Peptic ulcer disease - Emerging treatments

LOAD Helicobacter pylori eradication regimen

A quadruple regimen consisting of levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD) has been studied; however, it has not been shown to be superior to current standard treatment.[111]

Rifabutin-based Helicobacter pylori eradication regimen

The US Food and Drug Administration has approved the first rifabutin-based eradication therapy for H pylori in adults. The regimen consists of omeprazole, rifabutin, and amoxicillin. In two phase III trials, rifabutin-based treatment demonstrated high efficacy in H pylori eradication compared with placebo and active comparator (amoxicillin with omeprazole).[112][113][114][115]

Oral proton-pump inhibitor therapy for actively bleeding ulcers

Meta-analyses report comparable rates of recurrent bleeding among patients who were randomly assigned to oral or to intravenous proton-pump inhibitor (PPI) therapy for bleeding peptic ulcer.[116][117] Oral PPI therapy may be considered in those patients with active bleeding from peptic ulcer disease who cannot receive an intravenous infusion or in settings without this resource.[118]

Potassium-competitive acid blockers

Potassium-competitive acid blockers, such as vonoprazan, are potent inhibitors of gastric acid secretion. The speed of onset of a significant reduction in acid secretion is more rapid than with PPIs. Vonoprazan-based dual and triple therapies for H pylori eradication are at least as effective as comparable PPI-based therapies. However, in western populations the overall rates of H pylori eradication from vonoprazan-based dual and triple therapies (65% to 84%) are generally below desirable rates (90%).[119] At present these treatment regimes cannot be recommended unless satisfactory results are shown in the relevant local population. The increased potency of potassium-competitive acid blockers may offer some theoretical benefits over PPI-based regimens for H pylori eradication but the overall efficacy and cost-effectiveness of such regimens remains to be determined. Vonoprazan is effective for the treatment and prevention of peptic ulcer disease and aspirin- and non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulcers and may offer an alternative for PPI intolerance or toxicity.[120][121][122][123]

Haemostatic forceps for acute peptic ulcer bleeding

Haemostatic forceps are an option for treating bleeding peptic ulcers.[59][124] Results for haemostasis are comparable to thermal coagulation or using cap-mounted scope clips.[124][125] However, training in this technique is not yet widespread and the equipment may be more expensive.