Eradication of Helicobacter pylor reduces recurrence of gastric and duodenal ulcers and the risk of rebleeding, the presence of H.pylori should be confirmed before starting eradication treatment. Acid inhibition combined with antibacterial treatment is highly effective in the eradication of H.pylori; reinfection is rare.
For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin and either amoxicillin or metronidazole can be used. These regimens eradicate H.pylori in about 85% of cases, there is usually no need to continue antisecretory treatment (with a proton pump inhibitor or H₂-receptor antagonist), however, if the ulcer is large, or complicated by haemorrhage or performation, then antisecretory treatment is continued for a further 3 weeks.

Histamine H₂-receptor antagosits heal gastric and duodenal ulcers by reducing gastric acid output as a result of histamine H₂-receptor blockade; they are also used to relieve symptoms of GORD. Maintenance treatment with low doses for the prevention of peptic ulcer disease has largely been replaced in H.pylori positive patients by eradication regimens. In adults, H₂-receptor antagonists are used for the treatment of functional dyspepsia and may be used for the treatment of uninvestigated dyspepsia without alarm features. H₂-receptor antagonist therapy can promote healing of NSAID-associated ulcers (particularly duodenal) and also reduce the risk of acid aspiration in obstetric patients at delivery.

PPIs are effective short term treatments for gastric and duodenal ulcers; they are also used in combination with antibacterials for the eradication of H.Pylori and can be used for the treatment of dyspepsia and GORD. PPIs are also used for the prevention and treatment of NSAID associated ulcers. In patients who need to continue NSAID treatment after an ulcer has healed. the dose of PPI should normally not be reduced because asymptomatic ulcer deterioration may occur.

Particular care is required in those presenting with 'alarm featurs', in such cases gastric malignancy should be ruled out before treatment.

Measurement of serum magnesium concentrations should be considered before and durring prolonged treatment with a PPI, especially when used with other drugs than can cause hypomagnesaemia or with digoxin.