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Can a duodenal ulcer 12. Peptic ulcer of the duodenum - causes and symptoms in men or women, diagnosis and treatment. What foods to choose for a duodenal ulcer

And the intestines are diverse and do not appear immediately and not at the same time. The first characteristic signs of the manifestation of such diseases begin at an early stage and are mistaken by many people for frivolous functional disorders of the digestive system. At an early stage, the symptoms are blurred, many of the signs are similar, but a quick cure is still possible if the disease is diagnosed in time. The long process of the development of diseases at first manifests itself from case to case, episodically, about 1-2 times a year. The future patient of a gastroenterologist, without paying special attention to this, does not seek medical help, although the general deterioration of the condition progresses constantly and steadily, and this is due to the defeat of more and more new areas.

An irresponsible attitude to one's health leads to the fact that the signs of an ulcer or stomach become pronounced, and a stage of the disease sets in, at which it is already impossible not to react. Inflammation of the mucous membrane leads to permanent and acute pain in the epigastric region, indigestion, discomfort, deterioration of the general condition. In order to prevent serious organ damage, you need to consult a doctor at an early stage in order to undergo a diagnosis and decide on a successful treatment that is still possible. The longer the moment of making a decision is delayed, the more irreversible the consequences of delay will be.

1 Early manifestations

At an early stage, when they resemble gastritis in appearance, which is present in about 35% of adults, the pathology manifests itself as follows:

  • pain after eating in the epigastric region with irradiation to the back, lower back, chest;
  • pain at night;
  • pain symptom of hunger a few hours after eating (“hungry” pains);
  • negative sensations 1 and 2 hours after eating (“early” and “late” pains).

The continuous signaling of the receptors is also reinforced by concomitant, extremely negative sensations in the form of nausea that occurs for no apparent reason, often not associated with food intake, spontaneous, often in the morning when the stomach is empty. Gagging and vomiting occur later a short time after meal. A direct relationship with the process of eating causes loss of appetite, lack of desire to eat previously favorite foods, concomitant weight loss, deterioration appearance. All this is accompanied by a violation of peristalsis, increased gas secretion, bloating, constipation or diarrhea, a violation of the frequency of natural excretions. A reasonable person with such symptoms already understands the need to see a doctor.

The presence of constant pain causes changes in character: a person withdraws into himself, constantly listens to internal sensations, becomes quick-tempered and irritable. The disease becomes chronic, but its diagnosis is sometimes complicated by the absence of pain or its uncharacteristic manifestation, which is mistaken for symptoms of another lesion. They begin to treat him, often on their own, and the use of drugs in such cases only exacerbates the overall clinical picture.

2 The initial stage of the disease

At an early stage of a duodenal ulcer, the symptoms are outwardly similar to the same disease of the stomach. The specialist can determine the localization of the lesion, based on the differences that appear with symptoms:

  • pain is observed only on an empty stomach, which leads to nightly meals to relieve the symptom;
  • when you press on the stomach, a person experiences pain;
  • frequent sour belching accompanied by heartburn is characteristic;
  • vomiting is observed with blood, later blood clots appear in the feces.

The intensity of pain can be different depending on the degree, location, pain threshold of the patient. Seasonal exacerbations are characteristic, which become habitual and expected, which causes personal changes. A person becomes a hypochondriac, begins to treat himself with increased attention, demand the same from others, constantly listens to his feelings, often falls into depression. This is due to indigestion, accompanied by heartburn, belching, nausea, vomiting.

Intestinal ulcers are characterized by constant heartburn, sometimes simply unbearable, causing burning pain and giving off a rotten egg or recently taken food. All this leads to high fatigue, sensitivity to the weather, sometimes hysteria and fixation on oneself. Loss of appetite, as with a stomach ulcer, is not observed, on the contrary, it is increased, because the feeling of hunger causes pain, which food can soothe.

similarity external manifestations ulcers of the stomach and intestines at an early stage sometimes makes it difficult to localize the lesion. In the absence of appropriate treatment, which includes diet, the signs change somewhat and progress, indicating the stage of exacerbation.

3 Symptoms of exacerbation

Help not provided on time, irresponsible attitude to health digestive system cause an exacerbation of stomach ulcers, and the symptoms usually make you seek medical advice. During this period, the pain intensifies, becomes unbearable, accompanied by negative manifestations. It can hurt between the shoulder blades and in the lower back.

Atypical pain manifestations are accompanied by belching, nausea, vomiting, heaviness in the abdomen, general weakness, and increased sweating. The clinical picture may be individual, with the absence of some symptoms, but the main signs, including stool disorders, indicate the pathology of the digestive organs. When trying to survive an exacerbation, which usually manifests itself in autumn or spring, you can wait for the manifestation of life-threatening complications:

  • destruction of the stomach wall (penetration);
  • holes in the wall of the stomach (perforations);
  • development of an oncological disease (malignancy);
  • bleeding;
  • pyloric stenosis (narrowing of the narrow part of the stomach, up to a complete refusal to eat food that causes discomfort).

Treatment of an exacerbation of the disease, depending on the degree of its severity, can be inpatient, surgical, drug-dietary, strictly under the supervision of a doctor.

4 Duodenal ulcer

With an exacerbation of a duodenal ulcer, pain symptoms are characterized by the same intolerance and intensity as with a stomach ulcer. There comes a sharp change in the sensations of taste buds, heartburn, nausea, vomiting, constipation, a grayish coating on the tongue, and a fairly frequent increase in temperature. There may be a pulling pain under the right rib.

A characteristic sign is an aversion to dairy products, fruits, with increased appetite caused by the desire to get rid of pain by eating, weight loss is observed, constipation can be replaced by loose, fetid stools. Damage to the duodenum, which is not treated, can lead to:

  • disorders of the digestive system;
  • inflammation of the pancreas;
  • stagnation of bile;
  • stones in the gallbladder;
  • disruption of the liver;

The duodenum is the section of the gastrointestinal tract from the stomach to the jejunum. The organ received such an unusual name because of its length of 12 fingers located across. A duodenal ulcer (DU) is a disease of a relapsing nature, in which the mucous membrane of the organ is damaged with its further scarring. Characteristic is the alternation of the period of exacerbation and remission.

Types of ulcerative conditions of the duodenum in the acute stage can be as follows:

  • with bleeding,
  • with perforation,
  • without complications in the form of bleeding and perforation,
  • with bleeding and perforation.

duodenal ulcer in chronic stage has the same subspecies.

Why does duodenal ulcer form?

The main causes of duodenal ulcers are reduced to a long course of duodenitis - inflammation of its mucosa without the necessary treatment.

The disease develops due to two main factors:

  1. Impact of hydrochloric acid because of the acidity of the stomach. An aggressive effect occurs after acidic gastric juice enters the duodenum, is characterized by inflammation and further formation of an ulcer.
  2. Infection with Helicobacter pylori leads to long-term asymptomatic development of peptic ulcer. The bacterium enters the gastrointestinal tract, attaches to the walls of the stomach and duodenum, multiplies, releasing harmful substances that can lead to the death of mucous membrane cells. There is also an increase in acidity due to the release of ammonia by the bacterium.

It is believed that the disease affects more often young men due to neglect in a healthy way life, in particular:

  • Abuse alcoholic drinks and smoking, as well as large amounts of coffee and coffee drinks,
  • Disturbed diet with long intervals,
  • Eating too many foods that irritate the mucous membrane - salty, spicy, smoked and sour foods,
  • Availability chronic inflammation- gastritis and duodenitis,
  • Unstable emotional situation, psychological overstrain,
  • Genetic predisposition to this disease due to increased secretory function of the stomach.
  • Frequent use of medications - anti-inflammatory nonsteroidal drugs and glucocorticosteroids. The first group includes aspirin, ibuprofen, etc., the second - prednisolone.

How to suspect duodenal ulcer

Symptoms of a duodenal ulcer are most often clearly seen during an exacerbation. As a rule, it is spring and autumn. They appear as:

  • Pain syndrome of a stabbing or cutting nature. Pain is often localized in the upper abdomen below the sternum, under the right rib, in the back. These sensations depend on eating. Most often they appear on an empty stomach, as well as a couple of hours after eating. Pain in a duodenal ulcer will disappear after eating. This is due to the irritating effect of gastric juice on the mucous membrane. Almost all patients experience pain at night. This is easily explained by the fact that most of the hydrochloric acid is produced around 2 am.
  • The emergence of a feeling of hunger after a short period of time from the last meal.
  • Dyspepsia, characteristic of stomach ulcers, is less pronounced with duodenal ulcers. It appears as:
    • nausea,
    • vomiting,
    • belching,
    • heartburn,
    • swelling.
  • Lack of appetite due to severe pain syndrome. The result is weight loss.
  • With inadequate treatment, as well as its absence, internal bleeding or perforation of the ulcer may occur. The first is accompanied by the release of black feces. The second is the presence of severe pain in the stomach.
  • In rare cases, there may be no symptoms in a duodenal ulcer. This is especially true for the elderly.

There are no clear signs of a duodenal ulcer that allow you to accurately determine the presence of the disease without diagnostic measures.

How is duodenal ulcer diagnosed and treated?

When a patient contacts with complaints characteristic of peptic ulcer, the doctor begins the diagnosis by collecting data. To do this, it turns out the nature and location of pain, history, heredity, comparison with seasonality. During a visual examination, the doctor performs palpation of the abdomen in the region of the duodenum.

Diagnosis of a duodenal ulcer includes:

  • Determination of Helicobacter pylori in the blood by counting antibodies.
  • Measurement of the acidity of gastric juice, which allows to determine the main cause of the development of the disease - excessive secretion of hydrochloric acid,
  • X-ray of the duodenum with a contrast agent, allows you to identify the following pathological conditions:
    • mucosal defect - with a delay of a contrast agent in any area,
    • retraction of the mucosa on the opposite side of the ulcer,
    • scarring of the ulcer - the folds are arranged in the form of a star,
    • enhanced or delayed release of the contents of the duodenum.
  • FGS - endoscopic examination using a special apparatus. A modern method that allows you to personally determine the location and size of ulcers, bleeding and other complications. An approximate picture obtained by a diagnostic doctor during this examination is visible in the photo of a duodenal ulcer.
  • Examination of the duodenal mucosa material for the presence of Helicobacter Pylori.
  • As a result of determining the localization, the cause of the appearance and size, the doctor prescribes the treatment of duodenal ulcers. It may include 3-4 components and proceed within 2-3 weeks.

The main medicines for the treatment of ulcers are:

  • Antibiotics and antibacterial drugs - to eliminate Helicobacter pylori infection inside the body
    • macrolides. These include erythromycin and clarithromycin. In the case of the use of the latter in tablet form, it is necessary to adhere to a two-time intake after meals.
    • penicillin antibiotics. Ampiox is administered every 6 hours after meals.
    • metronidazole is applied every 8 hours.
  • The reduction of the secretory function of the stomach with a decrease in acidity and the elimination of pain is achieved by taking the following drugs:
    • remedies for duodenal ulcers based on bismuth. A striking example of such a drug is De-nol with an antibacterial effect on Helicobacter Pylori and an astringent property of the gastric mucosa. Reception is carried out before meals for 30 minutes in the amount of 4 times.
    • Omeprazole is taken before meals 2 times a day.
    • inhibitor of H2 - receptors - ranitidine - a couple of times a day, also before meals.
  • Elimination of pain with the help of a protective film on the duodenal mucosa. These types of drugs include antacids:
    • almagel, maalox - a spoon half an hour before meals.

In addition to medication, it is possible to treat the duodenum with the help of surgical methods. They become necessary when complications of a duodenal ulcer occur. These main conditions include:

  • Perforation of an ulcer is a through hole in the wall of the duodenum, which ensures the release of its contents into the abdominal cavity with the further development of peritonitis. This condition can be determined by the presence of acute shooting pain in the abdomen.
  • Ulcerative bleeding - as a result of corroding the walls, vessels suffer, which can begin to bleed. The main symptom is the presence of occult blood in the stool.
  • Ulcer penetration - the passage of an ulcer from the duodenum into the pancreas. This condition is characterized by acute pancreatitis.
  • Duodenal stenosis - the occurrence of a large scar in the duodenum. There is a delay in the movement of the contents into the following sections of the gastrointestinal tract, accompanied by vomiting.
  • Ulcer malignancy is a rare phenomenon accompanied by malignancy of mucosal cells in the area of ​​the ulcer and further development tumors.

As a rule, they resort to them very rarely. To do this, the area of ​​the gastrointestinal tract affected by the ulcer or the area where the nerve endings of the vagus nerve intersect is removed.

An exacerbation of a duodenal ulcer will become less likely if you follow a strict diet and diet with no addictions - alcohol, smoking. A stable emotional background is also necessary.

Diet for duodenal ulcer

Speaking of diet, food should be soft and well-chopped, have an average heating temperature - not too cold or hot. According to its characteristics, it should not be too salty, oily and spicy. The calorie content of the consumed daily dose of food should be equal to 2000. The number of meals should be 5. Thus, eating in small portions that are easily digested in the gastrointestinal tract is achieved. Food should be cooked by boiling or steaming. As drinks, it is desirable to use therapeutic mineral waters without gases - Essentuki and Borjomi, as well as teas with mint and lemon balm positively affect the duodenal mucosa.

Peptic ulcer of the duodenum involves the use of the following products:

  • Dairy products with a low fat content - milk, cottage cheese, sour cream, kefir.
  • Lean varieties of fish - pike perch, perch.
  • Meat low-fat varieties- white meat chicken, rabbit, veal.
  • Different kinds cereal crops- rice, buckwheat, hercules.
  • Dried bread after 1-2 days from production or crackers.
  • Boiled and steamed vegetables and fruits - beets, carrots, zucchini, eggplant, potatoes.
  • The use of various vegetable oils for food - olive, sea buckthorn, sunflower, corn.
  • Light pureed vegetable soups.

Both acute and chronic duodenal ulcer implies an absolute prohibition of the use of:

  • Fried, salty, as well as spicy and too spicy dishes,
  • Fruits with a high content of acid - pineapples, lemons, tomatoes, a number of citrus fruits.
  • Smoked meats and canned food,
  • Fatty meat - pork and lamb,
  • Fatty fish - salmon,
  • Pickled dishes - cabbage, cucumbers and tomatoes,
  • Fresh rye bread and muffins.

Preventive measures to prevent duodenal ulcer

The main measures to prevent such a painful condition are:

  1. Prevention of infection with Helicobacter Pylori infection - use only your own utensils due to the fact that infection occurs through saliva.
  2. Measures to prevent excessive release of hydrochloric acid in the area of ​​​​the stomach and duodenum - the rejection of habits harmful to the body - smoking and alcohol, the elimination of emotionally unstable conditions, adherence to diet and diet.
  3. Timely treatment of gastritis and duodenitis.

If you suspect a duodenal ulcer, you should consult a gastroenterologist who will help you get examined and tell you how to treat a duodenal ulcer. If there is a possibility of perforation or bleeding from the site of the ulcer, it is urgent to seek help from emergency doctors with subsequent hospitalization.

Ulcerative lesions occur on various grounds from malnutrition to genetic predisposition. It is very important to control this disease, as it can quickly develop into a cancerous tumor or reach the stage of perforation, when all the fluid from the duodenum or stomach comes out into the abdominal cavity. It is possible to recognize a duodenal ulcer, which affects mainly male patients from 20 to 50 years old, by various characteristic signs, after which it is necessary to immediately begin therapy to eliminate the pathology.

Signs of duodenal ulcer, symptoms

The main signs of the manifestation of the disease include the following manifestations:


Localization of pain in duodenal ulcer

Attention! The described symptoms affect the patient only in the acute stage. If the duodenal ulcer is mild or in remission, the maximum that will bother the patient is nausea and rare pain.

Causes of duodenal ulcer

Disease occurs in different reasons, the main ones being:

  • a large number of bacteria of the Helicobacter type, which are especially active in inflammatory processes, non-observance of elementary rules of personal hygiene;
  • poor psycho-emotional background, which can be characterized by prolonged depression, breakdowns, panic attacks and stress;
  • a hereditary factor, which is especially often transmitted only through the male line;
  • excessive acidity of gastric juice, which, with improper nutrition, actively enters the duodenum;
  • chronic inflammatory processes in the duodenum, which may have stages of remission and exacerbation;
  • a strong decrease in the protective functions of the body due to the presence or transfer of other diseases, including colds;
  • poor-quality food, with a lot of fatty and spicy foods;
  • excessive consumption of alcoholic products;
  • constant use of drugs to fight pathogenic bacteria and the use of steroids.

Symptoms of a duodenal ulcer

Attention! It is possible that a duodenal ulcer in a patient was provoked by several factors at once, which only a competent specialist will help to understand.

Medical treatment of ulcers

Talcid

Talcid is a powerful antacid medicinal product

A powerful antacid drug that is taken one hour after a meal. Usually, adults are prescribed two tablets of the drug, and the number of daily doses is four. It is recommended to carefully chew the pills, and then drink them with a small amount of any liquid, except for coffee and alcohol. AT childhood you can take 0.5-1 tablet per dose three times a day. The duration of therapy is approximately one month.

Relzer

You can take the medication in the form of a suspension or tablets. It is recommended to drink Relzer an hour after eating, and also before going to bed, in order to exclude the appearance of nighttime hunger pains. Adult patients and children over 15 years of age should take 1-2 scoops of the drug four times a day. In the form of tablets after 15 years, the drug is taken in two doses, also four times a day. The recommended duration of therapy is approximately two weeks; treatment should not be completed earlier even if symptoms disappear.

No-Shpa

No-Shpa tablets for duodenal ulcer

It is taken with severe pain syndrome for three to five days. The patient can take up to four tablets per day. Chewing or dividing them is not required, they are washed down only with clean water. You can take the recommended dose of an antispasmodic at any time without regard to food intake. If within three days the pain does not decrease, a mandatory additional examination is required to exclude bleeding and perforation of the ulcer.

Omez

Belongs to a class of antibiotics that contain the active substance omeprazole. Quickly relieves pain, inflammation and severe pain against the background of a duodenal ulcer. In the presence of ulcerative lesions, the patient is recommended to take 20 mg of the active substance twice a day for three weeks. If the ulcer has already provoked serious health complications, Omez is taken by intravenous infusions of 40 mg per day. The duration of such therapy is strictly individual.

famotidine

A medical preparation, the action of which is aimed at reducing the acidity of gastric juice, which helps prevent damage to the mucous membrane of the stomach and duodenum. Take the drug at 20 mg twice a day for four to eight weeks. If necessary, the patient may be advised to take 40 mg of the active substance once a day just before going to bed. The duration of therapy in this case is also 1-2 months.

Attention! Antacids are strictly prohibited from being mixed with other drugs. If you need to take several medications at once, antacids are taken two hours earlier or later.

Treatment of duodenal ulcer with folk remedies

Honey and olive oil

To prepare the medicine, you need to take 250 ml of pure linden honey and the same amount vegetable oil. Since honey quickly sugars, before mixing it is necessary to melt it in a water bath, bringing it to a temperature not higher than +65 degrees, the lower the temperature of the mixture, the better. After that, the oil and honey are carefully mixed and stored strictly in the refrigerator for 14 days. It is recommended that the patient consume a tablespoon of the mixture 15 minutes before meals. Since a patient with an ulcer must eat at least five small meals a day, it is worth taking the honey-olive mixture at least five times as well. The maximum allowable daily dose is seven tablespoons. The duration of therapy is two weeks.

psyllium seeds

To prepare the medicinal mixture, you need to take a tablespoon of the herbal mixture without a slide. It is added to 100 ml of boiling water, covered tightly and left to infuse all night, it is advisable to hold the mixture for at least 10 hours. After that, plantain seeds are removed with clean gauze and a ready-made solution of 15 ml is taken strictly one hour before meals three times a day. It is better to postpone the last reception for the evening. The duration of therapy is approximately 5-10 days, it all depends on the tolerability of the treatment and the severity of the patient's condition. It is used only during an exacerbation.

Propolis with oil


Signs when in the morning sucks in the stomach, nausea worries, hunger can be a signal of an impending disaster called an "ulcer". There is no need to wait for a persistent pain syndrome and formidable complications, but it is better to visit a therapist without delay at the slightest suspicion of the presence of a pathology. Consider what a duodenal ulcer is, its symptoms and treatment, diet, complications and consequences.

What is the duodenum

DPC (duodenum) - a section of the alimentary canal, located immediately behind the stomach. Its length is equal to the width of 12 fingers (fingers), which is 25-30 cm. It is similar in shape to a loop with a bend around the head of the pancreas. The wall consists of the same layers as the entire alimentary canal:

  1. External (from connective tissue) - performs protective functions.
  2. Muscular - provides contractile activity, contains nerve nodes.
  3. Submucosal (with many blood and lymphatic vessels) - forms crescent and spiral folds. They are not smoothed out even when the intestines are overflowing with food gruel.
  4. Mucous (with short and wide villi).

The duodenum is a part of the small intestine that performs a number of important functions:

  • The breakdown of carbohydrates, fats and proteins into molecules that can be absorbed into the blood.
  • Shift in the pH of food coming from the stomach towards an acidic reaction.
  • Regulation of the process of secretion of pancreatic juice and bile, depending on the nutrients contained in the chyme.
  • The job of a gatekeeper.

What causes an ulcer

Duodenal ulcer (ICD code 10 K26) occurs when the balance between the aggressive factors of the digestive canal and its protective capabilities is disturbed:

  • Creation of an alkaline environment.
  • Secretion of mucus.
  • Blood supply and nutrition of cells.

The disease begins with inflammation of the mucosa DPC, and ends with the formation of serious defects on it with a bottom in the muscle layer. They appear, as a rule, in the initial section of the duodenum, where acidic gastric juice is most often thrown.

The disease occurs in 10% of the population. Mostly they are young and middle-aged men. They are not drafted into the army.. In women, pathology is less common due to estrogens, which provide a trophic effect on tissues, improve their blood supply and nutrition, and increase vitality. It is not uncommon for women with an ulcer to recover completely during pregnancy.

Among the causes of the disease, not the last place is occupied by a spiral - a common inhabitant of the gastrointestinal tract. It coexists with the host for a long time, but under certain conditions it sharply increases the number of the colony and damages the cells that produce mucus.

Early theories of ulcer development include an imbalance between the protective properties of the mucosa and the destructive effects of enzymes and hydrochloric acid, which are observed with pylorus dysfunction. Today, no one denies that there are more ulcers among people with I blood group.

In Soviet times, the prevailing opinion was that defects in the duodenum are more often formed in people exposed to chronic stress, overwork (this stimulates the release of gastrin as an inflammatory mediator). The hormone is released in a larger volume if a person stays in the sun for a long time. Gastroenterologists are sure that an ulcer is a psychosomatic disease. Usually, people with constant mood swings, excessive suspiciousness, excitability, and anxiety suffer from it. An important circumstance is the weakening of the immune system.

Provocateurs of ulceration include corticosteroids and non-hormonal anti-inflammatory drugs, as well as antibiotics. The mucous membrane suffers from the negative effects of nicotine and alcohol. Ethyl alcohol causes her direct harm.

The repetition of the "family scenario" threatens those who had ulcers in their family. The reason is hereditary factors, namely psychological status, as well as the number of cells that produce hydrochloric acid. In combination with malnutrition, a hectic lifestyle, the likelihood of defects on the walls of the duodenum reaches 100%.

Symptoms of an ulcer, how it hurts

The pathology is characterized by a chronic relapsing course. Periods of exacerbations are replaced by remissions. In place of the damaged mucosa, scars form. Them big number deforms and narrows the lumen of the duodenum 12. Signs of an ulcer are more pronounced during exacerbation, among them:

  • Pain above the navel radiating to the region of the heart and scapula. Occurs at night, 2-3 hours after eating. It increases with the abuse of alcohol, non-compliance with the diet, taking a number of medications.
  • Mild belching and heartburn.
  • Feeling of a full stomach.
  • Nausea and vomiting.
  • Disorders of the stool with prolonged constipation, feces with mucus or blood impurities.
  • Irritability, sleep problems.
  • Weight loss even with a good appetite.

The disease worsens during the off-season. The most difficult, according to doctors, is a "silent" ulcer that occurs without pain. Occurs in 15% of cases. It makes itself felt only during exacerbation in the form of perforation or bleeding.

Accurate diagnosis

To diagnose a peptic ulcer, a doctor needs to find out:

  • How often discomfort in the epigastric region worries, what is it associated with.
  • Whether blood relatives suffered from problems with the gastrointestinal tract.

The patient is offered to take tests:

  • Urine, blood, feces.
  • To determine the pH level of gastric juice.

Among the instrumental diagnostic methods:

  • and elucidation of the state of the mucous layer with a biopsy for histological examination of the nature of the defects. The doctor can visually assess the characteristics of the ulcers. In parallel, it is possible to remove existing polyps.
  • to consider the outlines of the duodenum, its deformations, areas of narrowing, neoplasms. An outdated method that is used if the medical institution does not have the appropriate equipment or the patient has had a stroke, suffers from angina pectoris, recurrent attacks of bronchial asthma, and severe arrhythmias.

Ultrasound of the abdominal organs is one of the less informative methods for diagnosing the disease in question, but it also clarifies the overall picture.

Treatment of duodenal ulcer

The disease is successfully cured according to one of the specially designed schemes, including drip, injection, tablet preparations. Along with conservative therapy, useful:

  • Improving gymnastics, eliminating congestion in the digestive canal.
  • Spa treatment.
  • Physiotherapy.
  • Compliance with a special diet.

Together, these measures help get rid of Helicobacter pylori and bulbitis, do not allow development negative consequences. In case of complications, the patient is hospitalized in order to observe and take timely measures in each case.

Medicines

Conservative therapy is based on proton pump inhibitors to reduce the secretion of hydrochloric acid:

  • Omez.
  • Losek.
  • Gastrosol.
  • Pariet.

Gastrocepin and other drugs that block M-cholinergic receptors help to reduce the synthesis of pepsin and chloride acid, to resist pain. Their use often leads to dry mouth and increased heart rate.

H2-histamine blockers are no longer used in the practice of treatment, since when they are canceled, the signs of pathology quickly return.

Sucralfate is used to protect the bottom of the ulcer, De-nol helps to create a film on intestinal defects. Prostaglandins are used to stimulate regenerative processes and mucus formation.

Symptomatic treatment of duodenal ulcers is carried out using some groups of medicines:

  • Antispasmodics.
  • Drugs that improve the nutrition of the mucosa.
  • Antidepressants to calm the central nervous system.
  • Cerucal, Metoclopramide and other prokinetics to normalize intestinal motility.

Antacids in liquid form: Almagel, Maalox, in tablet form (Becarbon, Bellalgin) help eliminate heartburn, neutralize hydrochloric acid, and have an adsorbing astringent effect. The duration of action is from 10 minutes to an hour, depending on the alkalizing properties of the drug. Reception schedule: several times during the day with an additional portion at night.

In the presence of Helicobacter, antibacterial drugs are used:

  • Clarithromycin.
  • Amoxicillin.
  • Metronidazole.

If the microbes survived, therapy is carried out according to a different scheme. The process is controlled by a doctor. Self-medication can result in complications.

The duration of therapeutic measures is affected by the general condition of the patient, as well as the size of the ulcers. They usually last from 2 to 6 weeks. With exacerbation, bed rest and rest are indicated.

Baking soda, which has always been the #1 remedy for high acidity of gastric juice, really instantly neutralizes the cause of low pH. But it leads to the release of large volumes of carbon dioxide, which only enhances the secretory capabilities of the duodenum. Therefore, with frequent use, it does more harm than good.

Folk remedies

Among the most effective compositions:

  • Freshly squeezed potato juice(can be combined with cabbage). It is prepared simply: chop healthy tubers and squeeze out the liquid part from them. From 1 to 3 days - drink 1 tbsp. l. 3 times a day half an hour before meals. From 4 to 6 - 2 tbsp. l. With a gradual increase to 125 ml at a time. The course of treatment is 3-4 weeks. Take on a diet. Repeat if necessary.
  • No less useful natural honey. Ayurveda uses it to transport a range of healing medicines. It can be eaten in its pure form or taken in combination with olive oil (1:1) 5-6 times a day, 1 tbsp. l. mixtures. A course lasting 2 weeks is repeated if necessary after 10 days.
  • A decoction of 10 g of plantain seeds and 100 ml of boiling water. Let cool, drink 3 times 1 tbsp. l. one hour before meals.
  • A mixture of a kilogram of melted butter and 150 g of crushed propolis. For complete dissolution, hold in a water bath, store in the cold. Take 1 tsp. 3 times an hour before meals. The course of treatment is a month. You can repeat after 3 weeks.
  • Powerful wound healing antimicrobial anti-inflammatory action is characteristic of St. John's wort. His decoction is drunk in 1 tsp. on an empty stomach
  • To reduce the time of scarring of ulcers, relieve pain and discomfort in the abdomen, you can also use yarrow and calendula.

All folk remedies can be taken only after the permission of the doctor.

Surgery

Surgery is indicated for the following conditions:

  • The presence of polyposis, which increases the secretion of gastric juice.
  • Bleeding.
  • The degeneration of an ulcer into a cancerous neoplasm.
  • The ineffectiveness of drug therapy.

Local excision of the ulceration or resection of the duodenum is performed.

Diet

A sparing diet for an ulcer should become part of the patient's life. It can be zigzag, that is, during an exacerbation, it is as dietary as possible, and during periods of calm (within reasonable limits), even some harmful foods are allowed. Remissions will be longer if:

  • Eat at least 5 times a day in small portions.
  • Avoid cold and too hot foods optimum temperature for ulcer 25-30 °C.
  • Salt minimum.
  • With an exacerbation, only grated food.
  • Soft ripe fruits and vegetables.
  • Dilute concentrated juices with water.

Allowed and prohibited products

The list of dangerous products includes those products that provoke an increase in the acidity of gastric juice:

  • Sweets and rye bread.
  • Rich broths.
  • Fried meals.
  • Canned food.
  • Smoked products.
  • Citrus.
  • Garlic and onion.
  • Alcohol, fortified and dry wines.
  • Sparkling water.

The diet should include more soups with milk and vegetable broths, cereals, boiled meat and lean fish.

Foods rich in fiber irritate the walls of the duodenum. Therefore, it is worth eliminating or limiting the use of corn, peas, radishes, white cabbage.

Exacerbation of the ulcer

If a person violates the medical and protective regimen, does not follow a diet, abuses alcohol, is exposed to constant stress, then a chronic disease, which is characterized by an undulating course, inevitably worsens. In spring and autumn, the body's resistance decreases, so the manifestation of the ulcer becomes brighter. Rescues intensive therapy carried out in the department of surgery or gastroenterology for a period of 2 to 8 weeks.

Complications and consequences

With timely treatment of a duodenal ulcer, it is possible to stop the pain, achieve healing of the mucous membrane, and long periods of satisfactory well-being. Without adequate medical care, quite serious conditions are possible:

  • Narrowing (stenosis) of the duodenal lumen as a result of scarring. In this case, stagnation of food occurs, as well as repeated vomiting.
  • Internal bleeding, which can be recognized by dark, tarry stools, loss of consciousness.
  • The development of a cancerous tumor at the site of mucosal defects.

Particularly dangerous is intestinal perforation, which looks like a sudden rupture of its membranes with characteristic signs:

  • "Plate-like belly".
  • Nausea, vomiting.
  • Cold sweat.
  • Thirst.
  • Dagger pain.

After a while, the discomfort partially disappears. An imaginary improvement lasts no more than 24 hours, then peritonitis develops with chills, fever up to 38-39 ° C, confusion. In this condition, the patient must be urgently taken to the hospital.

The main symptoms of a stomach ulcer (peptic ulcer) are pain and dyspeptic syndromes (a syndrome is a stable set of symptoms characteristic of a given disease).

Pain is the most typical symptom of peptic ulcer of the stomach and duodenum. It is necessary to find out the nature, frequency, time of occurrence and disappearance of pain, the connection with the intake of food.

Up to 75% of patients complain of pain in the upper abdomen (more often in the epigastric region). Approximately 50% of patients experience pain of low intensity, and about a third of patients experience pronounced pain. The pain may appear or increase with physical exertion, eating spicy food, a long break in eating, drinking alcohol. In a typical course of peptic ulcer, pains have a clear connection with food intake, they occur during an exacerbation of the disease and are characterized by seasonality - they occur more often in spring and autumn. In addition, a decrease or even disappearance of pain after taking soda, food, antisecretory (omez, famotidine, etc.) and antacid (almagel, gastal, etc.) drugs is quite characteristic.

Early pain occurs 0.5-1 hour after eating, gradually increases in intensity, persists for 1.5-2 hours, decreases and disappears as gastric contents move into the duodenum; characteristic of gastric ulcers. With the defeat of the cardiac, subcardial and fundal departments, pain occurs immediately after eating.

Late pain occurs 1.5-2 hours after eating, gradually intensifies as the contents are evacuated from the stomach; characteristic of ulcers of the pyloric stomach and duodenal bulb.

"Hungry" (night) pains occur 2.5-4 hours after eating, disappear after the next meal; characteristic of duodenal ulcers and pyloric stomach. The combination of early and late pain is observed with combined or multiple ulcers.

The intensity of pain may depend on age (more pronounced in young people), the presence of complications.

The most typical projection of pain, depending on the localization of the ulcerative process, is the following:

  • with ulcers of the cardiac and subcardial sections of the stomach - the region of the xiphoid process;
  • with ulcers of the body of the stomach - the epigastric region to the left of the midline;
  • with ulcers of the pyloric and duodenal ulcers - the epigastric region to the right of the midline.

Palpation of the epigastric region may be painful.

The absence of the typical nature of pain does not contradict the diagnosis of peptic ulcer.

Dyspeptic syndrome is characterized by heartburn, belching, nausea, vomiting, impaired stool, as well as a change in appetite, a feeling of fullness or bloating of the stomach, a feeling of discomfort in the epigastric region. Heartburn occurs in 30-80% of patients, it can be persistent and usually appears 1.5-3 hours after eating. At least 50% of patients complain of belching. Nausea and vomiting are not uncommon in peptic ulcer disease, most often vomiting develops at the height of pain and brings relief to the patient, so patients can induce vomiting artificially. Almost 50% of patients suffer from constipation, which is more often observed with an exacerbation of the process. Diarrhea is not typical. Severe disturbances of appetite in peptic ulcer, as a rule, are not observed. The patient may restrict himself in nutrition with severe pain, which happens during an exacerbation.

It is imperative to clarify with the patient the presence of episodes of vomiting of blood or black stools (melena). Additionally, physical examination should purposefully try to identify signs of a possible malignant nature of ulceration or the presence of complications of peptic ulcer.

With a favorable course, the disease proceeds without complications, with alternating periods of exacerbation lasting from 3 to 8 weeks, and periods of remission, the duration of which can vary from several months to several years. An asymptomatic course of the disease is also possible: the diagnosis of peptic ulcer during life is not established in 24.9-28.8% of cases.

Symptoms of peptic ulcer depending on the localization of the ulcer

Symptoms of an ulcer of the cardiac and subcardial stomach

These ulcers are localized either directly at the esophageal-gastric junction or distal to it, but not more than 5-6 cm.

Characteristic for cardiac and subcardial ulcers are the following features:

  • men over the age of 45 are more likely to get sick;
  • pain occurs early, 15-20 minutes after eating and is localized high in the epigastrium at the xiphoid process itself;
  • Pain quite often radiates to the region of the heart and can be mistakenly regarded as angina pectoris. In differential diagnosis, it should be borne in mind that pain in coronary heart disease appears when walking, at the height of physical activity and disappears at rest. Pain in cardiac and subcardial ulcers is clearly associated with food intake and does not depend on physical wear, walking, does not calm down after taking nitroglycerin under the tongue, as with angina pectoris, but after taking antacids, milk;
  • weak expressiveness of a pain syndrome is characteristic;
  • pain is often accompanied by heartburn, belching, vomiting due to insufficiency of the cardiac sphincter and the development of gastroesophageal reflux;
  • often ulcers of the cardial and subcardial stomach are combined with a hernia of the esophageal opening of the diaphragm, reflux esophagitis;
  • the most characteristic complication is bleeding, ulcer perforation is very rare.

Symptoms of an ulcer of the lesser curvature of the stomach

Lesser curvature is the most common localization of gastric ulcers. Characteristic features are the following:

  • the age of patients usually exceeds 40 years, often these ulcers occur in the elderly and the elderly;
  • pains are localized in the epigastric region (slightly to the left of the midline), occur 1-1.5 hours after eating and stop after the food is evacuated from the stomach; sometimes there are late, "night" and "hungry" pains;
  • pains are usually aching in nature, their intensity is moderate; however, in the acute phase, very intense pain may occur;
  • often observed heartburn, nausea, rarely vomiting;
  • gastric secretion is most often normal, but in some cases it is also possible to increase or decrease the acidity of gastric juice;
  • in 14% of cases they are complicated by bleeding, rarely by perforation;
  • in 8-10% of cases, malignancy of the ulcer is possible, and it is generally accepted that malignancy is most characteristic of ulcers located at the bend of the lesser curvature. Ulcers, localized in the upper part of the lesser curvature, are mostly benign.

Symptoms of an ulcer of the greater curvature of the stomach

Ulcers of the greater curvature of the stomach have the following clinical features:

  • are rare;
  • older men predominate among patients;
  • symptoms differ little from the typical clinical picture stomach ulcers;
  • in 50% of cases, ulcers of the greater curvature of the stomach are malignant, so the doctor should always consider an ulcer of this localization as potentially malignant and make repeated multiple biopsies from the edges and bottom of the ulcer.

Symptoms of an antral ulcer

Ulcers of the antrum of the stomach ("prepyloric") account for 10-16% of all cases of peptic ulcer and have the following clinical features:

  • occur predominantly in young people;
  • the symptomatology is similar to the symptomatology of duodenal ulcer, late, “nightly”, “hungry” pains in the epigastrium are characteristic; heartburn; vomiting of sour contents; high acidity of gastric juice; positive Mendel sign on the right in the epigastrium;
  • it is always necessary to carry out a differential diagnosis with a primary ulcerative form of cancer, especially in the elderly, since the antrum is a favorite localization of gastric cancer;
  • in 15-20% of cases are complicated by gastric bleeding.

Symptoms of a pyloric canal ulcer

Pyloric canal ulcers account for about 3-8% of all gastroduodenal ulcers and are characterized by the following features:

  • persistent course of the disease;
  • a pronounced pain syndrome is characteristic, the pains are paroxysmal in nature, last about 30-40 minutes, in 1/3 of patients the pains are late, nocturnal, "hungry", but in many patients they are not associated with food intake;
  • pains are often accompanied by vomiting of sour contents;
  • persistent heartburn, paroxysmal excessive salivation, a feeling of fullness and fullness in the epigastrium after eating are characteristic;
  • with many years of recurrence, ulcers of the pyloric canal are complicated by pyloric stenosis; other frequent complications are bleeding (the pyloric canal is abundantly vascularized), perforation, penetration into the pancreas; 3-8% have malignancy.

Symptoms of a duodenal ulcer

Ulcers of the duodenal bulb are more often localized on the anterior wall. The clinical picture of the disease has the following features:

  • the age of patients is usually younger than 40 years;
  • men are more often ill;
  • epigastric pain (more on the right) appears 1.5-2 hours after eating, there are often night, early morning, and “hungry” pains;
  • vomiting is rare;
  • seasonal exacerbations are characteristic (mainly in spring and autumn);
  • a positive symptom of Mendel is determined in the epigastrium on the right;
  • the most common complication is ulcer perforation.

When the ulcer is located on back wall bulbs of the duodenum in the clinical picture, the following manifestations are most characteristic:

  • the main symptoms are similar to the symptoms described above, which are characteristic of the localization of an ulcer on the anterior wall of the duodenal bulb;
  • often there is a spasm of the sphincter of Oddi, dyskinesia of the gallbladder of the hypotonic type (feeling of heaviness and dull pain in the right hypochondrium with irradiation to the right subscapular region);
  • the disease is often complicated by ulcer penetration into the pancreas and hepatoduodenal ligament, the development of reactive pancreatitis.

Duodenal ulcers, unlike gastric ulcers, are not malignant.

Symptoms of extrabulbar (postbulbar) ulcers

Extrabulbous (postbulbar) ulcers are ulcers located distal to the duodenal bulb. They make up 5-7% of all gastroduodenal ulcers and have characteristic features:

  • most common in men aged 40-60 years, the disease begins 5-10 years later compared to duodenal ulcer;
  • in the acute phase, intense pain in the right upper quadrant of the abdomen, radiating to the right subscapular region and back, is very characteristic. Often the pain is paroxysmal in nature and may resemble an attack of urolithiasis or cholelithiasis;
  • pains appear 3-4 hours after eating, and eating, in particular milk, stops the pain syndrome not immediately, but after 15-20 minutes;
  • the disease is often complicated by intestinal bleeding , the development of perivisceritis, perigastritis, penetration and stenosis of the duodenum 12;
  • perforation of the ulcer, in contrast to localization on the anterior wall of the duodenal bulb, is observed much less frequently;
  • in some patients, the development of mechanical (subhepatic) jaundice is possible, which is due to compression of the common bile duct by an inflammatory periulcerous infiltrate or connective tissue.

Symptoms of combined and multiple gastroduodenal ulcers

Combined ulcers occur in 5-10% of patients with peptic ulcer. At the same time, a duodenal ulcer initially develops, and after a few years - a stomach ulcer. The proposed mechanism for this sequence of ulcer development is as follows.

With a duodenal ulcer, mucosal edema, intestinal spasm, and often cicatricial stenosis of the initial section of the duodenum develop. All this complicates the evacuation of gastric contents, stretching of the astral region (antral stasis) occurs, which stimulates gastrin hyperproduction and, accordingly, causes gastric hypersecretion. As a result, prerequisites are created for the development of a secondary gastric ulcer, which is more often localized in the region of the stomach angle. The development of an ulcer initially in the stomach and then in the duodenum is extremely rare and is considered an exception. It is also possible to develop them simultaneously.

Combined gastroduodenal ulcer has the following characteristic clinical features:

  • the accession of a gastric ulcer rarely worsens the course of the disease;
  • pain in the epigastrium becomes intense, along with late, nocturnal, "hungry" pains, early pains appear (arising shortly after eating);
  • the zone of localization of pain in the epigastrium becomes more common;
  • after eating, there is a painful feeling of fullness in the stomach (even after taking a small amount food), severe heartburn, often worried about vomiting;
  • in the study of the secretory function of the stomach, pronounced hypersecretion is observed, while the production of hydrochloric acid can become even higher compared to the values ​​that were available with an isolated duodenal ulcer;
  • the development of such complications as cicatricial pyloric stenosis, pylorospasm, gastrointestinal bleeding, perforation of an ulcer (usually duodenal) is characteristic;
  • in 30-40% of cases, the attachment of a stomach ulcer to a duodenal ulcer does not significantly change the clinical picture of the disease, and a gastric ulcer can only be detected during gastroscopy.

Multiple ulcers are called 2 or more ulcers, simultaneously localized in the stomach or duodenum 12. Multiple ulcers are characterized by the following features:

  • tendency to slow scarring, frequent recurrence, development of complications;
  • in some patients, the clinical course may not differ from the course of a single gastric or duodenal ulcer.

Symptoms of giant ulcers of the stomach and duodenum 12

According to E. S. Ryss and Yu. I. Fishzon-Ryss (1995), ulcers with a diameter of more than 2 cm are called giant. A. S. Loginov (1992) classifies ulcers with a diameter of more than 3 cm as giant.

Giant ulcers are characterized by the following features:

  • are located mainly on the lesser curvature of the stomach, less often - in the subcardiac region, on the greater curvature and very rarely - in the duodenum;
  • pains are significantly pronounced, their periodicity often disappears, they can become almost constant, which requires differential diagnosis with gastric cancer; in rare cases, the pain syndrome may be mild;
  • characterized by rapid onset of exhaustion;
  • very often complications develop - massive gastric bleeding, penetration into the pancreas, less often - ulcer perforation;
  • careful differential diagnosis of a giant ulcer with a primary ulcerative form of gastric cancer is required; possible malignancy of giant gastric ulcers.

Symptoms of long-term non-healing ulcers

According to A. S. Loginov (1984), V. M. Mayorov (1989), ulcers that do not scar within 2 months are called long-term non-healing. The main reasons for the sharp lengthening of the healing time of the ulcer are:

  • hereditary burden;
  • age over 50;
  • smoking;
  • alcohol abuse;
  • the presence of pronounced gastroduodenitis;
  • cicatricial deformity of the stomach and duodenum;
  • persistence of Helicobacter pylori infection.

For long-term non-healing ulcers, the symptoms are erased, and the severity of pain decreases during therapy. However, quite often such ulcers are complicated by perivisceritis, penetration, and then the pain becomes persistent, constant, monotonous. There may be a progressive drop in body weight of the patient. These circumstances dictate the need for a thorough differential diagnosis of a long-term non-healing ulcer with a primary ulcerative form of gastric cancer.

Peptic ulcer in old age

Under the senile understand ulcers that first developed after the age of 60 years. Ulcers in old people or the elderly are called ulcers that first appeared at a young age, but remain active until old age.

Features of peptic ulcer in these age groups are:

  • an increase in the number and severity of complications, primarily bleeding, compared with the age when the ulcer first formed;
  • tendency to increase the diameter and depth of the ulcer;
  • poor healing of ulcers;
  • pain syndrome is mild or moderate;
  • acute development of "senile" ulcers, their predominant localization in the stomach, frequent complication of bleeding;
  • the need for careful differential diagnosis with gastric cancer.