Peptic ulcer of the stomach and duodenum is a malaise due to the formation of one or more ulcers on the mucosa. A characteristic feature is the tendency to frequent relapses.
About the disease
Men are more likely to develop an ailment. The peak falls on the period from 20 to 50 years. Ulcers can reach deep layers, for example, to the muscle. Frequent complications are bleeding or perforation of the walls.
The lower the ulcer, the higher the aggressiveness of the gastric contents. This leads to a decrease in the contribution of trophic factors to ulceration. If the ulcer is located higher, the less aggression of the gastric contents.
Code of the disease according to ICD-10 - K26( duodenal ulcer) and K25( stomach ulcer).
Digestive juices consist of hydrochloric acid and pepsin. They are necessary for the destruction and digestion of starches. The level of hydrochloric acid is usually higher in patients with duodenal ulcer. In people with ulcers in the stomach, it is usually normal or below normal.
Pepsin plays a significant role in the formation of ulcers. Since the stomach and duodenum consist of proteins, they are very sensitive to the action of pepsin. The body has a "defense system".It includes mucous, bicarbonate, and some hormone-like substances. The destruction of protective mechanisms leads to the formation of erosion.
Reasons for the onset of
Helicobacter pylori bacteria play a major role. On the second place there is a long reception of anti-inflammatory nonspecific preparations.
To have an ulcer, it is enough to undergo treatment with aspirin, prednisolone or cytostatics in a standard dosage for 30 days. These medicines cause irreparable damage to the gastric and duodenum shell.
When the relationship between Helicobacter pylori and ulcer was first established, it was found that they occur in 90% of cases in patients with erosions. In bacteria carriers the probability of getting sick increases if:
- Age is more than 65 years.
- There is a history of bleeding GIT.
- Reception of anticoagulants.
- Among the factors affecting the peptic ulcer, it is noted:
- Dysfunction,
- Alcohol intake,
- Neuropsychiatric disorders.
These prerequisites are modifying. This means a person himself is able to influence them.
There are also non-modifying factors. These include:
- sex and age of the patient,
- genetic predisposition.
The reasons for the formation of the disease in large part in men is due to the fact that the female body protects sex hormones from the appearance of ulcers. During the menopause, the number of cases in both sexes becomes approximately equal.
Video about the causes of ulcer formation in the stomach:
Classification of
Peptic ulcer diseases are classified by:
- localization,
- disease stage,
- by the presence of complications.
Localization divides the disease into:
- gastric ulcer,
- duodenal ulcer,
- ulcers of unspecified site.
In the form of peptic ulcer there are no complications or complications. The latter include perforation, penetration, stenosis.
The stages of the disease differ in the saturation of the symptoms:
- First. The patient complains of severe pain, can not move, clutching his stomach. He throws in the heat, his lips turn blue and blood pressure decreases.
- Second. It has no severe pain syndrome. There is dryness in the mouth, increased gas generation, increased body temperature.
- Third. Comes with perforation of the ulcer. At this moment, a through defect is formed, which leads to peritonitis. Diagnosis is usually at this stage is not difficult, because the patient feels acute pain, comparable to a dagger blow.
Symptoms of ulcer
The main symptoms are pain and dyspeptic syndromes. Up to 75% of people complain of pain in the upper abdomen. Approximately 50% experience a tolerant experience, while 1/3 have severe pain.
Especially strong become during the performance of physical exercises, with the use of spicy food or during a long feast.
With a normal peptic ulcer, all the discomforting sensations have a clear connection with eating. Exacerbations appear in the spring or autumn. Often the symptoms become less pronounced after taking soda, antisecretory or antacid medicines.
The intensity of the sensations depends on the age. The younger the patient, the more complications.
For the dyspeptic syndrome characteristic are eructations, heartburn, nausea, vomiting, stool disorder, changes in appetite. Heartburn is noted in 80% of patients. An eructation makes itself felt in 50% of people. Most often, vomiting is accompanied by severe pain. Diarrhea is not a typical phenomenon for the disease. Thus the patient can limit itself in a delivery at occurrence of strong pains.
A good disease, the disease proceeds without complications. The acute period can last up to 8 weeks. The time of remission varies from several months to several years. Perhaps the asymptomatic course of the disease.
Diagnostics
Different methods are used for the study. Mandatory laboratory includes:
- OAM,
- OAK,
- occult blood feces analysis,
- total protein level, cholesterol,
- blood group and Rh factor,
- fractional study of gastric secretion.
Modern techniques allow detecting a bacterium with a high degree of accuracy. Check the availability of cells doctors are strongly recommended, because they are one of the most frequent causes of the disease. Endoscopic tests, morphological and immunoenzymatic tests are used for this.
One of the primary methods of investigation is endoscopy. A long thin tube with a video camera is inserted through the oral cavity. In combination with biopsy this method allows to detect peptic ulcers, bleeding, cancer and other problems. Method is compulsory:
- For people over 50 years of age who have symptoms of dyspepsia,
- Patients of different ages who have gastrointestinal bleeding, vomiting, difficulty swallowing.
Classic with gastric ulcer is the diagnosis of X-rays using contrast. The patient before the procedure must drink a solution containing barium. Then the X-ray machine processes the zones in which inflammations, scars and deformities can appear.
Standards for the treatment of peptic ulcer and duodenum
Treatment consists of several directions. Patients are required to follow a special diet, take medications and undergo LFK procedures. In addition, people's remedies are appointed, but sometimes even without surgery.
Menu power
Irritation of the stomach and bulb DPC should be minimal. Therefore, the diet should consist of well-boiled and wiped foods, which have a temperature of about 30 degrees.
Do not abuse food that stimulates the secretion of gastric juice.
Power must be a fraction. Therefore, you should eat small portions at regular intervals. The total caloric content of the daily volume of products during remission should not be less than 3000 kcal.
Allowed:
- Fresh milk and cream, non-acidic cottage cheese.
- Lean meat without veins, skin, fat.
- Cereals in different combinations.
- Vegetables cooked until soft. It is better in the form of mashed potatoes.
- Butter up to 30 gr.in a day. Macaroni and vermicelli.
- Yesterday's white bread. Sweet soft fruits and berries.
Strictly banned:
- Spicy vegetables, broths and mushrooms.
- Products made from butter or puff pastry.
- Marinades, canned food, smoked products.
- Vegetables and fruits with a sour taste. Nuts and seeds.
- Fatty meat and rich broths.
Diet for exacerbation of
In case of exacerbation, the most gentle diet is prescribed. Showing liquid boiled porridge, grated chicken meat and loose tea. You can drink a decoction of rose hips or with the addition of wheat bran.
With the disappearance of the symptoms of peptic ulcer exacerbation are appointed:
- Mucous rubbed soups, porridges.
- A steam souffle made from meat or fish, but no more than once a day.
- Eggs soft-boiled or in the form of an omelet, but no more than three times a day. Freshly made curd with milk or cream.
- Kissel with a little sugar.
- Crackers.
Preparations
Several main groups are distinguished for the treatment of peptic ulcer:
| Drug group | Description | Examples of preparations |
| Antagonists of H2-histamine receptors | Possess a strong antisecretory action. Reduce the production of hydrochloric acid, stimulate the formation of gastric mucus. | Today, mainly use drugs based on two active ingredients: Ranitidine, famotidine. |
| Inhibitors of the proton pump | The main group for the treatment of peptic ulcer. At reception there is a blocking of the final stage of formation of chloride acid. | Omeprazole, Pantoprazole, Rabeprazole, Lansoprazole, Esomeprazole. |
| M-cholinolytics | Drugs selectively block M-holonoretseptory stomach, without affecting the work of other organs. Appointed with severe pain, which is not eliminated by antacids. | Gastrocepin, Gastromen, Piregexal. |
| Bismuth preparations | Possess astringent, enveloping and antiseptic effect. When interacting with gastric juice, precipitation of insoluble salts occurs. This protects the mucosa from hydrochloric acid, eliminates pain. | De-Nol, Ventrisol, Ulquavis. |
| Antacids | Used as an adjunct to the main methods of treatment. They do not affect the production of hydrochloric acid, they neutralize the already existing acid. | Maalox, Rennie, Gastal, Almagel, Fosfalugel. |
| Antibiotics | Drugs are prescribed to inhibit the vital activity of Helicobacter pylori. | Clarithromycin, Amoxicillin, Tetracycline. |
Surgical treatment
Waiting tactics or surgical intervention are prescribed for patients with a high risk of bleeding.
Indication of the latter is the ineffectiveness of drug treatment, perforation or disruption of evacuation.
Stem vagotomy and gastroenterostomy are performed. This surgical intervention was more often used in the past years. Today it is appointed only in extreme cases.
Extensive abdominal surgery is used if the ulcer passes right through the organ wall, causing severe pain, the risk of developing infectious complications. It is performed both with a wide incision using standard surgical instruments, and laparoscopically. The latter method is used for perforated ulcers.
Other methods may be prescribed:
- Gastric resection. During the operation, the affected stomach is removed.
- Vagotomy. Cut the vagus nerve to interrupt communication from the brain.
- Antectomy. Removed the lower part of the stomach, responsible for the production of a hormone, which stimulates digestive juices.
- Pyloroplasty. In the process, the hole that leads to the 12-colon and small intestine increases.
Folk remedies
Peptic ulcer is treated with aloe. If you eat a piece before eating, you can not only cure the ulcer, but also remove some of the symptoms of the disease.
Another effective method is to prepare a decoction of plantain, string, St. John's wort. They are taken in the same amount and are brewed. Take a few glasses a day.
Herbalists advise using the following recipes:
- St. John's wort with oil. The grass is poured with olive oil and infused for 10 days. It is accepted for 25 g. Daily until the desired result is obtained.
- Potato juice. It comes from fresh grated potatoes, which must be squeezed through gauze. The resulting mixture is taken at 25 gr.before meals with increasing dose.
- Cabbage juice. It should be taken at least 6 weeks. Drink should be at least 5 glasses. Can be replaced with tomato or sea buckthorn.
LFK
Under the influence of intense muscle loads, the total amount of gastric juice decreases, and its acidity decreases. It is proved that the effectiveness of exercise therapy is associated with the phase of digestion. The oppressive effect of physical exertion more clearly after eating, gradually weakens after an hour or a half.
Specially selected exercises:
- improve peristalsis,
- normalize secretory function,
- have a positive effect on the organs of the abdominal cavity.
Patients with peptic ulcer disease. General development exercises, exercises for abdominal muscles, in conjunction with respiratory relaxation, are prescribed. Effective is walking, quiet games and relay races.
Peptic ulcer disease in children and its treatment
Symptoms depend on the stage and localization of the ulcer. Usually, children complain of severe pain, which is worse after eating.
When examined in children, there are manifestations of moderately severe chronic intoxication and hypovitaminosis. When palpation of the abdomen is determined by soreness.
Treatment is directed to several directions:
- elimination of bacteria that led to the formation of ulcers,
- normalization of secretion level,
- increased protective properties of the mucosa.
The correct selection of antacids and antisecretory drugs is also important. In the presence of casting of duodenal contents, en-sorbents are prescribed in the stomach.
Prevention of pathology
The main preventive measures include:
- Compliance with the rules of healthy eating. It should be ensured that there are no constipation, diarrhea, gassing processes.
- Reducing stress levels. We need a timely rest, a full sleep.
- Refusal of alcohol. Even small doses negatively affect the beneficial microflora of the digestive tract. If it is violated, the risk of developing a peptic ulcer increases several fold.
In conclusion, we note that in time the detected peptic ulcer with a full treatment has a favorable prognosis. In case of complications, life-threatening conditions may occur.