Medical experts now know that spicy foods and stress do not cause ulcers and that antacids and acid-suppressing drugs alone do not cure ulcers. What cures ulcers and prevents relapse is antibiotic therapy, preferably given in conjunction with an acid-suppressing drug to aid healing. H pylori is difficult to eradicate, so it usually takes two or more antibiotics to do the job. Studies have shown that dual or triple antibiotic therapy plus a histamine-2 (H2) receptor blocker or a proton-pump inhibitor (PPI) cures 85-90% of ulcer patients (H2 blockers inhibit the action of histamine, which normally stimulates acid production, and PPIs block the final step in acid production). Relapse is rare (less than 4% in studies in Europe, Australia, and the US). H pylori is very sensitive to tetracycline and amoxicillin; it is resistant to vancomycin, nalidixic acid, trimethoprim, and sulfonamides; and it readily becomes resistant to metronidazole, and to a lesser extent to clarithromycin, if either drug is used alone. Bismuth salts have topical activity against H pylori; colloidal bismuth blocks bacterial enzymes, disrupts cell walls, prevents the organism from sticking to stomach tissue, and persists in the mucous in antimicrobial concentrations for about two hours following dosing. Bismuth subsalicylate (PeptoBismol) is the product available in the US; bismuth citrate is available abroad and under FDA evaluation here.
source: Walsh JH, Peterson WL. N Engl J Med
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