Ulcer( peptic ulcer disease) of the stomach and duodenum - Causes, symptoms and treatment. MF.
Peptic ulcer( synonyms: peptic ulcer disease) - the formation of a ulcerative defect in the mucous membrane of the stomach or duodenum, as a result of the prevalence of aggression factors over the protective factors of the mucous membrane.
Causes of peptic ulcer.
| Reasons for | Peptic ulcer of the duodenum | Peptic ulcer of the stomach |
| Basic( 97-98%) | Infection with Helicobacter pylori. | Infection with Helicobacter pylori; Admission of NSAIDs( aspirin), corticosteroids( prednisolone). |
| Rare( 2-3%) | Acceptance of NSAIDs( aspirin), corticosteroids, cytotoxic agents; Crohn's disease; Hyperparathyroidism; Gastrinoma( Zolinger-Ellison syndrome); CNS disease; Cirrhosis of the liver; HIV infection. | Malignant neoplasms of the stomach( adenocarcinoma, sarcoma, etc.) and neighboring organs; Foreign bodies; Crohn's disease; Diabetes mellitus; HIV infection. |
Bacteria Helicobacter pylori and long-term administration( in a standard dosage, within a month) of non-specific anti-inflammatory drugs( NSAIDs), corticosteroids( prednisolone), cytostatics play a major role in the development of peptic ulcer. They damage the mucous membrane of the stomach and duodenum, weaken the mucosal protection factors and intensify the factors of aggression( increase in the level of hydrochloric acid, violation of the motility of the stomach).
Risk factors are only background, preparing the appropriate soil for the occurrence of various diseases.
Modifying factors( which can be affected):
1. Power failure.
2. Smoking, alcohol.
Have a negative effect on the course of the disease, often cause relapses.
3. Neuropsychiatric factors. Gastric secretion and gastric motility depend on the state of the nervous system. Depression, neuroses occur in 50-60% of patients.
Non-modifying factors( not to be affected):
1. Genetic predisposition.
2. Age and sex.
Ratio of men and women suffering from peptic ulcers 4: 1.It is believed that the body of a woman protects from pimples sex hormones. After the onset of menopause, this ratio is equalized. At a young age, peptic ulcers of the duodenum are more common, and in the older age groups - stomach ulcers.
Symptoms of peptic ulcer.
The leading signs of the disease are pain and dyspeptic( heartburn, sour stomach, nausea, vomiting) syndrome.
Pain occurs in the upper half of the abdomen, near the umbilical region. The nature of pain: paroxysmal, bursting, baking, they appear on an empty stomach( hungry pains), 2-3 hours after eating( in patients with peptic ulcer of the duodenum), decrease after eating. In patients with a stomach ulcer, pain occurs after half an hour - an hour after eating. Often pains are disturbed at night.
Heartburn - occurs due to throwing the contents of the stomach into the esophagus. It is characterized by a burning sensation behind the sternum. May occur after meals.
Nausea and vomiting are associated with increased vagal tone, increased gastric motility and hypersecretion of hydrochloric acid. Vomiting occurs at the height of pain, when it is maximally expressed. After vomiting, relief begins, the pain disappears or becomes noticeably weaker.
Many patients experience constipation.
With prolonged course of the disease, asthenia develops( weakness of malaise, insomnia), emotional lability. Decreased body weight is associated with a restriction in food intake, because of the fear of pain.
However, in the last decade the symptoms of peptic ulcer have changed. There were many malosymptomatic and atypical variants of peptic ulcer. The pains are often localized in the right hypochondrium, in the projection of the gallbladder, the appearance of pain in the lumbar region, similar to the pathology of the kidneys( pyelonephritis, urolithiasis), in the heart, behind the sternum, as in heart disease( angina, myocardial infarction).Sometimes the disease manifests itself only with heartburn, without pain syndrome. In 10% of patients, the disease occurs without clinical symptoms, only when complications occur - signs of the disease appear.
In case of frequent vomiting, diarrhea, adulteration of blood in the feces, severe weakness, you should immediately consult a doctor-therapist, gastroenterologist and undergo examinations to exclude complications or concomitant diseases.
Diagnosis of peptic ulcer.
1. EGDS( esophagogastroduodenoscopy) with targeted biopsy - is performed in all cases to establish a diagnosis. It determines the shape, size, depth of the ulcerative defect, reveals a violation of motility. When duodenal ulcers - once for diagnosis, with gastric ulcers - is repeated to control the healing of the ulcer.
2. Biopsy study:
- rapid urease test - express diagnostics of Helicobacter pylori;
- morphological study - for the diagnosis of Helicobacter pylor, mucosal status, malignant changes, exclusion of rare causes of peptic ulcers,
- bacteriological method. Helps to determine the sensitivity to antibiotics Helicobacter pylori.
3. The test for the presence of Helicobacter pylori - strictly required in every patient with a peptic ulcer. One of the test methods is sufficient: respiratory "C" - urease test, stool-test( the determination of Helicobacter pylori antigen in feces).
The results can be false-negative due to medication( antibiotics, bismuth preparations, proton pump inhibitors).Conducting the tests is possible only 4 weeks after stopping these medications.
4. General blood test( detection of anemia, inflammatory processes).
5. Analysis of feces for latent blood - diagnosis of acute and chronic hemorrhage.
6. X-ray examination of the stomach - if there are suspicions of complications, especially in the stenosis of the outlet stomach.
7. Ultrasound of the abdominal cavity organs - to detect concomitant pathology, complications.
8. Examination of the secretory function of the stomach( intragastric pH of the metry) - is important for the selection of the optimal treatment regimen.
9. Coagulogram - reduction of factors of the blood coagulation system.
Consultation of specialists.
Mandatory:
- the therapist;
- a gastroenterologist.
According to indications:
- surgeon - with complicated peptic ulcers( perforation, bleeding, stenosis);
- oncologist - if suspected of malignancy( malignant degeneration) of the stomach.
Treatment of peptic ulcer.
In peptic ulcers associated with Helicobacter pylori, the main treatment strategy is eradication therapy( complete elimination of bacteria).This leads to a rapid and qualitative scarring of ulcerative defects, and also reduces the risk of recurrence of the disease. Eradication therapy can kill bacteria in 80% of cases and almost does not cause side effects( no more than 5% of cases).Treatment is carried out according to standard schemes, which include antibiotics, proton pump inhibitors( omeprazole, pantoprazole, rabeprazole, esomeprazole), bismuth preparations. The necessary treatment regimen, dose of drugs, duration of treatment will be prescribed only by a physician-therapist, gastroenterologist.
After 4-6 weeks after the end of treatment, it is necessary to monitor the eradication of Helicobacter pylori with the help of a respiratory "C" urease test or stool-test( determination of Hp antigen in feces).And with a peptic ulcer of the stomach, it is also a control EGD.
With Helicobacter pylori negative peptic ulcers( when no bacteria are detected), the basis of treatment is the administration of antisecretory drugs: PPI( proton pump inhibitors) or H2-histamine receptors( famotidine).The choice of the drug, its dosage and the duration of treatment will be recommended by the doctor.
Locally active drugs are used only for the relief of pain or dyspeptic syndromes and do not form the basis of treatment. These include antacids, drugs, bismuth, antispasmodics, prokinetics. Antacids( Almagel, Maalox, fosfalugel, talcid, rutatsid) are used as enveloping agents, eliminate heartburn, pain. Take medication 3 times a day 1 hour after meals and 1 time at night.
In case of abnormal gastric motility, prescribe prokinetics( domperidone).Preparations of bismuth( de-nol) increase the factors of mucosal protection. The stool is painted black. When pain is prescribed spasmolytics( mebeverin, drotaverin).In asthenoneurotic conditions, the psychoemotional status is determined, with the subsequent prescription of appropriate drugs. Consultation of the psychotherapist is recommended.
The choice of the drug is determined by the specific clinical situation and performed by a specialist - a therapist or gastroenterologist.
Nutrition for stomach ulcer
To date, it has not been proven that liquid, sparing food reduces the manifestations and promotes the healing of peptic ulcers. Patients should avoid those foods that cause them pain, heartburn, nausea, constipation. Contraindicated late dinner, because it stimulates the production of hydrochloric acid at night, when the patient is sleeping and can not take antacids. It is recommended to stop smoking and alcohol abuse, as they contribute to relapse of the disease.
Folk remedies for stomach ulcers
The use of phytotherapy is based on the use of enveloping, analgesic, astringent, anti-inflammatory actions of medicinal plants. Collection of chamomile pharmacy( flowers) -10 grams, fennel( fruits) -10 grams, licorice( root) -10 g.2 teaspoons of the mixture brew 0.25 liters of boiling water, insist 30 minutes, filter. Take at night for 1 glass.
Rehabilitation after treatment.
Sanatorium treatment is an important rehabilitation measure. It is prescribed in the inactive period of the disease. Contraindications are complications of peptic ulcer( malignant degeneration, stenosis of the pylorus, bleeding - within the last 6 months), the first 2 months after surgical treatment, severe concomitant pathology. Sanatorium treatment includes a wide range of physiotherapeutic measures, the use of mineral water, aimed at normalizing the functions not only of the gastroduodenal region, but also of the body as a whole. Showing resorts: Zheleznovodsk, Essentuki, resorts of Transcarpathia, Truskavets.
Complications of peptic ulcer.
Complications of peptic ulcers include bleeding, perforation, penetration, stenosis of the pylorus, malignancy.
Stenosis of the gatekeeper is manifested by a feeling of fullness and pain in the epigastrium( the area under the xiphoid process), repeated vomiting eaten on the eve of food, weight loss.
When bleeding from the peptic ulcer, there is a sharp weakness, pale skin, vomiting at the beginning of the color of the coffee grounds, then unchanged blood with clots, black, tarry stool( melena), dizziness, falling blood pressure, loss of consciousness.
Perforation, perforation of the ulcer( breakthrough of the ulcers beyond the stomach or duodenum with the release of their contents into the abdominal cavity): sudden acute daggerache, localizing first at the site of perforation, then spreading throughout the abdomen, fatigue of the abdominal muscles, falling blood pressure.
Penetration( the spread of an ulcer beyond the walls of the stomach or duodenum in a number of lying organs - more often the pancreas, less often in the liver, the large intestine, the large omentum): constant pain in the upper abdomen with back pressure, collarbone, shoulder not related tofood intake. Reception of antacids does not stop the pain.
Malignancy of the ulcer( malignant degeneration): general weakness, decreased appetite, aversion to meat food, a sharp loss of body weight, constant aching abdominal pain, without clear localization.
In all cases of complications, urgent consultation of the therapist and surgeon is needed.
Prevention of peptic ulcer disease.
Preventive measures include the organization of a rational mode of work and rest, the rejection of bad habits, the use of ulcerogenic drugs( NSAIDs, corticosteroids, cytostatics).Patients who are forced to take these drugs for a long time should be monitored by the therapist. Prophylaxis is performed by taking proton pump inhibitors in the required dosage. Patients with a stomach ulcer and atrophic gastritis are subject to follow-up. In the presence of atrophy of the gastric mucosa - repeated EGDS with biopsy for monitoring the possibility of the appearance of precancerous conditions 1 time in 2 years.
Doctor's consultation on gastric and duodenal ulcer
Question: after the eradication therapy, a month later I passed stool-test( determination of the Helicobacter pylori antigen in the stool).The result is negative. Through the time, pains in the abdomen resumed. Has handed over again the analysis, result positive. What is the reason for this?
Answer: Relapse of the disease is probably associated with incompletely conducted eradication, with reinfection( repeated infection), with the use of ulcerogenic drugs( NSAIDs, corticosteroids, cytostatics), intensive smoking. Treatment of peptic ulcers associated with Helicobacter pylori should be performed before the complete elimination of bacteria. In resistant( drug-resistant) cases, treatment is carried out taking into account the results of bacteriological culture on the sensitivity to Helicobacter pylori.
Question: During the reception of medications, eradication of Helicobacter pylori( omeprazole, clarithromycin and amoxicillin) appeared liquid stool up to 4 times a day. What is the reason for this?
Answer: this is due to side effects of antibiotics. You can add to the treatment preparations that improve the intestinal microflora( lacidophil 2 capsules 3 times a day 2 hours before taking antibiotics)
Question: Is it possible to undergo an endoscopic examination of the stomach( EGDS) under anesthesia?
Answer: this is possible, but only after a preliminary consultation of an anesthesiologist.
Doctor therapist Irina Vostrykova
* Physical abuse in childhood and peptic ulcer have a connection
The victims of child physical abuse have twice the chance of an ulcer than people who have not been subjected to violence in childhood, according to a new study by scientists from the University of Toronto(University of Toronto).
"We have found a close and significant link between individuals who have been abused in childhood and who developed peptic ulcer disease in adulthood," says lead author Professor Esme Fuller Thomson. "Originally, I thought the link would be explainedfactors such as stress, obesity, smoking or alcohol abuse, factors that are very much associated with peptic ulcer, but even after adjusting for sixteen known variables, people who were exposed to physical abuse in childhood hadand 68% more likely to develop peptic ulcer. "
Co-author Jennifer Bottoms, emphasizes the double significance of the study."These results not only emphasize the importance of preventing child physical abuse," says Bottoms, "they also emphasize the need for regular screening of adults who have experienced childhood abuse because they are at risk of adverse health effects."
Professor Thomson's research will appear in the online version of the Journal of Interpersonal Violence. Researchers used data from a representative sample of a population of adult Canadians totaling 13,069 people. More than 1,000 people reported having been physically assaulted by a loved one before they turned 18 and 493 of them said that they had a peptic ulcer diagnosed in one of the medical facilities.