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peptic ulcer called a disease that manifests the formation of chronic ulcers in gastroduodenal zone (in the stomach and duodenum).
Ulcers may be single or multiple (more than three).Their essential difference from a mucosal surface defects (e.g., erosion) is that the damage affects deeper layers (including submucosal, muscle), gastric or intestinal wall.After healing of these ulcers are always formed scars.
On average, the prevalence of the disease is 10%.The duodenum is affected four times more often than the stomach.Among patients with male-dominated young and middle age with the first 0 (I) blood group.In women, the incidence of peptic ulcer disease is significantly increased with the onset of menopause (it is associated with deficient production of female hormones like estrogen).The mortality rate is less than 5%, most of it associated with severe complications of the disease (perforation, hemorrhage).
flow ulcer disease is often characterized by a certain seasonal cycles, its relapses (exacerbations) more likely to develop in the autumn and spring.
Causes stomach ulcers
Modern scientists believe that the basis for the development of peptic ulcer disease is a violation of an unsteady balance between the factors of aggression and factors protecting the gastroduodenal mucosa.Such factors of aggression are:
- excess production of gastric juice, with its essential ingredients: hydrochloric acid and pepsin;
- duodenal reflux (backflow of the contents of the duodenum together with bile components in the stomach);
- microbes infecting the gastric mucosa Helicobacter pylori (with these tiny organisms associated to 75% of gastric ulcers and localization of over 90% of ulcers found in the duodenum, they produce substances provoke inflammation and destruction of the mucosal cells).
should be noted that not all types of microorganisms Helicobacter pylori have ulcerogenic (potential ability to ulceration).And not all infected people will develop peptic ulcer disease and other germs associated with these illnesses (cancer of the stomach, chronic gastritis, MALT-lymphoma).To protect
- bicarbonate (a substance to neutralize the excess hydrochloric acid);
- mucoproteins (mucus that covers the stomach mucosa cells):
- sufficient blood flow to the gastroduodenal mucosa;
- adequate local mucosal immunity.
If a peptic ulcer is increased aggression factor activity on the background of shortage or lack of protection function of factors that leads to the formation of ulcers.
In addition, the emergence of new or relapse of peptic ulcer contribute:
- irrational inordinate power;
- chronic and acute mental stress or overload;
- family history (at 15 - 40% of the patients close relatives also have a peptic ulcer of a localization);
- smoking (it also slows down the healing of already formed ulcers);
- alcohol (strong drinks stimulate the production of aggressive gastric juices);
- existing chronic gastritis with high secretory activity (gastric acid production);
- environmental problems.
As a rule, the implementation of the existing genetic defect (an excess of cells synthesizing hydrochloric acid, or a shortage of production of the protective mucus components) leads the combined effect of various factors.
Classification of diseases
by location separately recovered:
- stomach ulcers:
- cardia ulcer;
- ulcer of the body;
- antral ulcer;
- pyloric channel ulcer;
- duodenal ulcers (localized in the duodenum):
- ulcer bulbs;
- zalukovichnaya ulcer;
- Combined ulcers (and at the same time affecting the stomach and duodenum).
Depending on the size of large ulcers are divided into:
- large ulcers (larger than 2 centimeters);
- giant ulcers (diameter greater than 3 cm).
During ulcer disease are distinguished:
- acute phase (relapse);
- phase subsides or fading exacerbation;
- remission phase.
Symptoms of stomach ulcers
Peptic ulcer disease has a fairly typical clinical manifestations.So often have complaints come to the reception of the patient experienced professional may suspect the disease.As a rule, patients are concerned:
- permanent or paroxysmal aching pain in the epigastric (upper abdominal) area or localized immediately below the xiphoid process of the sternum, directly related to the consumption of food (at the location of ulcers in the cardiac part they appear or are worse in just a few minutes,lesions of gastric body pains begin in half an hour or 1.5 hours, and in the case of duodenal localization they are developing empty stomach and cropped food);
- «night» of pain (the prerogative of duodenal ulcers and ulcer formed in the gastric outlet department);
- irradiation or distribution arising pains in the back, hypochondria or umbilical area (intermittent symptom);
- feeling of heaviness, burning, overflow and discomfort in the stomach on an empty stomach or after a meal;
- nausea, which can be replaced by copious vomiting, occurring at the height of digestion (about half an hour or 1.5 hours after eating the food), and leads to a marked relief (disappearance as nausea and pain), vomitus contain food eaten, sometimesIt is visualized in the bile;
- violations stool (often observed tendency to constipation reflex during an exacerbation);
- increased appetite (due to increased gastric secretion);
- weight loss (some patients are beginning to reduce the amount of food eaten and the frequency of its use because of fear of renewed pain);
- psycho-emotional disorders (depressed mood, excessive anxiety, aggression, fatigue, suicidal thoughts, inner tension, sleep disorders).
disease usually develops gradually.However, sometimes there is and quite asymptomatic disease.In such cases, the disease clinical debut appearance of complications or long postyazvennye scars are unexpected finding on endoscopy.
Complications of gastric ulcers
Peptic ulcer disease is fraught with serious complications that can be fatal.Each of them is characterized by its special clinical signs.These specific complications include:
- gastrointestinal bleeding (about its development indicate sudden weakness, a feeling of nausea, vomiting, black tarry stools and liquid, there may be loss of consciousness, with the existing abdominal pain stops);
- perforation or perforation (process extends to the entire thickness of the gastric or duodenal wall, through resulting from this defect sour content enters the abdominal cavity and causes the development of inflammation of the peritoneum - peritonitis; this complication is accompanied by intensive "dagger" pain and doskoobraznym muscle tension in the pitarea);
- penetration (penetration of ulcers in the next bodies located, more often - in the pancreas, and then there are signs of its inflammation, called pancreatitis: the changing nature and irradiation of pain, they can not be removed by conventional anti-ulcer agents);
- stenosis (severe scar deformity leads to a significant narrowing of the duodenal bulb or output portion of the stomach, which manifests stinking vomit yesterday's meal, a significant reduction in weight, decrease in appetite, metabolic disorders);
- gastric cancer (malignant transformation occurs in 4% of cases of stomach ulcers, her symptoms may be increasing weight loss, change in pain, loss of their relationship with food, aversion to food, progressive weakness, swallowing disorders sometimes appear above or manifestations of stenosis).
disease is already one of the physical examination of the patient with recurrent peptic ulcer or debut competent expert can get an approximate important diagnostic information.In severe exacerbations, which is accompanied by severe pain, patients lie on the side or the back with knees bent legs and hands pressed against a painful abdominal area.It helps reduce stress abdominals.If ulcerative defect is located on the rear wall of the stomach, the patient becomes a little easier when they lie down on his stomach and placed under his pillow.This provision reduces the pressure on the inflamed stomach celiac plexus and significantly reduces pain.
language in these patients lined with white-yellow coating.The lack of movement of the abdominal wall, synchronized with the breath, there is the development of peritonitis (invariable consequence of perforation of the stomach or duodenal ulcers).Pressing and rapping stomach doctor reveals in the projection area of the stomach and duodenum limited local soreness and sometimes local muscle tension.In addition, sometimes the pain is found in the reflex zones (spinous processes of the thoracic vertebrae series VII - XII - point Openhovskogo et al.).In the case of pyloroduodenal cicatricial stenosis rapping at the pit area can be identified specific to this complication splashing.
analyzing heard the complaint and data physical examination, followed by an expert to clarify the suspected diagnosis recommends a comprehensive survey:
- endoscopy (fibroezofagogastroduodenoskopiya) - the main diagnostic method to see ulcer defect, determine their location, quantity, appearance, value, depth, inflammatory changes in the mucosa around the ulcer, fresh and old scars, bleeding, set the bacteria contamination of Helicobacter pylori, to make the fence multiple biopsies (samples of gastroduodenal tissue) to prevent precancerous transformation of the mucosa and have already developed cancer process, to carry out local treatment (cessation of bleeding, obkalyvanie gastroduodenal ulcersslow scarring);
- hromogastroskopiya with contrast dyes (detects excessive gastric secretion and the formation of pre-cancerous changes);
- morphological analysis (microscopic examination confirmed canker, assesses the intensity of the inflammation, atrophic and sclerotic processes, eliminates the malignant transformation of gastric mucosa);
- X-ray with contrast barium suspension - technique verifies and specifies the location of the ulcers, their size and depth, eliminates the development of complications (stenosis, penetration), estimates the motor activity, the presence of scar deformities infiltrating the gastric wall oncological processes, but can not serve as a complete substitute forendoscopic examination;
- plain radiography for the detection of free air that has entered the abdominal cavity (specific indication of perforation);
- methods for detecting Helicobacter pylori (histology, rapid techniques, crop biopsies for special bacteriological medium, breathing, serological tests, and others.);
- endoscopic ultrasonography - a method used in the formation of suspected cancerous infiltration (thickening of the gastric wall);
- pH-meters - the study assesses the state of acid-forming function of the stomach (peptic ulcer disease when it is, as a rule, increased or normal).
Treatment of gastric ulcers
Depending on the specific clinical situation the patient is prescribed:
- conservative treatment:
- diet therapy;
- medical (drug) treatment;
- herbal medicine;
- surgical treatment:
- minimally invasive surgical procedures;
- radical surgery.
Most patients are treated on an outpatient basis.Hospitalized patients with intense pain, suspected complicated course, huge, profound and multiple ulcers, lack of effect of adequate outpatient treatment, patients with an unclear diagnosis.
With the advent of powerful and highly effective diet drugs acquired secondary importance in the treatment of patients with peptic ulcer disease.However, doctors usually advise patients to adhere to certain rules of supply.They boil down to the following requirements:
- for the purpose of chemical schazheniya inflamed mucosa to exclude all marinated, smoked, spicy, sour and overly salty foods (including rye bread, cranberries, plums, cranberries, red currants, ketchup, etc.);
- prohibited rich in extractive substances vegetables (onions, radishes, garlic, radish, watercress, etc..) And rich broth;
- undesirable eating too cold or too hot food;
- give food boiled (wipe it optional);
- necessary (as a kind of building material) for the healing of gastroduodenal mucosal protein enters the body of patients with a sufficient amount of boiled nezhilistogo lean meat, lean fish, egg white, soy and dairy products, special protein nutrient mixes (nutridrink, Supro 2640, Nutrizon,berlamin, nutrikomp etc.).;
- granularity of power (up to 6 times per day).
diet can be supplemented with medicinal mineral waters.They should be mineralized, with a minimal amount of carbon dioxide or no it with a neutral, alkaline or slightly acid reaction.These requirements correspond to such mineral waters as "Essentuki" №4, "Jermuk", "Borjomi", "Berezovskaya", "Slavyanovskaya", "Smirnoff" №1.They should be drunk in the form of slightly warmed 2 hours (with duodenal ulcers and ulcers of the stomach outlet) or half an hour after eating diet food (in the case of the localization of ulcers in the stomach).Begin treatment with a third cup of mineral water at the reception.Further provided tolerability its normal volume to increase the whole glass.
Currently, there are a lot of highly effective anti-ulcer drugs, so competent medical therapy is the basis of the treatment of patients with peptic ulcer disease.Recommended by doctors circuit drugs may include their group:
- Sekretolitiki - means reducing the production of hydrochloric acid and promote scarring ulcers:
ü M-anticholinergics (platifillin, gastrotsepin, metacin, telenzepine et al.);
ü H2 blockers (histamine) receptor (roksatsidin, ranitidine, famotidine, nizatidine, pilorid and others.);
ü blockers, proton pump (pantoprazole, omeprazole, lansoprazole, esomeprazole, rabeprazole, etc.) - The most powerful and advanced of all Sekretolitiki;
- means for the complete elimination (eradication) of microorganisms Helicobacter pylori (effective eradication schemes are combinations of proton pump blockers with certain antibiotics (tetracycline, clarithromycin, levofloxacin, metronidazole) and preparations containing bismuth);
- nonabsorbable antacids and suction, allowing the excess to neutralize the hydrochloric acid to stop muscle spasms (Rennie, protab, Maalox, Gustav, Almagel, kompensan, Aluminium phosphate gel, gelyusil varnish, Gaviscon, etc.);
- gastrotsitoprotektory enhancing resistance gastroduodenal mucosa:
- drugs colloidal bismuth (ventrisol, de-nol, and others.);