What to do if a stomach ulcer worsens? Symptoms and treatment of exacerbation of peptic ulcer

(peptic ulcer) - is one of the most common diseases gastrointestinal tract, is characterized by the formation of a small defect (up to 1 cm, rarely more) on the mucous membrane (sometimes submucosal) of the stomach, as a result of the aggressive action of certain factors on the mucous membrane (hydrochloric acid, bile, pepsin). It is a chronic disease, therefore it alternates between periods of exacerbations (most often in spring and/or autumn) and remissions (symptoms subside). A gastric ulcer is an irreversible disease, since a scar is formed in the area of ​​the gastric mucosa affected by the ulcer, and it does not have the functional ability (secretion of gastric juice), even after treatment.

Gastric ulcer affects approximately 10-12% of the adult population, about 400-500 cases of the disease per 100 thousand population. In the CIS countries there are about 12 cases per 10 thousand population. More often, the disease occurs among the urban population, perhaps this is due to psycho-emotional factors and nutrition. Men suffer from peptic ulcers more often than women. Women more often get sick in middle age (during menopause), due to hormonal changes in the body.

Anatomy and physiology of the stomach

• Cardiac part of the stomach, is a continuation of the esophagus. The border between the esophagus and the cardiac part of the stomach is the cardiac sphincter, which prevents the reflux of food in the opposite direction (into the esophagus);
• Fundus of the stomach- this is the convex part of the stomach, dome-shaped, which is located to the left of its cardiac part;
• Body of stomach– this is the largest part, has no clear boundaries, is a continuation of the bottom, and gradually passes into its next part;
• Pyloric part of the stomach, is a continuation of its body, is located at an angle relative to the body of the stomach, and communicates with the lumen of the duodenum. At the junction of the pyloric part of the stomach into the duodenum, a circular muscular thickening is formed, which is called the pyloric sphincter. When it closes, it acts as an obstacle to the passage of food mass into the duodenum, preventing food from returning to the stomach.

• Outer layer represented by the serous membrane, is the inner layer of the peritoneum;
• Middle layer represented by the muscular layer, which consists of muscle fibers located longitudinally, radially (in a circle) and obliquely. The circular layer forms the cardiac sphincter, which prevents the backflow of food into the esophagus, and the pyloric sphincter, which prevents the backflow of food into the stomach. At the border between the middle layer (muscular membrane) and the inner layer (mucosa), there is a poorly developed submucosa.
• Inner layer - mucous membrane , is a continuation of the esophageal mucosa, has a thickness of about 2 mm, and forms many folds. In the thickness of the gastric mucosa there are several groups of gastric glands that secrete components of gastric juice.

1. Cardiac glands, located in the cardiac part of the stomach, secrete mucus;
2. Fundic glands, located in the fundus of the stomach, are represented by several groups of cells, each of which secretes its own components of gastric juice:

• the main cells secrete the digestive enzyme pepsinogen, from which pepsin is formed, which is involved in the breakdown of proteins from food into peptides;
• parietal cells secrete hydrochloric acid and Castle factor;
• accessory cells secrete mucus;
• undifferentiated cells are precursors for the maturation of the above cells.

• Secretory function stomach, consists in the secretion of gastric juice, which contains necessary components(primarily hydrochloric acid) for initial stages digestion and formation of chyme (food bolus). About 2 liters of gastric juice are secreted per day. It contains: hydrochloric acid, pepsin, gastrin and some mineral salts. The acidity of gastric juice is determined by its content of hydrochloric acid, its amount may vary depending on the composition of the food and diet, the age of the person, the activity of the nervous system, and others. When the secretory function of the stomach is disrupted, a person’s acidity increases, i.e. the release of hydrochloric acid increases, or decreases and is accompanied by a decrease in the release of hydrochloric acid.
• Motor function stomach, occurs as a result of contraction of its muscle layer, resulting in the mixing of food with gastric juice, primary digestion and its movement into the duodenum. Impaired gastric motility, which develops as a result of impaired tone of the muscular wall, leads to impaired digestion and evacuation of gastric contents into the intestine, which are manifested by various dyspeptic disorders (nausea, vomiting, bloating, heartburn and others).

Mechanism of gastric ulcer formation

Causes of stomach ulcers

Stomach ulcers develop for 2 main reasons:

• BacteriumHelicobacter Pylori in certain (favorable) conditions for it, it has a destructive effect on the cells of the gastric mucosa, destroys local protective factors of the gastric mucosa, as a result of which, in the absence of treatment, a defect in the form of an ulcer is formed. Infection occurs through the saliva of an infected person (lack of hygiene, using unwashed dishes after an infected person). Infected people on the globe, there are about 60%, but not everyone gets stomach ulcers, perhaps this is due to predisposing factors. To prevent Helicobacter Pylori infection, you must wash your hands and use clean utensils before eating.
• Increased acidity , develops as a result of increased secretion of hydrochloric acid, which has a corrosive effect on the gastric mucosa, with subsequent formation of a defect.

Factors leading to the formation of stomach ulcers

• Nervous and emotional stress leads to increased secretion of gastric juice (hydrochloric acid);
• Genetic predisposition to the formation of stomach ulcers, including a hereditary increase in acidity;
• Smoking, drinking alcoholic beverages, coffee, nicotine and ethyl alcohol stimulate the formation of gastric juice, thereby increasing acidity;
• Presence of a pre-ulcerative condition (chronic gastritis), chronic inflammation gastric mucosa, leads to the formation of defects in the form of ulcers;
• Disturbed diet: fast food, long breaks between meals, lead to disruption of the secretion of gastric juice;
• Abuse of sour, spicy and rough foods leads to stimulation of the secretion of gastric juice, and the possible formation of inflammation and defects in the gastric mucosa;
• Long-term use medications that have a destructive effect on the gastric mucosa. Such medications include: non-steroidal anti-inflammatory drugs (Aspirin, Ibuprofen and others), glucocorticoids (Prednisolone) and others.

Symptoms of a stomach ulcer during an exacerbation

1. Dull, cutting, stabbing pain in the upper abdomen, most often in the middle (in epigastric region), can give to left hypochondrium. The appearance of pain is associated with eating, approximately 0.5-1 hour after eating, stops after approximately 2 hours, this is associated with emptying of the stomach. Pain appears as a result of irritation of the ulcer surface with food, and it is relieved with antacids (Almagel). The pain is also characterized by seasonality, i.e. exacerbation occurs in spring and autumn.
2. Dyspeptic disorders:

• heartburn occurs as a result of the reflux of acidic gastric contents into lower sections esophagus. It appears simultaneously with the onset of pain;
• Nausea and vomiting also occur at the same time that pain occurs. Vomiting is accompanied by relief for the patient;
• sour belching, constipation, develop due to increased gastric acidity;

1. Weight loss, occurs due to the fear of eating food, which contributes to the appearance of pain.

Complications of gastric ulcer, perforated gastric ulcer (ulcer perforation)

• Perforation (perforation) of the ulcer, develops as a result of the destruction of all layers of the stomach wall and its end-to-end perforation. It is an acute process and therefore requires urgent medical (surgical) care, since as a result of perforation, gastric contents are released through a through hole in the stomach wall, resulting in the development of peritonitis.
• Ulcerative bleeding occurs as a result of corrosion of a vessel in the stomach wall at the level of the ulcer. The main symptom is vomiting blood and general weakness. Bleeding leads to loss of circulating blood volume and the possible development of shock. Requires urgent surgical intervention to stop bleeding.
• Ulcer penetration- this is the penetration of an ulcer through the wall of the stomach into nearby organs, most often the pancreas. In this case, acute pancreatitis also occurs.
• Stenosis of the pyloric part of the stomach, such a complication develops if the ulcer is localized in this area. As a result of ulcerative stenosis of the pyloric part of the stomach, food is not able to pass from the stomach to the intestines. This complication requires surgical treatment to restore the passage of food into the duodenum.
• Perigastritis, develops as a result of reaching the inflammation zone around the ulcer, serous membrane stomach. As a result of this complication, adhesions form with neighboring organs (for example: liver or pancreas), which leads to deformation of the stomach.
• Ulcer malignancy, those. formation of a malignant tumor from an ulcer. This is a fairly rare complication, but the most life-threatening for the patient.

Diagnosis of gastric ulcer

During an objective examination of the patient - palpation of the abdomen, tension is observed abdominal wall V epigastric region and in the left hypochondrium.

To accurately confirm a gastric ulcer, the following are used: instrumental methods research:

1. Blood test for the content of Helicobacter Pylori antibodies.
2. Determination of the acidity of gastric juice (PH - metry), Using a probe inserted into the stomach, a portion of gastric juice is taken and its acidity, which depends on the content of hydrochloric acid, is examined.
3. X-ray examination stomach, reveals following signs characteristic of a stomach ulcer:

• niche symptom - delay contrast agent in the area of ​​a defect in the gastric mucosa;
• ulcer shaft - characterizes the area of ​​inflammation around the ulcer;
• cicatricial-ulcerative deformation of the gastric wall, characterized by the direction of the folds of the mucous membrane around the ulcer, in the form of a star;
• symptom index finger, characterized by retraction of the gastric mucosa on the opposite side to the ulcer;
• pylorospasm, spasmed pyloric sphincter does not allow contrast agent to pass through;
• accelerated and delayed evacuation of contrast agent from the stomach;
• Detects the presence of possible complications (ulcer perforation, penetration, ulcerative stenosis).

1. Endoscopic examination (fibrogastroduodenoscopy), This method consists of examining the gastric mucosa using a fibrogastroduodenoscope. This research method determines the location of the ulcer, its exact size, and possible complications (including bleeding from the ulcer).
2. Microscopic examination biopsy of the gastric mucosa taken during fibrogastroduodenoscopy for the presence of Helicobacter Pylori.

Treatment of stomach ulcers

1. Eradication (destruction)Helicobacter Pylori, is carried out using antibiotic therapy.

Groups of antibiotics used for Helicobacter pylori infection:

• Macrolides (Erythromycin, Clarithromycin). Clarithromycin tablets are used 500 mg, morning and evening;
• Penicillins: Amoxicillin is prescribed 500 mg 4 times a day, after meals;
• Nitroimidazoles: Metronidazole, taken 500 mg 3 times a day, after meals.

1. Reducing the acidity of gastric juice, relief of pain and heartburn, is carried out using the following groups drugs:

• Proton pump inhibitors: Omeprazole, prescribed 20 mg 2 times a day, before meals;

• H2 receptor inhibitors: Ranitidine, prescribed 150 mg 2 times a day, before meals.

• Antacids (Almagel, Maalox). Almagel is prescribed to drink 1 tablespoon 30 minutes before meals;
• Bismuth preparations (De-nol) have both an astringent mechanism for the gastric mucosa and a bactericidal effect against Helicobacter Pylori. De-nol, prescribed 120 mg 4 times a day, 30 minutes before meals.

Diet for stomach ulcers

Food for a patient with a stomach ulcer should be warm, liquid or pureed, boiled or steamed. The patient must follow a diet, eat small portions 5 times a day, and reduce the total daily caloric intake to 2000 kcal/day. Milk has a very good astringent effect, so it is recommended to drink a glass of milk every morning and at night. Also good effect have hydrocarbonate mineral waters that contribute to the alkalization of gastric contents, these include Borjomi, Essentuki No. 4, Arshan, Burkut and others.

It is also recommended that the patient drink soothing teas (from lemon balm, mint). Food should be rich in vitamins, minerals and proteins, so the diet must include dishes made from vegetables. Dairy products: cottage cheese, kefir, cream, low-fat sour cream, regulated recovery processes in organism. Fish and meat dishes can be consumed without fatty varieties(chicken, rabbit, perch, pike perch). For more fast healing ulcer surface, the diet includes fats plant origin(For example: olive oil, sea buckthorn). It is very good to include milk porridge (oatmeal, rice, buckwheat) in your diet every morning. White or gray bread, it is better to eat not fresh (yesterday's), as well as crackers.

Prevention of stomach ulcers

– a chronic polyetiological pathology that occurs with the formation of ulcerative lesions in the stomach, a tendency to progression and the formation of complications. To the main clinical signs peptic ulcer disease includes pain in the stomach and dyspeptic symptoms. The diagnostic standard is an endoscopic examination with a biopsy of pathological areas, radiography of the stomach, and detection of H. pylori. Treatment is complex: diet and physiotherapy, eradication of Helicobacter pylori infection, surgical correction of complications of the disease.

An acute ulcer forms when it spreads pathological process deep into the mucous membrane (beyond its muscular plate). The ulcers are usually single, take on a rounded shape, and look like a pyramid when cut. In appearance, the edges of the ulcer also do not differ from the surrounding tissues; the bottom is covered with fibrin deposits. Black coloration of the bottom of the ulcer is possible if the vessel is damaged and hematin forms ( Chemical substance, formed during the oxidation of hemoglobin from destroyed red blood cells). Favorable outcome acute ulcer consists of scarring within two weeks, an unfavorable one is marked by the transition of the process to a chronic form.

The progression and intensification of inflammatory processes in the area of ​​the ulcer leads to increased formation of scar tissue. Because of this, the bottom and edges of a chronic ulcer become dense and differ in color from the surrounding healthy tissue. A chronic ulcer tends to enlarge and deepen during an exacerbation; during remission it decreases in size.

Symptoms of stomach ulcer

The clinical course of gastric ulcer is characterized by periods of remission and exacerbation. Exacerbation of peptic ulcer is characterized by the appearance and increase of pain in the epigastric region and under the xiphoid process of the sternum. With an ulcer of the body of the stomach, the pain is localized to the left of the center line of the body; in the presence of ulceration of the pyloric region - on the right. Pain may radiate to the left half of the chest, shoulder blade, lower back, and spine. Gastric ulcer is characterized by the onset of pain immediately after eating with increasing intensity within 30-60 minutes after eating; pylorus ulcer can lead to the development of night, hunger and late pain (3-4 hours after eating). The pain syndrome is relieved by applying a heating pad to the stomach area, taking antacids, antispasmodics, inhibitors proton pump, H2-histamine receptor blockers.

In addition to pain, peptic ulcers are characterized by a coated tongue, bad smell from the mouth, dyspeptic symptoms - nausea, vomiting, heartburn, increased flatulence, stool instability. Vomiting mainly occurs at the height of stomach pain and brings relief. Some patients tend to induce vomiting to improve their condition, which leads to progression of the disease and complications.

Atypical forms of gastric ulcer can manifest as pain in the right iliac region (appendicular type), in the heart (cardiac type), and in the lower back (radiculitis pain). IN exceptional cases pain syndrome with gastric ulcer it may be completely absent, then the first sign of the disease is bleeding, perforation or cicatricial stenosis of the stomach, for which reason the patient seeks medical care.

Diagnostics

The gold standard for diagnosing gastric ulcers is esophagogastroduodenoscopy. Endoscopy allows you to visualize the ulcerative defect in 95% of patients and determine the stage of the disease (acute or chronic ulcer). Endoscopic examination makes it possible to timely identify complications of gastric ulcer (bleeding, cicatricial stenosis), conduct endoscopic biopsy, and surgical hemostasis.

Treatment of gastric ulcer

The main goals of therapy for peptic ulcer include repair of the ulcer, prevention of disease complications, and achievement of long-term remission. Treatment of gastric ulcer includes non-drug and drug treatments, surgical methods. Non-drug treatment of peptic ulcer involves following a diet, prescribing physiotherapeutic procedures (heat, paraffin therapy, ozokerite, electrophoresis and microwave exposure), it is also recommended to avoid stress, maintain healthy image life.

Drug treatment should be comprehensive and affect all parts of the pathogenesis of ulcerative gastrointestinal tract. Anti-Helicobacter therapy requires the use of several drugs to eradicate H. pylori, since the use of monoschemes has shown to be ineffective. Attending physician in individually selects a combination the following drugs: proton pump inhibitors, antibiotics (clarithromycin, metronidazole, amoxicillin, tetracycline, furazolidone, levofloxacin, etc.), bismuth preparations.

If you seek medical help in a timely manner and carry out a complete anti-Helicobacter treatment regimen, the risk of complications of gastric ulcer is minimized. Emergency surgery Peptic ulcer (hemostasis by clipping or suturing a bleeding vessel, suturing an ulcer) is usually required only for patients with a complicated pathology: perforation or penetration of an ulcer, bleeding from an ulcer, malignancy, and the formation of scar changes in the stomach. In elderly patients, if there is a history of complications of ulcerative gastritis in the past, experts recommend reducing the duration of conservative treatment to one to one and a half months.

Absolute indications for surgical intervention: perforation and malignancy of the ulcer, massive bleeding, cicatricial changes in the stomach with disruption of its function, gastrojejunostomy ulcer. K conditionally absolute indications include penetration of ulcers, giant callous ulcers, recurrent gastric bleeding against the background of ongoing conservative therapy, lack of ulcer repair after suturing. A relative indication is the absence of a clear effect from drug therapy for 2-3 years.

For decades, surgeons have been discussing the effectiveness and safety of various types of surgical intervention for gastric ulcers. Today, gastrectomy, gastroenterostomy, different kinds vagotomy. Excision and suturing of a gastric ulcer is used only in extreme cases.

Prognosis and prevention

The prognosis for gastric ulcer largely depends on the timeliness of seeking medical help and the effectiveness of anti-Helicobacter therapy. Peptic ulcer is complicated by gastric bleeding in every fifth patient, from 5 to 15% of patients suffer perforation or penetration of the ulcer, and 2% develop cicatricial stenosis of the stomach. In children, the incidence of complications of gastric ulcer is lower - no more than 4%. The likelihood of developing stomach cancer in patients with peptic ulcer is 3-6 times higher than among people who do not suffer from this pathology.

Primary prevention of gastric ulcer includes preventing infection with Helicobacter pylori infection, eliminating risk factors for the development of this pathology (smoking, cramped living conditions, low level life). Secondary prevention is aimed at preventing relapses and includes following a diet, avoiding stress, and prescribing an anti-Helicobacter drug regimen when the first symptoms of ulcerative disease appear. Patients with gastric ulcer require lifelong monitoring, endoscopic examination with mandatory testing for H. pylori once every six months.

It is not so difficult in the future to identify the signs of a new attack and consult a doctor in time. A visit to a specialist is the only acceptable option, says gastroenterologist Inna Burkova. From her practice, 80% of patients who came to the surgeon’s table with complications self-medicated or ignored the attacks. The rest are mainly people with additional risk factors: with 15-20 years of illness, elderly, weakened by others chronic diseases, heavy smokers.

What triggers an attack of peptic ulcer of the stomach or duodenum?

A middle-aged person suffering and undergoing therapy during exacerbations has virtually nothing to worry about.

If symptoms similar to an exacerbation of a stomach or duodenal ulcer bother you for the first time, you should not engage in self-diagnosis. After all, the signs of an ulcer are very easy to confuse, for example, with pancreatitis or cholecystitis.

Drug treatment for exacerbation of gastric ulcer

Diet for exacerbation of gastric and duodenal ulcers

Exacerbation of gastric and duodenal ulcers: prevention

Spring and autumn are the favorite seasons for peptic ulcer disease and during these periods it costs special attention monitor your health. Those who have ulcers usually consult a doctor for a preventive course of antiulcer drugs or mineral waters. It is necessary to try to avoid stress (geneticist Alexander Kolyada spoke about this in detail in the article), reduce physical exercise and adhere to a preventive diet.

Here are a few more general rules, .

1. Healthy sleep(it is always appropriate): try to go to bed at the same time, sleep at least eight hours a day, avoid at night.
2. To prevent the ulcer from worsening, it is necessary to give up bad habits (and this is not only alcohol, but also smoking).
3. Try to eat more mushy and liquid foods.
4. It is recommended to avoid going to a Chinese restaurant or: you don’t need fatty and spicy food.
5. The habit of fractional meals will help to avoid stomach and duodenal ulcers.
6. Try to eat slowly, chewing thoroughly. It is better to organize meals in such a way that you do not feel hungry - with breaks of three to four hours.
7. Walking after eating will help avoid heaviness and belching.
8. For the prevention of stomach ulcers daily norm meat and fish should not exceed 150-200 g, and fat (including vegetable origin) - 30-40 g.
9. Smoked, fried and pickled dishes would be better replaced.
10. and, which contain non-acidic dairy products will also help avoid relapses of exacerbation of stomach and duodenal ulcers.

Few people are not familiar with heaviness in the stomach after eating. And most do not pay attention to such sensations, believing that this is a temporary consequence of overeating or poor nutrition.

However, if such sensations begin to visit you more and more often, and stomach pain is added to them, then you urgently need to take care of yourself. After all, this may indicate an incipient ulcer.

A gastric ulcer is a disease that is manifested by the formation of chronic ulcerative defects in the gastroduodenal zone (in the stomach and duodenum). Ulcers can be either single or multiple (more than three).

The main difference between a chronic gastric ulcer and erosion is deeper penetration into the stomach wall, penetration not only into the cells of the mucous membrane, but also into the submucosal layers, healing of the defect with the formation of a scar.

As you know, when treating stomach ulcers it is important to eliminate following symptoms - strong pain in the stomach area, frequent vomiting, heartburn, “hunger pains” that stop after eating. Exacerbation of the disease may be accompanied by intolerable night pain. Therefore, when drug treatment must be used A complex approach with mandatory consideration of the individual characteristics of the process for effective elimination causes of the disease.

Causes

What it is? The development of gastric ulcers is mainly associated with the presence of a long-term ulcer that arose against the background of infection (Helicobacter Pylori). This microbe is transmitted from a sick person to a healthy person through close interaction with him (through saliva, poor personal hygiene, eating food from the same container, etc.).

However, the presence of infection does not guarantee the occurrence of gastritis or ulcers. This or that disease develops under the influence of provoking factors:

• alcohol abuse;
• irregular meals;
• continuous use of certain medications;
• the predominance of coarse, spicy and salty foods in the diet;
• physical and nervous stress;
• vitamin deficiency;
• severe stress and depression;
• spinal and abdominal injuries;
• the presence of blood clots in the vessels of the stomach;
• lack of rest and sleep.

Stomach ulcers are not hereditary, but the likelihood of infection with Helicobacter bacteria in living conditions increases significantly, so the disease is often diagnosed in members of the same family. It is necessary to remember that the development of gastric ulcer occurs against the background of several risk factors, but the constant whirlpool of negative emotions and nervous breakdowns come first.

Symptoms of gastritis and ulcers

A huge load is constantly placed on the human stomach. And often, disruptions occur in the normal functioning of the digestive system, which are often the result of various diseases stomach, requiring immediate treatment. Their symptoms are quite clear. This:

• change in appetite;
• feeling of thirst;
• pain;
• dyspepsia;
• belching;
• heartburn.

These symptoms are observed both when a person has gastritis and when he has an ulcer.

What causes stomach ulcers?

A gastric ulcer is a defect in the gastric mucosa, rarely ˃1 cm (sometimes submucosal), surrounded by an inflammatory zone. Such a defect is formed as a result of the action of certain factors that lead to an imbalance between protective factors (gastric mucus, gastrin, secretin, bicarbonates, muco-epithelial barrier of the stomach and others) of the gastric mucosa and aggressive factors (Helicobacter Pylori, hydrochloric acid and pepsin).

As a result of certain reasons, there is a weakening of the effect and/or a decrease in the production of protective factors and an increase in the production of aggressive factors, as a result of which the non-resistant area of ​​the gastric mucosa undergoes an inflammatory process, with the subsequent formation of a defect. Under the influence of treatment, the defect is overgrown with connective tissue (a scar is formed). The area where the scar has formed does not have functional capacity (secretory function).

Signs

The manifestations of signs of a stomach ulcer are directly related to the location of the ulcer, the age of the patient, as well as individual pain tolerance.

Among various signs Gastric ulcers can be identified by pain in the epigastric region, which usually occurs after eating. Patients often report symptoms of stomach ulcers such as heartburn, sour belching, nausea after eating, vomiting, and weight loss.

In order to correctly diagnose the disease, the doctor studies the data of a fibrogastroscopic examination, as well as an x-ray. In some cases, a biopsy is performed and gastric juice is analyzed.

To other signs stomach ulcers include:

• nausea;
• vomiting, which brings relief;
• sleep disturbances, irritability;
• (with hidden frequent bleeding);
• belching sour;
• reduction in heart contractions due to increased influence parasympathetic nervous system;
• weight loss, especially if the patient deliberately fasts for fear of pain or induces vomiting for relief.

Signs of bleeding from a stomach ulcer are vomiting in the form of “ coffee grounds"and dark, almost black stool.

Symptoms of a stomach ulcer

Certain symptoms are characteristic of a stomach ulcer: sharp pain, gnawing, constant or burning in the epigastric region or in the stomach, sometimes radiating to the back.

Usually, with a gastric ulcer, symptoms begin to bother you 20-30 minutes after eating, and pain on an empty stomach is typical, subsiding after eating and reappearing after 1.5-2.5 hours, as well as night pain. The ulcer may be accompanied by nausea and vomiting. Sometimes heartburn occurs. Constipation is common.

A stomach ulcer is dangerous because it can lead to bleeding, in which case black stool appears. It is also possible to develop obstruction of the digestive system due to the formation of scars and adhesions with frequent exacerbations of the ulcerative process. Exacerbations occur in the spring and autumn.

If you do not think about how to treat a stomach ulcer in a timely manner, serious complications may develop - gastric bleeding, perforation of the wall of the stomach or intestine, stenosis (narrowing) of the stomach or intestine, the appearance of a malignant tumor at the site of the ulcer.

The manifestation of peptic ulcer symptoms is aggravated by:

• fatty meat products, lard, rich broths;
• roast;
• all kinds of spices: mustard, pepper, cloves, etc.;
• spicy and salty;
• canned, smoked food, sausages;
• bakery products from butter dough, pies, rye bread;
• strong tea, coffee;
• carbonated drinks.

Also, don't eat a lot of salt. It is better to avoid it completely, since it slows down healing and interferes with the elimination of the inflammatory process.

Diagnostics

To accurately diagnose and, accordingly, prescribe adequate treatment for gastric ulcers, the following methods are used:

1. FGS with a sample of the mucous membranes around the ulcer;
2. Bacteriological examination of samples for the presence of Helicobacter pylori;
3. X-ray with barium contrast;
4. Blood tests - and;
5. Study of the functions of the duodenum and stomach.

You should consult a doctor at the first symptoms of a stomach ulcer in order to promptly diagnose the disease and receive the necessary treatment.

If the ulcer is not treated

Stomach ulcer is a disease that needs to be treated, otherwise it will cause you a lot of trouble.

1. It can become a constant source of pain.
2. Ulceration of the stomach wall can lead to bleeding. And frequent bleeding can even cause anemia.
3. – a serious complication in which a through hole appears in the wall of the stomach. Then the contents of the stomach can spill into abdominal cavity and cause peritonitis.
4. Spasm of the stomach walls can cause food to be unable to pass through it and move through the gastrointestinal tract.

Don't tolerate pain and don't wait for complications. Treat your disease and feel like a healthy person!

Prevention

You can prevent the occurrence and development of stomach ulcers through prevention:

• avoiding traumatic, stressful situations;
• timely diagnosis of Helicobacter pylori infection and its treatment;
• refusal of uncontrolled use medicines;
• normalization of diet.

Perforated stomach ulcer: symptoms

A perforated gastric ulcer (or perforated ulcer) is essentially the appearance of a through hole in the wall of the stomach and the leakage of stomach contents into the abdominal cavity of the patient and its parts.

This phenomenon is very dangerous in itself; quite a large number of deaths occur in cases where the diagnosis of the disease was carried out too late, or in cases where the patient ignored simple rules treatment and recovery after surgery.

It is impossible to miss the symptoms of a perforated gastric ulcer, since they are very intense and pronounced and appear in stages:

1. First there is a sharp pain in the stomach area, radiating to chest, collarbone or back, similar to pain from a knife blow. Some patients compare the sensation of pain with the sensation of a strong and sharp burn.
2. The pain tends to grow, intensify with movement and surrounds the entire torso.
3. After some time (from 4 to 6 hours), the pain decreases and false relief occurs.
4. At this time, the abdomen becomes swollen and hard to the touch - “stone belly” - due to the accumulation of gases under the diaphragm. Mainly radiological signs stomach ulcers, which indicate damage to the abdominal cavity when stomach contents enter it.
5. The temperature rises, the skin turns pale, and the mouth feels dry.
6. Gradually, the pain syndrome returns, tachycardia, stool disorders, and a general severe deterioration in well-being may be observed. This critical condition, in which urgent surgery is vital.

A through hole in the wall of the stomach is a rather dangerous sucking for the human body, which, in the absence of proper treatment and careful monitoring, can lead to fatal outcome. Adequate treatment includes mandatory surgical intervention, since this pathological condition cannot be treated conservatively.

Treatment of stomach ulcers

When a stomach ulcer is diagnosed, treatment should include measures to heal the ulcer and eliminate the causes that caused it. They reduce the irritating factor of gastric contents through the use of gentle diets and drug treatment.

It can be either surgical or medicinal. If treatment does not lead to the desired effect, surgery is prescribed so that the ulcer does not develop into malignant tumor. The larger the ulcer and when it is located closer to the esophagus, the more surgery is indicated. Especially if you are sick old age and he has low acidity stomach.

The course of treatment of stomach ulcers with drugs may consist of the following points (duration – up to 7 weeks):

1. Antacid tablets, emulsions, gels, solutions to reduce the influence of aggression factors. Mostly non-absorbable antacids are used (Almagel, Gastal, Maalox, Gaviscon, bismuth preparations, Vikalin, Vikair, Topalcan).
2. Antisecretory agents to reduce the production of hydrochloric acid and histamine blockers (omeprazole, pirenzepine, ultop, famotidine, ranitidine, rabeprazole, torsid, lecedil, gastrosedin).
3. Cytoprotectors to increase the protective function of the mucous membrane (sucralfate, licorice preparations - carbenoxalone, andapsin).
4. Antiulcer drugs: blockers calcium channels, lithium preparations (nifedipine, cordafen, verapamil, isoptin).
5. Treatment with antibiotics if H. Pylori bacteria are detected (amoxicillin, metronidazole, amoxiclav, azithromycin, clarithromycin).
6. , prebiotics to eliminate the phenomena of dysbiosis (Linex, Normobact, Bifidumbacterin, Lactobacterin, Colibacterin).
7. Prokinetics to reduce reflux symptoms (domperidone, motillium, chaga preparations, cerucal, propulse).
8. Sedatives(valerian, motherwort, antipsychotics).
9. Vitamins, antioxidants (sea ​​buckthorn oil, triovit, triviplus).

The patient has been under follow-up care for at least 5 years since the ulcer scarred. If conservative therapy is ineffective, surgical treatment of the disease is prescribed.

Surgery for peptic ulcer

Surgery is considered the most adequate treatment for gastric ulcers today, since ulcerative formations tend to degenerate into malignant ones.

At the moment, there are several types of operations:

1. Resection - during this operation, both the ulcerative formation and the part of the stomach around this formation that produced increased amount of hydrochloric acid. During resection, at least 2/3 of the stomach tissue is removed.
2. Vagotomy - this type The operation was performed relatively recently and is a fairly popular method of treating stomach ulcers. It involves cupping nerve endings, responsible for the production of gastric secretions. After surgery, the ulcer heals on its own. Vagotomy is also used for duodenal ulcers. The disadvantage of this operation is possible violation motor function stomach.

Rehabilitation after and during treatment of a stomach ulcer necessarily includes special therapeutic diet, the essence of which is to consume the most sparing food possible using a fractional nutrition system.

Stomach ulcer after surgery

After the operation, the patient can start working in about two to three months. It all depends on how the stomach ulcer behaves after the operation, when the stitches are removed and discharged from the hospital. All this depends on the progress of recovery and wound healing. If everything is in order, the stitches are removed after about 7-9 days, but you are discharged from the hospital a little earlier.

It is very important to follow a diet after surgery. As a rule, you are allowed to drink liquid after two days, half a glass of water per day, dosing with a teaspoon. Gradually every day the water is replaced with soup or broth. Then, after about eight days, they are allowed to eat meat, potatoes, cereals, and so on, but only in pureed form. In order not to cause harm to the postoperative condition, it is necessary to observe strict diet and listen to the doctor.

How to treat stomach ulcers with folk remedies?

Over many years of studying numerous herbs, tree fruits and other natural products, traditional healers have compiled a huge number of recipes for various diseases, including ulcers.

The success of treating stomach ulcers with traditional methods depends on the correctness of their choice in each specific case, so to ensure that these procedures are not useless, it is best to discuss them with your doctor.

1. Squeeze juice from 2 kg of fresh cabbage; to improve the taste, add celery juice to it in a 3:1 ratio, which, like cabbage, has an anti-ulcer effect. Instead, you can add a few tablespoons of tomato, pineapple or lemon juice. Store the mixture in a cool place and drink 250 ml daily in the morning on an empty stomach. Course of treatment: 3 weeks.
2. Sea buckthorn oil. It is best to purchase it at a pharmacy. However, you can prepare it at home. To do this, juice is squeezed out of the berries and placed in a cold place. The oil will gradually float to the surface. It is scooped up and stored in the refrigerator. Take a teaspoon before meals 3 times a day. Course 3-4 weeks.
3. Following a diet can cure stomach ulcers potato juice. To do this, you need to squeeze the juice out of the grated potatoes. It is taken in the morning, on an empty stomach, diluted one to one with water. Food after taking it can be consumed only after half an hour. After a week you can already feel relief. Treat with this method for four to eight weeks.
4. For cooking effective medicine for stomach ulcers you will need aloe 3-5 years old. Before harvesting leaves, it does not need to be watered for 2 weeks. After this time, you need to carefully cut off about 250 grams of leaves and place them in a cool, dark place. After a couple of days, the leaves need to be minced and about 250 grams of honey added, everything thoroughly mixed and put on fire. The mixture must be constantly stirred and brought to a temperature of 50-60 degrees. Then add half a liter of red wine to the warm mixture. Mix everything together thoroughly and leave for a week in dark place. Take this medicine 3 times a day, a tablespoon approximately an hour before meals; in the first 5-7 days it is better to start with a teaspoon.
5. Chop a kilogram of nuts. Eat the kernels and collect the shells in one glass. Fill the glass with the shell with alcohol and let it sit for a week and a half. You need to take one tablespoon on an empty stomach 20 minutes before you eat. And so three times a day.

Remember, to cure a peptic ulcer, you first need to eliminate the causes of the ulcer.

Diet for exacerbation of stomach ulcers

During exacerbations of peptic ulcers, food should be mushy, food should be thoroughly chopped or ground. Carbohydrates are digested fastest, followed by proteins. Processing requires significant time fatty foods, so at this stage it is better to abandon it.

Pureed, easily digestible food is indicated, which practically does not increase the secretion of gastric juice:

• soft-boiled eggs, steamed omelet;
• white, slightly dried bread;
• dairy, chicken, vegetable soups made from potatoes, beets;
• boiled vegetables: carrots, potatoes, beets, zucchini, pumpkin;
• milk and dairy products;
• boiled dishes of beef, chicken, veal, steamed cutlets;
• boiled low-fat fish;
• buckwheat, semolina, rice, oat groats, pasta;
• weakly brewed tea;
• sweet jelly, compotes;
• decoctions of rose hips, wheat bran, non-acidic berry juices;
• alkaline mineral water without gas.

To speed up the healing of ulcers, it is useful to consume butter and vegetable oils.

Peptic ulcer is complex disease, which causes a whole range of reasons. First of all, this is a hereditary predisposition associated with the volume and rhythm of gastric juice secretion and digestive enzymes duodenum.

If to hereditary predisposition There are also such factors as irregular nutrition, dry food, smoking and abuse of strong alcoholic drinks, taking certain medications (Aspirin, Prednisolone, etc.), immune disorders, frequent stress and heavy physical activity, which disrupt the blood circulation of the digestive organs and their mechanisms. nervous regulation, then the disease can flare up like a fuse - you just need to bring a match. This “match” is a small bacterium that lives in the stomach, Helicobacter pylori.

Features of the course of peptic ulcer disease

Ulcers of the stomach and duodenum occur in the form of exacerbations and remissions. During the course, a pre-ulcerative state, the onset of the disease, relapses, remissions and complications are noted. There are gastric ulcers with a frequently recurrent and continuously relapsing course.

Exacerbations of the disease more often occur in the off-season and have a fairly clear connection with stress, heavy loads and dietary errors. An exacerbation can last for several weeks, then subsides and goes into remission.

It is very important to timely detect gastric and duodenal ulcers in the initial stages, when they respond well to treatment. To do this, it is worth knowing the main symptoms of this disease.

The main symptom of ulcer recurrence is pain.

The most characteristic symptom of relapse of the disease is increasing paroxysmal spasmodic pain in the abdomen. A peculiarity of ulcerative pain is its connection with food intake. Abdominal pain is divided into:

• early pain - appears immediately after eating or within the next hour; they talk about the localization of the ulcer in primary departments stomach;
• late pain - does not occur immediately, but 2-3 hours after eating; these pains indicate the presence of an ulcer in the final sections of the stomach;
• hunger pains – pains that appear on an empty stomach; patients with such pain try to eat as quickly as possible - this immediately relieves the pain; a characteristic sign of an ulcerative process in the duodenum;
• Night pain is one of the types of hunger pain; the patient wakes up at night from severe pain.

Spasmodic pain from a stomach ulcer appears suddenly, can radiate to the back and decrease (sometimes completely disappear) after vomiting. The vomit has a pronounced sour smell. Patients try to induce vomiting themselves to relieve pain. Characteristic is an increase in pain, reaching its peak, and then the same gradual decrease and disappearance.

Attacks of pain can last up to 2-3 hours or more. To reduce pain, the patient takes a position that somehow alleviates the pain; This is usually a position on your side or back with your knees pressed to your chest.

All types of pain can be eliminated by taking antispasmodics - medications that relieve spasms of the smooth muscles of internal organs (Papaverine, No-shpa, Halidor, etc.). The pain also goes away from taking soda or other drugs that neutralize acidic gastric contents (antacids - Almagel, Maalox, Gastal, etc.).

Symptoms of indigestion during exacerbation of peptic ulcer

These symptoms include heartburn, belching, nausea, and vomiting. Heartburn can bother the patient constantly or appear along with an attack of pain and disappear with it. If the ulcer is localized in the upper part (bulb) of the duodenum, heartburn, as well as pain, does not appear immediately after eating. Hunger pains may also appear, accompanied by sour belching.

If the ulcerative process is localized in the middle of the stomach, then heartburn is rare. Symptoms such as nausea and belching of eaten food are more typical for them. Frequent vomiting and stool retention appears when the ulcer is localized in the middle of the duodenum.

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Exacerbations of gastric and duodenal ulcers can be complicated by bleeding, perforation and penetration (penetration) of the ulcer into nearby organs.

Symptoms of bleeding from peptic ulcer

Bleeding is the most common complication exacerbation of the ulcerative process. Massive bleeding is relatively rare, but it is very dangerous. Alarming symptoms heavy bleeding– this is rapidly increasing weakness and dizziness, sometimes with loss of consciousness. The death of the patient can only be prevented by timely surgical treatment.

More typical are minor bleedings, which are accompanied by the appearance of dark brown vomit in the form of coffee grounds, black feces, and dizziness. Such patients are also subject to urgent hospitalization.

Symptoms of perforation of the wall of the gastrointestinal tract

Perforation is a common serious complication of exacerbation of an ulcer of any localization. This complication has very characteristic symptoms: the patient suddenly develops severe (“dagger”) pain in the abdomen. The pain is so severe that the patient cannot take a breath, he literally loses consciousness from the pain. It is in a forced state with its knees pressed to its chest and is afraid to move.

If in such a condition the patient is not provided with immediate surgical care, then after a few hours the pain will decrease, which is a sign of the onset of peritonitis - inflammation of the membrane lining the abdominal cavity and covering internal organs. After a few more hours, the pain increases again, the body temperature rises, and characteristic signs of peritonitis appear. The patient can only be saved urgent hospitalization and surgical treatment.

Symptoms of ulcer penetration

Penetration, or germination of an ulcer into surrounding organs, is another complication that develops against the background of an exacerbation of the disease. An ulcer can grow from the stomach into the pancreas, liver and their ligaments. Symptoms of penetration: severe, increasing abdominal pain that is not relieved by antispasmodics and soda, vomiting that does not bring relief to the patient. The patient requires urgent hospitalization.

Late complications of peptic ulcer

Such complications of gastric and duodenal ulcers develop after repeated relapses of the disease. TO late complications refers to stenosis of the pylorus - the circular muscle (sphincter), located on the border of the stomach and duodenum. This complication causes a disruption in the movement of food mass through digestive tract. Symptoms of pyloric stenosis: heaviness and distension in the stomach after eating, which does not go away for a long time. Then vomiting joins this symptom, and it can all end in intestinal obstruction.

Late complications of a stomach ulcer also include malignancy - the degeneration of an ulcer into cancer. Gastric ulcers often become malignant; such a complication is not typical for duodenal ulcers. Suspicion of malignancy can cause the appearance of constant abdominal pain that has lost connection with food intake. Also characteristic is a decrease in appetite, weight loss, and increasing weakness.

Signs of exacerbation of gastric and duodenal ulcers must be identified and treated as early as possible, otherwise surgical intervention cannot be avoided.