.

Treatments

First of all prevention is very important reducing cigarettes and non-inflammatory steroids drugs, to relieve pain there are administrated antiacids such as: Maalox, Mylanta, and Amphojel, but watch out ulcers frequently return when you cease taking the antiacids medication. Histamine antagonists are cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid) are effective in the healing of ulcers because that reduce the acid output but ulcers return when this medication is stopped. Patients may experience during the treatment: hallucinations, headache, confusion, lethargy. Cimetidine and ranitidine should't be taken in combination with alcohol, anyway those doses must be adjusted and monitored.

Asomeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexium), and rabeprazole (Aciphex) are proton-pump inhibitors are used in the treatment of gastric and duodenal ulcers and esophageal ulcers. They have no side effects even after long time using them and do not affect the digestion and absorption. Sucralfate and misoprostol promotes healing and protects the lining against acid attacks, Cytotec protects the lining from the effect of non-inflammatory steroids drugs. One of the adverse reactions of Cytotec is miscarriage. More studies suggest the use of combined antibiotics, tetracycline, amoxicillin, metronidazole (Flagyl), clarithromycin (Biaxin), and levofloxacin to eradicate H. Pylori. By elminating H. Pylori bacteria you will decrease the risk of gastric cancer in the future and the return of ulcer. There are no suficient proves that intake of coffee and alcohol determines peptic ulcers, dietary restrictions and bland diets may not have the expected result.