Ulcer ( peptic ulcer disease ), stomach and duodenal ulcer - Causes, Symptoms and Treatment .MF .
Peptic ulcer (synonyms: ulcer) - the formation of the ulcer in the mucous membrane of the stomach or duodenum, as a result of the prevalence of aggression factors of mucosal protective factors.
Causes of peptic ulcer disease.
|reasons||peptic duodenal ulcer||Peptic ulcer|
|Main (97-98%)|| Infection |
| Infection |
Receiving NSAIDs (aspirin), corticosteroids (prednisone).
|rare (2-3%)|| Receiving NSAIDs (aspirin), corticosteroids, cytotoxic drugs; |
gastrinoma (Zollinger-Ellison syndrome);
Cirrhosis of the liver;
HIV - infection.
| Malignant neoplasm of stomach (adenocarcinoma, sarcoma, and others.) And adjacent organs; |
HIV - infection.
by Helicobacter pylori and long-term use (in the standard dosage for a month), non-specific anti-inflammatory drugs (NSAIDs), corticosteroids (prednisone), cytotoxic drugs play a major role in the development of peptic ulcer dis
risk factors are only the background, to prepare appropriate ground for the emergence of various diseases.
Modifying factors (that can be influenced):
1. Eating disorders.
2. Smoking, alcohol.
have a negative impact on the course of the disease, often cause relapses.
3. Neuropsychiatric factors.Gastric secretion and gastric motility is independent of the nervous system.Depression, neuroses occur in 50-60% of patients.
not modifying factors (which can not be influenced):
1. Genetic predisposition.
2. Age and sex.
ratio of men and women suffering from peptic ulcers 4: 1.It is believed that a woman's body prevents ulceration sex hormones.After menopause, this ratio is leveled.At a young age is more common peptic ulcer of the duodenum, and in the older age groups - stomach ulcers.
Symptoms of peptic ulcers.
leading signs of the disease are pain and dyspeptic (heartburn, acid regurgitation, nausea, vomiting) syndrome.
pain occurs in the upper abdomen, the umbilical region.The nature of pain: paroxysmal, arching, baking, they appear fasting (hunger pains), 2-3 hours after a meal (in patients with peptic ulcer of the duodenum), decrease after meals.In patients with gastric ulcer pain occurs after half an hour - an hour after eating.Often the pain disturb the night.
Heartburn - is caused by the cast of the stomach contents into the esophagus.It is characterized by a burning sensation behind the breastbone.It may occur after ingestion.
Nausea and vomiting associated with increased vagal tone, increased motility of the stomach and hypersecretion of hydrochloric acid.Vomiting occurs at a height of pain when it is maximally expressed.After vomiting occurs relief of pain disappear or significantly weakened.
Many patients have constipation.
With long-term course of the disease developing asthenia (weakness malaise, insomnia), emotional lability.Weight loss due to the restriction in food intake, due to fear of pain.
However, in the last decade have changed the symptoms of peptic ulcer disease.There was a lot oligosymptomatic and atypical variants of peptic ulcers.The pain is often localized in the right upper quadrant, in the projection of the gallbladder, may cause pain in the lumbar region, similar to kidney disease (pyelonephritis, urolithiasis), in the heart, in the chest, as in heart disease (angina, myocardial infarction).Sometimes the disease is manifested only heartburn, without pain.In 10% of patients the disease is asymptomatic, but when complications occur - there are signs of the disease.
In the event of frequent vomiting, diarrhea, blood in the stool, severe weakness should immediately consult a doctor - physician, gastroenterologist and get tested to rule out complications or comorbidities.
diagnosis of peptic ulcer disease.
1. EGD (esophagogastroduodenoscopy) with biopsy - is carried out in all cases to establish the diagnosis.It determines the shape, size and depth of the ulcer reveals dysmotility.When duodenal ulcers - once for the diagnosis, ulcers of the stomach - is carried out repeatedly to monitor the healing of ulcers.
2. Research biopsy:
- bystryys urease test - rapid diagnosis of Helicobacter pylori;
- morphological study - for the diagnosis of Helicobacter pylor, the state of the mucous membrane, malignant change, except for rare causes of peptic ulcers,
- bacteriological method.It allows you to determine the sensitivity to antibiotics Helicobacter pylori.
3. The test for the presence of Helicobacter pylori - is strictly required in every patient with peptic ulcer.Just one of the research method: breathing "C" - urease test, stool - test (apredelenie infection with Helicobacter pylori stool antigen).
false-negative results may be under the influence of medication (antibiotics, bismuth drugs, proton pump inhibitors).Conducting tests is only possible 4 weeks after discontinuation of these drugs.
4. Complete blood count (anemia detection, inflammatory processes).
5. Fecal occult blood test - diagnosis of acute and chronic blood loss.
6. X-ray examination of the stomach - if you suspect the presence of complications, first of all - in stenosis of the output of the stomach.
7. ultrasound of the abdomen - to identify comorbidities, complications.
8. Study of gastric secretory function (intragastric pH meter) - is set to select the optimal treatment regimens.
9. Coagulation - reduction of clotting factor.
consultation of experts.
According to the testimony:
- the surgeon - in complicated peptic ulcers (perforation, bleeding, stenosis);
- oncologist - in cases of suspected malignancy (malignant transformation) of the stomach.
treatment of peptic ulcer.
When peptic ulcers associated with Helicobacter pylori, the main strategy of treatment is eradication therapy (complete elimination of bacteria).This leads to a rapid qualitative scarring and ulcers, and also reduces the risk of disease relapse.Eradication therapy is able to kill bacteria in 80% of cases, and almost does not cause side effects (less than 5% of cases).Treatment is carried out according to standard regimens, which included antibiotics, proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, esomeprazole), bismuth preparations.The desired treatment regimen, the dose of drugs, treatment duration will appoint a doctor - internist, a gastroenterologist.
Through 4-6nedel after treatment is necessary to control for the eradication of Helicobacter pylori using breathing "C" - urease test or stool - test (determination of Hp antigen in stool).A peptic ulcer is also a control endoscopy.
When Helicobacter pylori negative peptic ulcers (when the bacteria is not detected), the mainstay of treatment is the appointment of antisecretory drugs: PPI (proton pump inhibitors) or H2-histamine receptors (famotidine).The choice of drug, its dosage and duration of treatment will recommend a doctor.
locally acting drugs are used only for the relief of pain and dyspeptic syndromes, and do not constitute a basis for treatment.These include antacids, medications, bismuth, spasmolytics, prokinetics.Antacids (Almagel, Maalox, Aluminium phosphate gel, Taltsid, rutatsid) are applied as enveloping means, eliminate heartburn pain.Taking medications 3 times a day 1 hour after a meal and one at night time.
appoint prokinetics (domperidone) In case of violation of gastric motility.Bismuth preparations (de-nol) increase mucosal protective factors.Chair dyed black.When the pain prescribe antispasmodics (mebeverin, Drotaverinum).When astenonevroticheskih conditions determine psycho-emotional status, followed by the administration of appropriate drugs.Recommended counseling therapist.
choice of drug is determined by the specific clinical situation and provides specialist - a gastroenterologist or internist doctor.
Meals for gastric
Today it is proved that the liquid, sparing diet reduces symptoms and promotes healing of peptic ulcers.Patients should avoid the foods that cause them pain, heartburn, nausea, constipation.Contraindications late dinner, because it stimulates the production of hydrochloric acid during the night, when the patient is asleep and can not take an antacid.Recommended cessation of smoking and alcohol abuse, as they contribute to relapse.
Folk remedies for the treatment of stomach ulcers
The use of herbal medicine is based on the use of enveloping, analgesic, astringent, anti-inflammatory action of herbs.Collection of chamomile (flowers) -10 c, Fennel (fruit) to 10 grams, licorice (root) -10 c.2 teaspoons of the mixture brew 0.25 liters of boiling water, insist 30 minutes, strain.Take on night 1 glass.
rehabilitation after treatment.
Spa treatment is an important rehabilitation measures.It is administered in an inactive period of the disease.Contraindications are the complications of peptic ulcers (malignant transformation, pyloric stenosis, bleeding - during the last 6 months), the first 2 months after surgery, severe comorbidities.Spa treatments include a wide range of physiotherapy facilities, the use of mineral waters, aimed at normalizing the functions of not only the gastroduodenal region, but also the whole organism.Showing resorts Zheleznovodsk, Essentuki, resorts Transcarpathia, Truskavets.
Complications of peptic ulcer disease.
Complications of peptic ulcers include: bleeding, perforation, penetration, stenosis of the pylorus, malignancy.
pyloric stenosis manifested a sense of fullness and epigastric pain (area under the xiphoid process), repeated vomiting eaten on the eve of food, weight loss.
When bleeding from a peptic ulcer appears severe weakness, pale skin, vomiting at the beginning of the color of coffee grounds, then unmodified blood clotted, black, tarry stools (melena), dizziness, drop in blood pressure, loss of consciousness.
perforation, perforation of the ulcer (breakthrough ulcer outside of the stomach or duodenum with the release of their contents into the abdominal cavity): suddenly there is a sharp knife-like pain, localized at first in place of perforation, and then spread throughout the abdomen, doskoobraznoe napryazhenenie abdominal muscles, drop in blood pressure.
Penetration (spreading ulcer outside wall of the stomach or duodenum in the next underlying organs - often the pancreas, at least in the liver, large intestine, greater omentum): persistent pain in the upper abdomen with dedication in the back, collarbone, shoulder, unrelateda meal.Acceptance of antacids relieves the pain.
ulcers Malignization (malignant transformation): general weakness, loss of appetite, aversion to eating meat, severe weight loss, constant aching pain in the abdomen, with no clear localization.
In all cases of complications should immediately consult a physician and surgeon.
Prevention of peptic ulcer disease.
Preventive measures consist in the organization of rational work and rest, avoiding harmful habits, receiving ulcerogenic drugs (NSAIDs, corticosteroids, cytostatics).Patients who are forced to take a long time, these drugs should be under the supervision of a therapist.Prevention carried reception proton pump inhibitors in the required dosage.Dispensary observation to be patients with gastric ulcer and atrophic gastritis.If there is atrophy of the gastric mucosa - repeated endoscopy with biopsy to monitor the possible occurrence of precancerous lesions 1 time in 2 years.
Doctor's consultation on a stomach ulcer and duodenal ulcer
Question: after eradication therapy, after a month has handed over analyzes stool - test (apredelenie infection with Helicobacter pylori stool antigen).The result is negative.Through time, abdominal pain resumed.I passed the re-analysis, a positive result.What is the reason?
answer may relapse due to incomplete eradication conducted with reinfection (reinfection), with taking ulcerogenic drugs (NSAIDs, corticosteroids, cytostatics), heavy smoking.Treatment of peptic ulcers associated with Helicobacter pylori should be carried out to the complete elimination of bacteria.In resistant (resistance to drugs) cases, treatment is carried out based on bacteriological culture results for sensitivity to Helicobacter pylori.
Q. while taking drugs for diarrhea appeared to 4 times a day over the eradication of Helicobacter pylori (omeprazole, clarithromycin and amoxicillin).What is the reason?
Answer: it is associated with side effects of antibiotics.For treatment, you can add the preparations improving intestinal microflora (latsidofil 2 capsules 3 times a day for 2 hours before taking antibiotics)
Question: Is it possible to undergo an endoscopic examination of the stomach (endoscopy) under anesthesia?
Answer: This is possible, but only after prior consultation of an anesthesiologist.
therapists Vostrenkova Irina
* Physical abuse in childhood and peptic ulcer have a connection
have child physical abuse victims twice the chance of developing ulcers than people who have not been abused in childhood, according to a new study, scientistsUniversity of Toronto (University of Toronto).
"We found a strong and significant association between individuals who were abused as children, and who develop peptic ulcer disease when growing up," says lead author, Professor Esme Fuller Thomson (Esme Fuller Thomson). "Initially, I thought that the link willexplained by factors such as stress, obesity, smoking and alcohol abuse, factors that are very strongly associated with peptic ulcer disease, but even after adjusting for sixteen known variables, the people who have been exposed to physical violence in childhood, had a 68% higher probability ofthe development of peptic ulcer disease. "
co-author Jennifer Bottoms (Jennifer Bottoms), emphasizes the dual importance of research."These findings not only underline the importance of prevention of child physical abuse," says Bottoms, "they also emphasize the need for regular surveys of adults who have experienced childhood abuse, because they are at risk of adverse health effects."
Research Professor Thomson will appear in the online version of the journal Journal of Interpersonal Violence.The researchers used a representative sample of the population data of adult Canadians, the total number of 13,069 people.More than 1,000 people reported being physically abused by someone close, before they turned 18, and 493 of them said that they had been diagnosed with peptic ulcer in one of the medical institutions.