## Drug of Choice for Peptic Ulcer Healing **Key Point:** Proton pump inhibitors (PPIs) are the gold standard for healing peptic ulcers in both H. pylori–negative and H. pylori–positive disease, with superior efficacy and faster healing rates compared to all other agents. ### Mechanism of Action Omeprazole irreversibly inhibits the H^+^/K^+^-ATPase pump on parietal cells, reducing gastric acid secretion by >90%. This creates an optimal pH environment (>3.0) for ulcer healing. ### Healing Rates & Timeline | Agent | Duodenal Ulcer Healing (4 weeks) | Gastric Ulcer Healing (8 weeks) | Mechanism | |-------|----------------------------------|--------------------------------|----------| | **PPI (Omeprazole)** | 80–90% | 85–95% | Acid suppression | | H₂-receptor antagonist | 60–70% | 70–80% | Partial acid suppression | | Sucralfate | 50–60% | 60–70% | Mucosal protection | | Misoprostol | 60–70% | 65–75% | Cytoprotection | **High-Yield:** PPIs achieve faster healing (2–4 weeks for duodenal ulcers) and are superior for: - Refractory ulcers - NSAID-induced ulcers - Zollinger–Ellison syndrome - H. pylori eradication (as part of triple/quadruple therapy) ### Clinical Rationale in This Case Since the patient is H. pylori–negative and NSAID-free, idiopathic acid hypersecretion or occult NSAID use is likely. A PPI provides: 1. Rapid symptom relief (within 24–48 hours) 2. Confirmed ulcer healing on repeat endoscopy (4–8 weeks) 3. Prevention of complications (perforation, bleeding) **Clinical Pearl:** Even in the era of H. pylori eradication, PPIs remain first-line for symptom control and mucosal healing because they work independently of the underlying etiology. [cite:Harrison 21e Ch 297]
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