Peptic Ulcer
Peptic ulcer is a polygenically inherited chronic disease that occurs with the formation of ulcers in the stomach or duodenum with possible progression and development of complications.
In the structure of diseases of the gastrointestinal tract, peptic ulcer occurs in 1.7% of people. In the structure of peptic ulcer disease, duodenal ulcer is significantly prevalent, accounting for about 81% of all cases of the disease. Stomach ulcer makes up only 13% of all cases of peptic ulcer. The combination of duodenal ulcer and stomach is found in 6% of cases of peptic ulcer.
The disease affects mainly children aged 7 to 14 years. Before puberty, boys and girls get sick equally. With the onset of puberty, the frequency and severity of diseases in boys increase, and in girls the peptic ulcer is less common and has a favorable course. This is associated with the protective role of female sex hormones, stimulating the restoration of the mucous membrane of the stomach and duodenum after exposure to damaging factors.
The hereditary predisposition is considered to be the most important factor in the development of duodenal ulcer. The index of familial burden in case of peptic ulcer in children is 60-80%, and an increase in the aggressive properties of gastric juice in one of the parents of a sick child is detected in almost 100% of cases.
Predisposing to the development of peptic ulcer disease in children are: infection of the gastrointestinal tract Helicobacter pylori. With peptic ulcer Helicobacter pylori in the mucous membrane of the stomach is found in 86-88% and in the mucosa of the duodenum in 96% of cases. Also, an early translation for artificial feeding, inaccuracies in the diet( eating large amounts of fatty, fried, spicy, salty foods, as well as spices and extractives) can also provoke the development of peptic ulcer. Adverse effects also have a long-term use of certain medicinal
agents( aspirin, hormones, cytostatics, etc.).An important role in the development of peptic ulcer is given to the characteristics of the family structure, such as family nutrition. Low mobility or excessive physical overloads can also lead to the development of the disease. Foci of chronic infection( carious teeth, adenoids, chronic tonsillitis), intestinal parasitosis, neuropsychiatric overload, smoking and substance abuse, and food allergy also occur with peptic ulcer of the stomach and duodenum, as they have a damaging effect on the gastrointestinal tract.
Manifestations of peptic ulcer are characterized primarily by the typical pain syndrome, which was described for the first time at the beginning of the century by Moinigan. The pain occurs on an empty stomach either 1.5-2 hours after a meal, often at night. Pain syndrome is characterized by the fact that the pains are stubborn paroxysms, cutting, stitching. Pain can be transmitted to the back, right shoulder and shoulder blade. In most cases, it is localized above the navel and to the right of the midline of the body. Pain passes after eating, taking antacids or antispasmodics. For peptic ulcer, as well as for chronic gastroduodenitis, seasonal exacerbations are characteristic( in the autumn-spring period).Characteristic violations of the digestive function of the gastrointestinal tract, which is manifested by vomiting at the height of pain without previous nausea, heartburn, belching. Thus the appetite is usually saved, even it is raised or increased. There is an increased tendency to constipation.
Often, signs of a violation of the function of the autonomic nervous system are revealed, which is manifested by increased fatigue, sweating, emotional lability, lowering of blood pressure, and a decrease in heart rate.
Upon examination, the doctor can determine the signs of hypovitaminosis( which indicates a disturbed absorption of vitamins in the gastrointestinal tract), the lining of the tongue with a white coating, sometimes a reduced fatness rushes into the eyes. When you feel your abdomen, soreness is determined in the zones characteristic for this disease.
The classical course of peptic ulcer is observed in less than 50% of people with this disease. Most patients have atypical pain syndrome. In 15% of people with peptic ulcer there are no manifestations of this disease at all, in 3% of cases the disease manifests itself for the first time as complications( eg, bleeding).
Additional methods of examination for peptic ulcer are FGDS, X-ray examination of the gastrointestinal tract. When carrying out these measures, the location of the ulcer is determined, the stage of the disease and the nature of the disorders are determined.
The severity of the course of peptic ulcer is determined by the healing of ulcers, the presence or absence of complications, the duration of the period of well-being( when all manifestations of the disease are absent) and the frequency of exacerbations. The mild course of the disease is characterized by the healing of ulcers in a period of up to 1 month, the period of well-being lasts more than 1 year. With an average severity of the peptic ulcer, healing of the ulcerative defect lasts more than 1 month, and the period of well-being lasts less than 1 year. The severe course is characterized by the presence of complications, frequent exacerbations( more than 2 exacerbations per year), combined and multiple ulcers of the stomach and duodenum, as well as long periods of their healing.
To assess the aggressive properties of the gastric secretion, gastric sounding is performed, pH-metry. To assess the motor function of the stomach apply ultrasound, electrogastrographic or X-ray examination. It is important to identify infection with Helicobacter pylori.
Treatment of peptic ulcer is complex, includes regimen, diet, drug and non-pharmacological treatment, as well as prevention of exacerbations and development of complications.
Bed rest is needed only for a period of intense pain.
The diet is based on the principles of mechanical, chemical, thermal shading of the gastric mucosa. From food, exclude spicy seasonings, restrict consumption of table salt and foods rich in cholesterol. Food should be taken 4-5 times a day. In the acute phase of the disease, therapeutic diets are used.
Drug treatment for peptic ulcer of the stomach and duodenum is prescribed exclusively by the attending physician. In this case, the means that reduce the aggressive properties of gastric juice are used. These drugs include Almagel, phospholugel, maalox, megalac, vicair, vikalin. Take 1,5-2 hours after eating and before bedtime for 2-3 weeks. Also can be used drugs pirentsepin or gastrocepin, riabal, famotidine, omeprazole, moose, omez. To improve the motor function of the gastrointestinal tract, papaverine, but-shpa is used. These drugs are used occasionally for pain caused by intestinal spasm. In addition, with the same purpose( improvement of the motor function), cerucal or motilium can be used. These drugs are taken before meals and at night for 10-14 days. A good effect is given by drugs that enhance the protective properties of the mucous membrane: carbenoxolone, sucralfate, denol. Antibacterial agents are used to rid the body of Helicobacter pylori, which plays an important role in the treatment of peptic ulcer. The duration of antibiotic therapy is 7 days.
In the absence of signs of cicatrization of the ulcer during the control conduction of FGDS, which is carried out 2-3 weeks after the start of treatment, endoscopic methods of treatment of ulcer( laser therapy, gluing with medical glue, irrigation with special medications) are used.
When a combination of peptic ulcer of the stomach and( or) duodenum with the phenomena of vegetoneurosis( neurosis due to disturbance of the function of the vegetative nervous system), tranquilizers, sedative( soothing) herbs are prescribed, and a preparation such as sulpiride( eglonil) has a good effect.
Surgical treatment of peptic ulcer of the stomach and( or) duodenum is carried out with violation of the integrity of the wall of the stomach and( or) duodenum( perforation), the transition of a ulcerative defect( penetration), not amenable to drug treatment, to a number of located organs. Also, the operation is necessary in the case of unceasing massive bleeding from the ulcer, with the formation of a scar scarring of the transition of the stomach into the duodenum( pyloroduodenal stenosis).
The basis for the prevention of exacerbations of peptic ulcer of the stomach and( or) duodenum is the eradication( eradication) of the gastrointestinal tract Helicobacter pylori. Measures to eliminate this microorganism should be carried out at the first detection of a ulcerative defect. If the first attempt at eradication fails, repeat it no earlier than 4 months after the first treatment. With successful treatment to eliminate Helicobacter pylori exacerbation of gastric ulcer and( or) duodenal ulcer are observed only in 5% of cases.
Prevention of peptic ulcer disease of the stomach and( or) duodenum, along with the exclusion of external factors of its formation, suggests the timely detection and treatment of the pre-ulcer state. This concept was first proposed by AV Novik and VM Uspenskii. The presence in a person of hereditarily conditioned features of the stomach and duodenum, which can under certain conditions be transformed into a peptic ulcer, is considered as a pre-ulcer state. The criteria are established, with the combination of which the formation of peptic ulcer of the stomach and( or) duodenum is very likely. These criteria include: weighed heredity for peptic ulcer disease( especially cases of this disease) among relatives of the first degree of kinship( mother, father, brothers, sisters), increased acidity of gastric juice, characteristic changes in urine and duodenal juice that can be determinedonly in the laboratory. Equally important is the membership in the I blood group, as well as signs of impaired function of the vegetative department of the nervous system. Since the realization of the hereditary predisposition to peptic ulcer of the stomach and( or) duodenum occurs through gastroduodenitis, which occurs when the pylori becomes infected with the gastrointestinal tract, this type of gastroduodenitis is also considered an important criterion for the prepulses state. Predyazvennoe state requires the same methods of examination, treatment and dispensary observation, as peptic ulcer of the stomach and( or) duodenum.
Dispensary observation of people suffering from peptic ulcer is carried out for life. In the first year after the exacerbation of the disease, it is carried out 4 times a year, from the second year - 2 times a year. The main method of observation, in addition to questioning and examination, is an endoscopic examination of the state of the gastrointestinal tract( GGD), in which the condition of the ulcerative defect is determined and the effectiveness of the treatment is evaluated.