Which agent is the treatment of choice for NSAID-induced peptic ulcers when NSAIDs cannot be discontinued?

Proton Pump Inhibitors (PPIs) are the treatment of choice for NSAID-induced peptic ulcers when it is not possible to discontinue the use of NSAIDs. PPIs work by irreversibly inhibiting the proton pump in the stomach lining, which results in a significant decrease in gastric acid secretion. This reduction in acidity promotes the healing of peptic ulcers and also helps to prevent the recurrence of ulcers in patients who must continue taking NSAIDs, as these medications can damage the gastric mucosa and increase acid production.

In contrast, antacids provide symptomatic relief by neutralizing stomach acid but do not promote ulcer healing or prevent recurrence effectively. H2 receptor antagonists reduce acid secretion but are typically not as effective as PPIs in healing NSAID-induced ulcers. Sucralfate, while it can also promote ulcer healing by forming a protective barrier over the ulcer site, does not address the underlying issue of acid secretion as effectively as PPIs do when NSAIDs must be continued. Therefore, using a PPI is a more comprehensive approach to managing NSAID-induced peptic ulcers in patients who cannot stop their NSAID therapy.