Damage to the mucous membrane of the duodenum causes a number of painful sensations. The period of the disease occurs with periods of exacerbation and attenuation of symptoms. The longer a patient does not seek medical help, the greater the likelihood of complications developing. The treatment path to complete recovery is long and multi-stage. If you follow the recommendations of your doctor and diet, duodenal ulcer can be cured forever.

Etiology of the disease

Peptic ulcer disease tends to be asymptomatic at first. The first signs in the form of heaviness and heartburn do not lead the patient to think about the presence of a serious chronic disease. Periods of acute course are followed by relief and disappearance of symptoms. In moments of relief, a person believes that the disease has passed and there is no need to seek medical help or undergo examination. As the symptoms progress, they worsen and bring more and more discomfort. The symptoms spread to other organs, disrupting the functioning of the entire digestive system. In the absence of treatment, damage is prone to degeneration into malignant formations.

Frequent pain on an empty stomach, belching with an acidic odor, and heartburn are the main signs of a duodenal ulcer. Before treating a duodenal ulcer on your own using traditional methods or medications, you must undergo a full examination and consult a gastroenterologist. Medical tests and instrumental study of the disease will help eliminate complications and choose the right treatment tactics.

The following factors lead to damage to the surface of the stomach and duodenum:

• chronic and acute stressful situations;
• frequent use of medications that corrode the mucous membrane;
• bad habits;
• poor nutrition;
• entry into the body of the bacterium Helicobacter pylori;
• hereditary factor;
• accompanying illnesses.

As the disease progresses, it spreads to other internal organs and causes complications, in some cases death. Therefore, it is important to undergo treatment in a timely manner.

A direct connection between duodenal ulcers and nervous system disorders is obvious, which is why it is more often associated with psychosomatic diseases.

Character traits that are characteristic of people with peptic ulcers:

• high ambitions;
• workaholism;
• perfectionism;
• increased excitability;
• mood swings and sudden changes in emotions;
• soul-searching;
• doubtfulness;
• problems expressing yourself and feelings;
• manic focus on one aspect of life;
• disgust.

A set of measures to get rid of the disease

In addition to medicinal methods of treatment, duodenal ulcers in the early stages can be cured forever with both medications and the addition of traditional methods (after the doctor’s approval) and a complete change in lifestyle. Eliminating stress factors, changing your diet and having a healthy lifestyle always lead to improved well-being and recovery.

The choice of treatment method depends on the cause that caused erosive damage on the surface of the digestive organs. For bacterial infection, a course of antibiotics is recommended. To increase effectiveness, drugs from different groups are prescribed together. In conditions of increased acidity, antibacterial therapy is supplemented with antienzyme agents. In case of a stressful cause of the disease, the main component is sedatives and antidepressants with mandatory consultation with a psychotherapist. To accelerate the healing of damage to the surface of the digestive organs, it is recommended to supplement therapy with drugs with regenerating properties.

In case of a complicated course with intestinal perforation or bleeding, a duodenal ulcer can only be cured by surgical intervention. The postoperative period is spent in a hospital under the supervision of doctors. A multicomponent approach to the treatment of the disease with adherence to dietary nutrition and improvement of the functioning of the nervous system is the basis for a successful recovery.

During an exacerbation of the disease, the patient must be in a hospital facility with bed rest for at least the first two weeks.

In cases of bacterial etiology of the disease, the basis of treatment is antibiotics. The following active ingredients of drugs are active against the cause of Helicobacter pylori peptic ulcer: metronidazole, azithromycin, amoxicillin, clarithromycin, josamycin.

Antibacterial therapy for the treatment of ulcers is prescribed in several regimens: two-component, three-component, four-component. After the full course, it is necessary to undergo a re-examination for the presence of Helicobacter pylori. In cases of unsatisfactory tests, the group of antibiotics is changed, combined and a second course is prescribed.

To prevent the development of dysbiosis while taking antibiotics, probiotics are prescribed to maintain normal intestinal microflora. Popular effective products: Linex, Hilak Forte, Bifidumbacterin, Lactobacterin, Bak Set.

In order to finally get rid of bacterial infection in case of peptic ulcer, the course of antibiotics must be completed completely, observing the dosage and regimen.

Mandatory components in the treatment regimen for peptic ulcers are agents that reduce or prevent the production of hydrogen chloride and disable histamine receptors and the proton pump. The choice of drugs depends on the etiology and the presence of contraindications. Multidirectional action accelerates the healing of damage and promotes rapid onset of relief. Antisecretory agents help suppress the production of aggressive gastric secretions, relieving inflammation.

Increased production of hydrogen chloride is detrimental to the surface of the digestive organs. High acidity disrupts the functioning of the stomach and corrodes the mucous membrane.

To relieve pain, heartburn and protect the inside of the stomach and duodenum, antacids and bismuth preparations are recommended.

Bismuth-based medications are harmful to Helicobacter pylori; they cover the inner surface of the digestive organs with a protective coating, protecting them from aggressive factors. Trade names of bismuth-based products: De-nol, Vikair.

Antacids eliminate excess hydrogen chloride, relieve inflammation, and protect the mucous membrane. For ease of use, dosage forms are produced in the form of lozenges that quickly dissolve and suspensions. Combined antacids not only relieve pain, but also eliminate bloating and flatulence.

Medicines to speed up healing

Minor damage to the mucous membrane heals on its own when taking enveloping agents. In cases of extensive ulcers or slow regeneration, agents are recommended to accelerate epithelization and repair of ulcers. Preparations based on protein-free blood of young calves have a minimum of contraindications and side effects. For peptic ulcers with this active ingredient, injections of Actovegin and Solcoseryl are prescribed. Methyluracil stimulates the restoration of damaged epithelium, but has more side effects and contraindications and is prescribed less frequently.

Relief of nausea and vomiting

Prokinetic agents help improve peristalsis, relieve attacks of nausea and eliminate the urge to vomit. Metoclopramide (another trade name Cerucal) disables the vomiting and nausea center in the brain. Prescribed in the form of tablets and injections (in cases where it is impossible to take the drug orally). Motilium promotes better peristalsis and relieves the creeping feeling of nausea. Trimedat relieves spasms, improves peristalsis in both diarrhea and constipation, and eliminates nausea.

Drugs to eliminate spasms

Spasmodic pain in peptic ulcers is relieved using approved drugs: No-shpa (Drotaverine), Duspatalin (Veremed, Dutan, Mebeverine, Sparex), Spasmol, Spazoverine. Drugs in this group relax the smooth muscles of the digestive tract and reduce its contractile functions. To relieve pain and spasms during peptic ulcer disease, only certain groups are allowed that do not affect the condition of the mucous membrane; non-steroidal anti-inflammatory drugs are prohibited.

Stabilization of the nervous system

Research into the causes of the disease suggests that it most often occurs against the background of nervous disorders. To improve the psychological state, doctors prescribe sedatives, antipsychotics, antipsychotics, and antidepressants. The choice of group depends on the nervous disorder and the patient's condition. All drugs in these categories are strictly prescribed by a doctor.

For peptic ulcers of the duodenum and stomach, especially during exacerbations, therapeutic procedures are indicated. The multidirectional effects of physiotherapy act on different causes of the disease.

During exposure to currents, spasms are relieved, blood supply is improved, and inflammation is eliminated. With an ultrasound procedure and electrophoresis with novocaine, excessive secretion formation is reduced and pain is relieved. After procedures with therapeutic mud, blood circulation becomes better and inflammation goes away. Microwave and heat therapy combats inflammation and pain.

Only the attending physician, after a full comprehensive examination, prescribes a category of physiotherapy in order to enhance the effect of drug treatment for duodenal ulcers.

Therapeutic diet therapy

Anyone who is diagnosed with a stomach or duodenal ulcer must understand that for a complete recovery it is necessary to change their lifestyle and eating habits, which led to this disease. An obligatory component of the complex of treatment of the disease is dietary nutrition, especially at first and during exacerbation.

The basis of therapeutic nutrition is the exclusion of foods that irritate the surface of the internal digestive organs.

The first two weeks of therapy are prohibited:

• alcohol;
• smoking;
• fried;
• seasoned with spices;
• pickled and salted;
• indigestible and rough food;
• carbonated drinks;
• rich broths.

Allowed:

• milk and dairy products;
• porridge;
• eggs;
• lean, easily digestible meat;
• light, lean vegetables;
• all food must be pre-boiled and chopped;
• the temperature of hot dishes is about 50, cold - 40;
• eat six times a day in small portions.

At the next stage, vegetables, fruits, and fruit juices are gradually introduced. In any case, every patient must understand that in order to cure a duodenal ulcer forever, it is necessary to change both the diet (do not eat junk food, fast food) and give up bad habits such as drinking alcohol and smoking. Switching to a healthy diet will prevent the recurrence of the disease and ensure comfortable well-being and digestion.

Traditional treatment recipes

Official medicine does not prohibit resorting to traditional methods. In home treatment, if you follow the doctor’s recommendations for taking medications, physiotherapy, and following a diet, taking natural remedies will increase the effectiveness of the entire complex.

All doctors agree that it is unlikely that duodenal ulcers can be cured forever using traditional medicine alone; without drug therapy, the course of the disease can only be alleviated.

To heal damage to the mucous membrane of the digestive system, sea buckthorn oil is taken 1-2 teaspoons after meals for ten to fourteen days.

Bee products help restore the mucous membrane, relieve inflammation and pain. Honey and propolis are used to treat peptic ulcers at home. Alcohol solutions are avoided to avoid irritation of the digestive organs. Mix honey with olive oil and drink a teaspoon half an hour before meals. Propolis is diluted with butter or vegetable oil and drunk before meals for at least a month.

An effective folk remedy is a decoction of flax seeds. The herbal remedy is infused in a water bath and drunk 50 ml before meals for two months.

Mumiyo or stone oil has multidirectional effects on duodenal ulcers:

• bactericidal against Helicobacter pylori;
• promotes rapid healing;
• strengthens the immune system;
• protects the gastric wall from aggressive environments;
• neutralizes high acidity.

Mumiyo is drunk in its pure form in tablets or diluted with milk and water. The duration of use depends on the severity of the symptoms. To enhance the therapeutic effect, alternate with freshly squeezed cucumber juice.

During illness, it is useful to include bananas in your diet. They have a calming effect on the mucous membrane, relieve inflammation, and normalize digestive processes. Due to the high content of potassium, magnesium and beneficial compounds, they improve the functioning of the nervous system.

Freshly squeezed juices from potatoes and cabbage restore the functioning of the digestive system and help in the treatment of ulcers. Take on an empty stomach two to three times a day.

Phytotherapy

To cure duodenal ulcer permanently, in addition to medication, both traditional medicine and herbal medicine are added.

Chamomile decoction is drunk to relieve inflammation, spasms and regulate peristalsis. Flowers help eliminate nervous disorders.

Yarrow has analgesic and healing properties. The herb is infused for five minutes in a water bath and taken on an empty stomach, half a glass in the morning and evening.

The collection of medicinal herbs has multidirectional effects: yarrow, chamomile, St. John's wort, mint, centaury. The components are taken in equal proportions and left in a water bath for half an hour. Take twice a day, half an hour before meals in the morning and evening.

Clover flowers help relieve symptoms of peptic ulcers. They are brewed with fireweed and drunk half a glass twice a day.

Before taking any medicinal herbs, you should consult your doctor.

Regulation of psychosomatics

Constant chronic stress, depression, and scrolling through negativity in the head do not always respond to treatment with sedatives and antidepressants. Working with a psychologist to identify the reasons that led to the disorder comes first. To improve the situation, you need to change your attitude towards people and situations that cause attacks of anger and stress. Every patient with a psychosomatic cause of duodenal ulcer must learn to easily and calmly assimilate and “digest” information from the outside world. Fear and lack of self-confidence, according to psychologists, lead to damage to the digestive organs. After normalization of the psychosomatic sphere, ulcer healing occurs quickly.

To cure a stomach or duodenal ulcer quickly and permanently, you must strictly adhere to the recommendations of a gastroenterologist for taking medications, physical therapy, combining this with the normalization of the emotional state and traditional methods. A single-component approach gives unsatisfactory results, so doctors resort to complex therapy. To avoid the re-development of peptic ulcers, patients are advised to change their lifestyle, eating habits, normalize the functioning of the nervous system and all body systems, and consult a doctor promptly if any ailment occurs.

A duodenal ulcer affects the mucous membranes; the symptoms of the pathology usually worsen in the autumn and spring seasons, when the period of remission turns into an exacerbation stage, requiring mandatory treatment.

When the disease occurs, ulcerations form on the mucous membranes - deep single or extensive defects that result in life-threatening complications. The disease is treated with therapeutic and surgical methods, traditional medicine.

Scientists have proven that duodenal ulcer is formed under the influence of harmful bacteria - Helicobacter pylori. Microorganisms create pathogenic microflora in the intestines, which leads to peptic ulcers.

There are many carriers of Helicobacter Pylori among people, but a small proportion of them develop the disease. The majority of infected people have no symptoms of the disease. Helicobacter bacteria are in a “dormant state” in their body.

The manifestation of the disease is facilitated by:

• disrupted diet;
• rough and spicy food;
• nicotine, alcohol;
• genetic predisposition;
• stress;
• systematic use of a number of medications;
• high acidity of gastric juice.

Therapy directly depends on the etiology of the disease. Therefore, treatment of duodenal ulcer is prescribed after establishing the symptoms and causes that led to its development.

Symptoms

When the disease progresses, the following symptoms occur:

1. Pain of varying intensity, localized in the epigastrium and under the sternum. If an ulcer of the duodenal bulb occurs, the pain is similar to that which appears with cardiac pathologies, or radiates to the back.
2. Painful sensations appear when the stomach is empty and at night.
3. The pain subsides after consuming antacids - drugs that neutralize hydrochloric acid, or milk.
4. Pain increases when a bolus of food, saturated with hydrochloric acid, exits the stomach into the cavity of the duodenum.
5. Attacks of pain occur up to several times a day. The further the disease progresses, the more often they appear, and their intensity increases.

In children and elderly patients, signs of the disease are mild. With erased symptoms, a duodenal ulcer is detected late, and treatment begins in advanced conditions. Sometimes this leads to a dangerous complication - perforation (a through ulcer through which intestinal contents leak into the abdominal cavity) and, as a consequence, to peritonitis.

Complications

If duodenal ulcers are not treated, severe complications develop that threaten the patient's life. The disease, as it progresses, causes:

1. Internal bleeding. Blood vessels affected by ulcerations bleed. Internal blood loss is indicated by hematemesis and anemia. Surgery helps save the patient.
2. Perforation. Open ulcers form on the intestinal drains. Through the lesions, intestinal contents leak into the abdominal cavity, causing peritonitis. In such a situation, treatment of the duodenum is performed only surgically. Otherwise the patient will die.
3. Penetration. Ulcerated intestinal fluids penetrate the liver or pancreas. Conservative therapy brings temporary relief. The patient is relieved of the pathological condition through surgery.
4. Stenosis. The affected areas of the intestine swell and scar, which ends in narrowing of the lumen and blockage. Intestinal obstruction is accompanied by vomiting, constipation and flatulence, heaviness and pain in the stomach. Edema is eliminated using medications. The question of how to cure a duodenal ulcer complicated by adhesive stenosis has only one answer - surgery.
5. The appearance of a cancerous tumor in areas of ulceration. In this case, treatment of the duodenum is carried out using chemotherapy, radiation, and surgery.

Drug therapy

Treatment of duodenal ulcer is carried out using the following medications:

1. Pain syndrome is relieved using medications that inhibit the production of gastric juice: Omez, Gastrozol, Bioprazol.
2. Products that form a protective film on the intestinal walls are used: Almagel, Maalox.
3. To destroy bacterial infection, antibiotics are prescribed: Amoxicillin, Clarithromycin, Metronidazole. If the therapy has not achieved its goals, a new ulcer treatment regimen is drawn up, which includes other antibacterial drugs: Omeprazole, De-Nol, Ranitidine, Tetracycline.
4. To stimulate intestinal motility, the following are prescribed: Trimedat, Cerucal, Motilium.
5. Therapy includes analgesics, antispasmodics, multivitamins, sedatives, and antidepressants.

Exacerbated and chronic ulcers are treated with conservative methods from 2 weeks to 1.5 months. The duration of treatment is influenced by the patient’s condition and the size of the lesions. Treatment regimens are selected only by a doctor.

In case of exacerbation, a strict therapeutic diet is followed - table No. 1. When remission occurs, variety is added to the diet. But in both cases, they adhere to fractional meals, take only gentle food, exclude fried, fatty, salty, smoked, and spicy foods. Products are boiled or steamed.

Surgery is performed if an emergency situation arises caused by a serious complication: intestinal obstruction, peritonitis, bleeding.

Folk recipes

Treating duodenal ulcers at home is a long process. In addition to medications, patients are recommended to use folk remedies. Herbal remedies, honey, aloe, sea buckthorn oil, and mineral water help fight the disease.

Products with sea buckthorn oil

The disease is treated with agents that can envelop the mucous membranes, tighten ulcerative formations on them, and regenerate damaged cells and tissues. Sea buckthorn oil has these properties. The medicine heals damage to the mucous membranes. To suppress the disease, pure malo or its combination with other natural remedies is used.

Recipes revealing how to treat duodenal ulcers with sea buckthorn oil:

1. Before breakfast, drink 1 teaspoon of oil on an empty stomach. After taking the medicine, spend 1 hour in bed, periodically changing body position. Therapy is carried out daily until 200 ml of oil is drunk. At the beginning of treatment, heartburn sometimes appears. Tea soda dissolved in water (0.5 teaspoon per glass of liquid with a temperature not exceeding 60 °C) helps relieve the discomfort.
2. Recurrence of the disease is prevented by consuming a mixture of oil (1 teaspoon) and honey (1 tablespoon) once a day. They are treated with the drug for a whole year. With daily use of the medicine, symptoms of the disease do not appear.
3. To get rid of duodenal ulcer, make a mixture of a 2% solution of baking soda and oil. For one dose, prepare a mixture of 50 ml of soda solution and 1 teaspoon of sea buckthorn oil. Drink the product for 30 days.

Traditional preparations with aloe

Aloe heals ulcers and erosions that occur on the intestinal mucosa. The juice of the plant enhances the effect of the components used in mixture with it and accelerates healing.

The following preparations are prepared based on aloe:

1. Combine aloe, honey and butter in equal parts. The mixture is consumed 3 times a day. First, drink 1 tablespoon of homemade medicine, then eat. Honey inhibits the development of bacteria, oil, protecting the mucous membrane with a film, eliminates pain, aloe heals ulcerations.
2. From a three-year-old aloe plant, the leaves are cut off and crushed. To 150 g of aloe add 50 g of honey and butter, pour in 10 ml of Cahors. Place in a water bath and heat until the components dissolve. Take 1 tablespoon three times a day on an empty stomach, washed down with milk or soda solution. After 30 minutes they eat. Treatment lasts 30 days. A repeat course is carried out after 10 days.
3. Healers have created an effective method that explains how to treat ulcers of the duodenum and bulb. Before breakfast, drink 1 raw egg. Maintain a five-minute interval, eat 1 teaspoon of honey. Then, after a 5-minute break, take a small piece of aloe and eat the pulp. Complete the procedure by taking 1 teaspoon of sea buckthorn oil. Have breakfast 30 minutes later.

Recipes with honey

It is useful to use honey for duodenal ulcers; it improves the functioning of the digestive organs, has an anti-inflammatory effect, relieves heartburn and irritation, nourishes the mucous membranes, and promotes the healing of ulcers.

Treatment of duodenal ulcers is carried out using the following recipes:

1. Add 35 g of honey to 250 ml of warm water. Stir until dissolved and drink. Food is taken after 1.5 hours, provided that the acidity of gastric juice is increased. When acidity is low, drink the mixture 10 minutes before meals. Treatment lasts for 2 months. During the treatment period, sweets are completely removed from the menu. If heartburn occurs, it can be neutralized by drinking 125 ml of milk.
2. Prepare a mixture from 500 g of honey, 500 ml of olive oil and freshly squeezed juice of 2 lemons. The mixture is made in a glass bottle, capped, and stored in the refrigerator. Before drinking the medicine, shake it up. Drink 1 tablespoon 3 times a day before meals. The interval between taking the medicine and food is half an hour. The pain syndrome subsides on the 5th day. Take the medicine again after a month. Treatment of duodenal ulcers according to this recipe is carried out twice a year: at the end of autumn and at the beginning of spring.
3. Combine 500 g of honey and butter. Add 200 g of powder obtained from walnut partitions. The mixture is mixed, consumed on an empty stomach before breakfast, 4 teaspoons.

Herbal infusions

You can treat duodenal ulcers with folk remedies using herbs. Symptoms of the disease will disappear if you take decoctions of the following medicinal plants:

1. A collection is prepared from elecampane, licorice, chamomile, calendula, yarrow, marshmallow and blueberry flowers. Measure out 2 teaspoons of each herb. Pour the mixture into 1 liter of boiling water. To infuse, leave for 1 hour. Drink ½ glass three times a day. The interval between taking the decoction and eating is 30 minutes. A home remedy is indicated for the treatment of ulcers with high acidity of gastric juice.
2. For low acidity, prepare a collection of aralia, chamomile, St. John's wort, dandelion root, calendula, wormwood, mint, plantain, calamus, and sage. Mix 2 teaspoons of raw materials. Add 1 liter of boiling water to the prepared mixture. Let the mixture stand for 1 hour. Use 125 ml. Food is taken after 30 minutes.
3. To 20 g of mint add 10 g of fennel and caraway seeds. The collection is poured into ½ liter of boiling water. Leave to infuse for 30 minutes. The decoction is used for ulcers, which are accompanied by indigestion, intestinal cramps, and bloating.

Mineral water

After the disease transitions from an acute state to the remission stage, patients are recommended to drink non-carbonated alkaline mineral water. The following mineral water is suitable for treatment:

• Borjomi;
• Essentuki No. 4;
• Slavyanovskaya;
• Berezovskaya;
• Smirnovskaya No. 1;
• Jermuk.

Drink healing waters three times a day, 200 ml. If acidity is high, drink warm water, taking small sips. A glass is drunk within 7 minutes and eaten after 30 minutes. Drinking water is allowed 1.5–2 hours after eating.

If the goal is to relieve heartburn, drink water slowly, in small doses (no more than 50 ml) with an interval of 20 minutes.

Before treatment, mineral water is heated to 40°C in order to release gases that provoke increased secretory function.

If secretion is reduced, drink cool water before meals. An interval of 30 minutes is maintained between the treatment procedure and food intake.

If an exacerbation occurs when drinking water, reduce the dose, frequency of administration, or interrupt treatment for 1–2 days. If individual side effects occur, consult a doctor or stop treatment.

The pathology quickly recedes and does not produce side effects if treatment with folk remedies is combined with drug therapy, physiotherapy, diet, and drinking mineral waters. Recovery is accelerated by quitting alcohol and smoking. The risk of relapse is minimized if the patient eliminates provoking factors, strengthens the immune system, and increases stress resistance.

In fact, almost all manuals on gastroenterology contain a single disease - peptic ulcer of the stomach and duodenum. It is very rare to find two separate chapters dedicated to these diseases. This happens for one reason: these diseases have a lot in common. In fact, this is a manifestation of the same disease, occurring both in the stomach and in the duodenum.

Of course, isolated defects may occur, and then a diagnosis will be made according to the affected organ. But it happens that multiple lesions involve both the stomach and the initial segment of the intestine, which is the duodenum.

It is known that on average, 9 - 10% of the entire adult population are diagnosed with peptic ulcer (both gastric and duodenal ulcers). The incidence is constantly growing, since this problem is a social one.

On the one hand, fast food and cola, the habit of eating hot dogs and chips without taking time off from the computer causes an increase in morbidity among young people. On the other hand, the deterioration of life of Russians, the increase in the share of palm oil and cheap substitutes, and the predominant diet of potatoes and noodles in villages also leads to a decrease in immunity, especially against the background of alcoholism and chronic depression.

Duodenal ulcer - what is it?

manifestation of the disease in the intestines and stomach

What happens in the intestines in this case, what ulcers are formed, how do the signs of ulcers in the intestines differ from gastric localization, and how to treat them? Everyone understands what “ulcer” means. This is a tissue defect, usually deep, which has a bottom, walls and edges.

With regard to the initial parts of the intestine, we can say that a duodenal ulcer is a defect that arose in the intestinal wall and penetrated not only deep into the mucous membrane, but also into the submucosal layer, and even deeper.

If the defect occurs only on the mucous membrane, it is called erosion, and it is easier to treat than ulcers. After all, in the end, the ulcer can “eat a through hole”, and as a result, a serious complication arises - a perforated duodenal ulcer, which requires urgent surgery for life-saving reasons.

As for peptic ulcer disease itself, it is a long-term, chronic process, which is characterized by a wave-like course, with periods of exacerbations and remissions, which reflects the “state” of the ulcer.

Preventing the question, it must immediately be said that any deep defect, unlike erosion, cannot heal without leaving a mark. Our body is designed in such a way that all lesions that are deep enough leave behind a scar of connective tissue. So, any boil on the skin heals, albeit with the formation of a tiny but lifelong scar. But it doesn't stop you from living.

But a scar on the wall of an actively contracting intestine can not only prevent it from contracting, but also reduces the surface area suitable for absorption. In addition, the scar can roughly “pull” the wall, and as a result, the intestinal lumen will decrease. All this leads to adverse consequences. What causes an ulcer to appear?

Why does it occur?

This is all due to the aggressive influence of gastric juice, which is known to dissolve meat. It does not affect the healthy intestinal wall, since it is protected from its harmful effects, but when the protective barriers fall, erosion first occurs, and then ulcers.

Most often, this damaging factor is an infection caused by the inconspicuous microbe Helicobacter pylori, which is found in the stomach of all people, but in some it causes a decrease in local immunity and potentiates the development of the disease. In addition, there are predisposing factors. These include:

• Heredity (horizontal and vertical relatives get sick on average three times more often);
• Blood type. Thus, gastric ulcers more often occur in people of group II, and duodenal defects - in patients with blood group I;
• Psychotrauma, chronic stress, anxiety;
• The presence of active inflammation – duodenitis with a weakening of the mucous protective barrier;
• Long-term treatment with NSAIDs (acetylsalicylic acid, Indomethacin, Voltaren, diclofenac, ibuprofen and other drugs), treatment with steroid hormones (systemic connective tissue diseases, bronchial asthma, immunological diseases, multiple sclerosis).

You should be aware that intravenous infusions of high doses of steroid hormones (pulse therapy, 1 gram of methylprednisolone daily for three days) can lead to the formation of ulcers in such a short time. Therefore, before treatment, it is imperative to undergo an FGDS, and during the treatment process, take medications that prevent the formation of ulcers.

• Alcohol abuse, smoking and other bad habits.

At the same time, in chronic drunkards, for whom vomiting is a common thing, submucosal ruptures of the gastric mucosa often occur, which are sources of bleeding, even if a mucosal defect does not form.

Finally, it is known that:

• duodenal ulcer localization occurs more often in young people (20 - 40 years old), and gastric ulcer - in older people;
• ulcers in the duodenum occur 2–3 times more often.

How does the disease manifest itself?

7 main manifestations of the disease

The main symptom of a duodenal ulcer is pain, which can simulate various conditions, since in addition to abdominal pain, unpleasant and painful sensations may appear in the lower back, in the left and right hypochondrium. What characteristic symptoms occur with ulcerative lesions, and especially with exacerbation of this disease?

7 signs of an exacerbation of the disease

Let us consider the “season” of exacerbation. The cause may be stress and errors in diet, feasting and many other factors when the clinical picture appears. After all, it is the exacerbation of the duodenal ulcer that allows the doctor to make a preliminary diagnosis. And during the remission phase, the disease may not manifest itself at all and may not cause any complaints in the patient.

1) Pain is seasonal. The ulcer “loves” the spring and autumn seasons. This is partly due to changes in nutritional patterns and fluctuations in immunity;

2) Ulcer pain is, of course, associated with food intake. This must be taken into account in case of atypical pain syndrome. For example, pathology of the musculoskeletal system involves increased pain when moving, and pain due to angina pectoris and abdominal aortic aneurysm may be associated with increased blood pressure;

3) At the same time, there is “early pain”. Already half an hour after eating spicy, rough and “forbidden” food, pain occurs if the ulcer is in the stomach, and after a few hours it goes away when the food leaves the stomach. But “late pain,” which appears one and a half to two or more hours after eating, is precisely indicative of a pathological defect either in the outlet of the stomach (pyloric), or when the defect is localized in the duodenum;

4) In addition, with duodenal ulcers, “hunger pain” occurs, which appears if you don’t eat for 6–7 hours, and it subsides after eating, that is, the opposite direction occurs: food does not provoke, but calms. Sometimes this option appears at night, and then you need to eat urgently, or even better, drink milk, this brings quick relief.

Typically, in patients with duodenal ulcers, pain appears in the epigastrium, and slightly to the right of the center, but, of course, there may be exceptions to the rule. Irradiation, that is, the spread of pain, can occur both in the lower back and in the interscapular space, or in the right scapula.

Of course, pain can vary. It appears due to irritation of the ulcer by gastric juice, and this is peptic pain. Therefore, it disappears after taking medications and food. In addition, the pain can be caused by intestinal spasms, so it goes away with the use of heat and antispasmodics, and by drinking milk. Finally, there is inflammatory pain, since at the edges of the defect and in its depth there is always a focus of inflammation expressed to varying degrees.

5) Vomiting is also an important criterion for diagnosis. With duodenal defects, it occurs in the same way, at the height of pain, but later than with stomach ulcers - a couple of hours after eating;

6) Heartburn and belching also occur in all types and localization of peptic ulcers, but with duodenal ulcers there is often bitterness in the mouth caused by the reflux of bile into the stomach;

7) Tension of the abdominal muscles is a sign of an exacerbation of the process, and in combination with sharp pain, this may indicate the occurrence of exacerbations.

What complications can occur with duodenal ulcers?

Complications and danger of ulcers

In any case, an ulcer is a ticking time bomb. Next to it there is always a “restless state” of the mucous membrane. An inflammatory process is observed there, metaplasia (change and degeneration) of the epithelium occurs. As a result, malignancy of the ulcer may occur, with its degeneration into cancer.

The appearance of scars is caused by stenosis and difficulty in moving food further through the intestines, resulting in stagnation of food in the stomach, the so-called gastrostasis.

In the presence of a chronic ulcer, a scar may form on its edges, while the bottom of the ulcer will be active and even deepening. This defect is called a callous ulcer. In addition, there is perforation and penetration as independent complications. What is the difference?

With perforation, the ulcer simply breaks through the intestinal wall, and the duodenal contents spill into the sterile abdominal cavity. A sharp, dagger-like pain occurs, and then it subsides, and microbial inflammation of the peritoneum begins - peritonitis. It was peritonitis that was the cause of Pushkin’s death, although its mechanism was different - a bullet wound to the large intestine.

In the case of penetration, we are dealing with a covered perforation. The ulcer “eats” right through the intestine, but it turns out that the perforation site is covered by a dense organ, for example, the omentum, or the pancreas. Therefore, gastric juice begins to destroy this organ, and the intestine “solders” to it.

• Finally, bleeding can become a complication if there is a blood vessel at the bottom or in the wall of the ulcer.

Treatment of duodenal ulcers, diet and medications

What to do first?

First of all, treatment should begin with the planned elimination of provoking factors. There are three big “pillars” on which the treatment of peptic ulcer disease by a gastroenterologist is based:

1. Reduce the aggression of gastric juice and carry out the destruction (eradication, or eradication) of Helicobacter pylori infection, reduce inflammatory manifestations;
2. Achieve normalization of motor-evacuation function in the stomach and duodenum, and eliminate intestinal spasm;
3. reduce anxiety and stress levels, for which herbal remedies, sleep-improving medications, or even antidepressants can be used.

To achieve these goals, both diet and various groups of drugs are used.

About diet and nutrition

Diet and products for duodenal ulcers, of course, must be chosen correctly. The goal is to spare the duodenum as physically, chemically, thermally and mechanically as possible. Meals should be small, but frequent.

However, based on numerous studies, it has been found that there is no significant difference whether the patient adheres to the diet or not: this does not affect the quality and timing of outcomes and complications.

However, it remains necessary to eat five meals a day, with a predominant steam method of cooking, as well as avoiding hot and spicy seasonings, coffee, alcohol, smoked foods, marinades and fried foods.

In addition to diet, it is important to establish control over the intake of NSAIDs, as well as stop smoking.

Treating ulcers at home with medications

The patient can easily use tablets for duodenal ulcers at home. Indications for hospitalization are a severe exacerbation with a risk of complications, as well as the complications themselves.

Treatment of duodenal ulcers with drugs involves prescribing the following drugs (since there are a lot of them, we present one drug from each group):

• for nausea and vomiting, Cerucal, also known as metoclopramide, and domperidone, also known as Motilium, are used;
• in order to relieve spasms of the stomach and intestines, “No-Shpa”, or drotaverine hydrochloride, is used;
• To get enveloping drugs into the intestine, you can use Phosphalugel, which relieves hunger pain well.

These drugs discussed above are symptomatic and have virtually no effect on ulcer healing and recovery. Therefore, the basis of treatment is an eradication regimen, in which several antibiotics are prescribed (clarithromycin and amoxicillin), against the background of effective suppression of secretion (omeprazole and an H2 receptor blocker, for example, famotidine).

There are a number of alternative eradication regimens, for example, the use of a colloidal preparation of bismuth salts “De-nol” with metronidazole and amoxicillin.

About surgical treatment

Currently, the progress of conservative treatment has led to the fact that most surgical interventions are performed for emergency reasons, for example, for complications.

At the same time, despite the fact that the mortality rate during operations performed under emergency conditions is 10–15% higher, their absolute number has decreased, which is good news.

This is a worldwide trend in developed countries. And planned surgical treatment is currently used to correct the functions of the pancreas and gallbladder, and traumatic radical interventions such as intestinal resection are used less and less.

Prognosis for ulcer treatment

A duodenal ulcer, the symptoms and treatment of which we briefly reviewed, usually occurs in the bulbous part (bulb). Almost the entire contingent (more than 90%) of patients is diagnosed with Helicobacter pylori infection. Therefore, eradication schemes, which lead to cleansing the body of pathogens, make it possible to recover from peptic ulcer disease.

• It is especially pleasing that the duodenal location of the ulcer almost never becomes malignant, unlike stomach ulcers, and does not degenerate into cancer.

If doctors have to deal with an uncomplicated form of a duodenal ulcer, then most patients experience stable remission. But there are groups of patients who, despite significant improvement in their condition, still require active and continuous therapy. These groups include:

• if interruption of the course after improvement again led to an exacerbation and the appearance of a clinic;
• if there is a history of complications, for example, cicatricial stenosis, bleeding, perforation.

If active treatment is carried out correctly and with great commitment, then in most cases surgical intervention can be completely avoided and, indeed, their number has decreased significantly recently.

Peptic ulcer of the stomach and duodenum is a fairly common pathology. According to statistics, it affects 5-10% of the population of various countries, with men 3-4 times more likely than women. An unpleasant feature of this disease is that it often affects young people of working age, depriving them of their ability to work for some, and quite long, period. In this article we will look at the symptoms of stomach and duodenal ulcers, the causes of the disease and how to diagnose it.

What is peptic ulcer?

This is a recurrent chronic disease of the stomach and duodenum, characterized by the formation of one or more ulcerative defects on the mucous membrane of these organs.

The peak incidence occurs between the ages of 25-50 years. In all likelihood, this is due to the fact that it is during this period of life that a person is most susceptible to emotional stress, often leads an unhealthy lifestyle, and eats irregularly and irrationally.

Causes and mechanism of occurrence

Defects in the mucous membrane of the stomach and duodenum occur under the influence of so-called aggression factors (these include hydrochloric acid, the proteolytic enzyme pepsin, bile acids and a bacterium called Helicobacter pylori) if their number prevails over mucosal protective factors (local immunity, adequate microcirculation, prostaglandin levels and other factors).

Factors predisposing to the disease are:

• infection with Helicobacter pylori (this microbe causes inflammation in the mucous membrane, destroying protective factors and increasing acidity);
• taking certain medications (nonsteroidal anti-inflammatory drugs, steroid hormones);
• irregular meals;
• bad habits (smoking, drinking alcohol);
• acute and chronic stress;
• heredity.

Symptoms

Peptic ulcer of the stomach and duodenum is characterized by a chronic, wave-like course, that is, from time to time a period of remission is replaced by exacerbation (the latter are observed mainly in the spring-autumn period). Patients make complaints during the period of exacerbation, the duration of which can vary between 4-12 weeks, after which the symptoms regress for a period of several months to several years. Many factors can cause an exacerbation, the main of which are gross errors in diet, excessive physical activity, stress, infection, and taking certain medications.

In most cases, peptic ulcer disease debuts acutely with the appearance of intense pain in the stomach.

The time of onset of pain depends on which part of the ulcer is localized:

• “early” pain (appears immediately after eating, decreases as the contents of the stomach enter the duodenum - 2 hours after eating) are characteristic of ulcers located in the upper part of the stomach;
• “late” pain (occurs approximately 2 hours after eating) bothers people suffering from ulcers of the antrum of the stomach;
• “Hungry” or night pain (occurs on an empty stomach, often at night and decreases after eating) is a sign of duodenal ulcer.

The pain does not have a clear localization and can be of a different nature - aching, cutting, boring, dull, cramping - in nature.

Since the acidity of gastric juice and the sensitivity of the gastric mucosa to it in people suffering from peptic ulcer disease are usually increased. It can occur simultaneously with pain or precede it.

Approximately half of patients complain of belching. This is a nonspecific symptom that occurs due to weakness of the cardiac sphincter of the esophagus, combined with the phenomena of antiperistalsis (movements against the flow of food) of the stomach. Belching is often sour, accompanied by drooling and regurgitation.

Frequent symptoms of exacerbation of this disease are nausea and vomiting, and they are usually combined with each other. Vomiting often occurs at a height of pain and brings significant relief to the patient - it is for this reason that many patients themselves try to induce this condition in themselves. Vomit usually consists of acidic contents mixed with recently eaten food.

As for appetite, in people suffering from peptic ulcer it is often unchanged or increased. In some cases - usually with intense pain - there is a decrease in appetite. Often there is a fear of eating food due to the expected subsequent occurrence of pain - sitophobia. This symptom can lead to significant weight loss in the patient.

On average, 50% of patients have complaints of defecation disorders, namely constipation. They can be so persistent that they bother the patient much more than the pain itself.

Diagnosis and treatment of peptic ulcer

Complaints and palpation of the patient’s abdomen will help the doctor suspect the disease, and the most accurate method of confirming the diagnosis is esophagogastroduodenoscopy, or EGD.

It depends on the degree of its severity and can be either conservative (with optimization of the patient’s regimen, compliance with dietary recommendations, use of antibiotics and antisecretory drugs) or surgical (usually for complicated forms of the disease).

At the rehabilitation stage, the most important role is played by diet therapy, physiotherapy, and psychotherapy.

Which doctor should I contact?

Treatment of gastric and duodenal ulcers is carried out by a gastroenterologist, and in case of complications (for example, bleeding or perforation of an ulcer), surgical intervention is necessary. An important stage of diagnosis is FGDS, which is performed by an endoscopist. It is also useful to visit a nutritionist, undergo physical therapy, consult a psychologist and learn how to properly cope with stressful situations.

ULCERS OF THE STOMACH AND DUODENUM.

Peptic ulcer --- chronic recurrent disease, prone to progression, involving in the pathological process along with stomach (AND)and duodenum (duodenum) other organs of the digestive system, leading to the development of complications that threaten the patient’s life.
This disease mainly affects the working age population.

Etiology.

• Hereditary predisposition(if there is more congenital HCI or IgA, the protective reaction is less).
• Psycho-social factor
• Nutritional factor. Systematic eating disorders. Very hot food is equivalent to 96% alcohol in its effect on the gastric mucosa. The volume of food taken also matters. You need to eat often, in small portions.
• Bad habits. Smoking weak risk factor, but annoying.
• There is a controversial version of the influence among scientists Alcohol on the gastric mucosa.
  It is believed that constant use Alcohol in very small quantities, no more than 20-30g, of high quality (mulberry vodka, whiskey, gin) contribute to scarring of ulcers, if there is no concomitant gastritis and duodenitis; and wine, cognac, on the contrary, have a negative effect on peptic ulcers. But we must remember that even the highest quality alcohol in large quantities is detrimental to the gastric mucosa.
• Coffee and tea has an irritating effect on the stomach and increases acidity.
• Vascular factor. In the elderly, vascular atherosclerosis leads to ischemia, the protective barrier is disrupted, and an ulcer forms. It is believed that an ulcer is a stomach infarction.
• Infectious factor, Helicobacter Pilory.

Pathogenesis.

There are 3 major pathogenetic mechanisms:

• Nervous mechanism
• Hormonal or humoral
• Local, most important

1.Nervous mechanism.
Small constant stresses are much more dangerous than rare violent ones. The cerebral cortex is exposed, foci of unextinguished, stagnant excitation develop, the subcortex is activated, the hypothalamus, pituitary gland, adrenal glands are activated, the vagus, and gastroduodenal zone are activated.
That is, the nervous mechanism of regulation of the gastroduodenal zone is disrupted.
Motor skills are lost, there may be a spasm, hypertonicity, etc.

2. Hormonal mechanism.
Pituitary gland - Hypothalamus - Adrenal gland.
Under the influence of corticosteroids, the barrier and blood supply to the mucosa are disrupted.

3. Local factor.
The most important factor. Without it, the above factors will not lead to an ulcer. The local factor is the interaction of aggressive factors and protective factors.
A healthy person has a balance between these factors.

Factors of aggression:

• HCI,
• pepsin,
• bile,
• duodeno-gastric reflux,
• motor impairment
• spasm,
• hypertonicity.

Protective factors:

• a layer of mucus covering the mucous membrane, if of normal consistency, viscosity composition;
• mucous membrane, normal trophism;
• level of regeneration (if regeneration is normal, then this is a protective factor);
• normal blood supply;
• bicarbonates.

In young people, aggression factors and their increase play an important role. And in the elderly, a decrease in protective factors plays an important role.
In the pathogenesis of duodenal ulcers, a special role is played by hypermotility and hypersecretion under the influence of activation of n.vagus (factors of aggression). In the clinic there are clear, rhythmic pains, heartburn, increased acidity. In the pathogenesis of peptic ulcer disease, the state of the mucous membrane (barrier) plays an important role, the state of the protective factors, hypersecretion does not matter. Since a stomach ulcer occurs against the background of gastritis, malignancy occurs frequently; with duodenal ulcers, this occurs rarely.

In women of childbearing age, complications occur 10-15 times less than in men. In women, ulcers also recur less frequently, heal more smoothly, and the scars are more tender than in men. With the onset of pregnancy, relapses stop and exacerbation subsides. With the onset of menopause, the frequency and course of peptic ulcers equalizes with men.

Clinical symptoms.

1. Pain syndrome --- Cardiac, central peptic ulcer syndrome (not because it is strong, but specific to peptic ulcer disease).The pain can be dull, burning, aching, paroxysmal, sharp, and also accompanied by vomiting.In some cases, patients may experience flatulence and bloating as an equivalent pain symptom.

A) Diurnal rhythm of pain associated with food intake - - during the day there is a clear alternation in time for a given patient. For example:
Eating --- rest, after 1, 2, 3 hours -- pain --- this happens in patients with peptic ulcer of the pyloroduodenal zone.
Eating --- pain -- then rest after a while--- this is typical with ulcers of the entrance to the stomach.
At the same time, they distinguish early (after 30–60 minutes), late (after 1.5–2 hours), hungry (6–7 hours after eating) and night pain.

b) The presence of seasonal frequency of the disease.
In most cases, 90% of the disease worsens in the autumn-spring period. Moreover, this patient is often observed in certain months (for example: always in September and May, in rare cases in the winter-summer period) .

V) Localization of pain – pain is localized in a certain limited area in the epigastric region, mainly to the right of the midline.

• Patients often point at the dot with their finger.
• With a duodenal ulcer, if the ulcer is on the posterior wall, then the pain may be on the left - this is an atypical localization of pain.
• With soft superficial palpation, local sensitivity and pain correspond to the location of the ulcer.
• Percussion according to Mendel (Mendel's sm) - along the rectus abdominis muscles from top to bottom, we alternately tap on the right, then on the left to the navel. Pain is detected at one point. This point approximately corresponds to the projection of ulcers, the point localization of pain.

2. Heartburn.
Typically, heartburn precedes a peptic ulcer for several months, years, in the pre-ulcer period. Heartburn occurs in the same way as pain, depending on the location of the ulcer.

3. Vomit.
Just like heartburn depends on impaired motor skills. This is gastroesophageal reflux, just like heartburn.
Vomit in patients with ulcer usually occurs at the peak of pain and brings relief. In some patients, the equivalent of vomiting may be nausea and excessive salivation.
Vomiting immediately after eating indicates damage to the cardiac part of the stomach, after 2–3 hours - an ulcer of the body of the stomach, 4–6 hours after eating - an ulcer of the pylorus or duodenum. Vomiting in the form of “coffee grounds” indicates a bleeding gastric ulcer (rarely duodenal ulcer). And young people often, during an exacerbation of the disease, have very persistent constipation, colitis.

Features of peptic ulcer disease in adolescents.

Gastric ulcers are practically not found in them; duodenal ulcers are 16-20 times more common.

It occurs in 2 forms:

• Latent
• Painful

1. Latent occurs in the form of gastric dyspepsia syndrome (belching, nausea, hypersalivation). Children with this pathology are physically poorly developed, neurotic, capricious, have poor appetite, and poor academic performance. It can last from 2-5 years and turn into a painful form.
2. Painful form.
Extremely pronounced pain syndrome, in children it is stronger than in adults, the pain is persistent. In adolescence, complications often occur - perforation, bleeding.

Features of peptic ulcer in adults.

In elderly and elderly people, patients over 50 years of age, stomach ulcers are 2-3 times more common than duodenal ulcers.
Localization of stomach ulcers.
Localization is more common in the area of ​​the inlet (cardial) part of the stomach, the lesser curvature and the outlet (pyloric) part. Ulcers can be large, often gigantic, wrinkled, and difficult to treat. The pain syndrome is mild, dyspepsia is pronounced, and the acidity level is reduced. Ulcers develop against the background of atrophic gastritis (atrophic hypertrophic gastritis). Complications occur 2-3 times more often than in young people. And malignancy of ulcers at this age occurs very often.
Localization of duodenal ulcers.
90% of duodenal ulcers are localized in the bulb (bulbar, initial section), 8-10% are postbulbar ulcers (area of ​​the large duodenal nipple).
Complications of ulcers:
Bleeding, perforation, covered perforation, penetration (towards the pancreas, lesser omentum), cicatricial disease, pyloric stenosis, malignancy.

TYPES OF ULCERS.

Ulcers located in the inlet (cardiac) part of the stomach.

The cardiac section is the upper section of the stomach, adjacent to the esophagus through the cardial opening. With cardiac ulcers, the following symptoms are observed.
1. Pain localized at the xiphoid process, behind the sternum.
2. The pain radiates in the left half of the chest, left arm, left half of the torso, paroxysmal pain (very reminiscent of ischemic heart disease), not relieved by nitroglycerin. More often these ulcers occur in men over 40 years of age.
3. Heartburn.

Differential diagnosis of gastric ulcer and
The patient is given validol and antacid. For peptic ulcers, the antacid immediately calms down. In case of ischemic disease, validol relieves pain within 2 minutes, and if after 20-30 minutes, then it is not ischemic heart disease. These ulcers are difficult to detect because the endoscope quickly passes through this area and is more difficult to detect. Malignancy and bleeding often occur.

Ulcers on the lesser curvature of the stomach.

Classic peptic ulcer of the stomach, if there is an infectionH. Pilory, usually located at the small curvature.
This is characterized by:
1. Early, aching, moderate pain in the epigastric region (epigastric region), lasting 1–1.5 hours and stopping after the evacuation of food from the stomach.
2. Dyspepsia.
3. Weight loss in 20-30% of patients.

Ulcers of the antrum of the stomach.

For ulcers antrum (vestibule) The following symptoms appear in the pyloric part of the stomach:
1. Pain most often occurs on an empty stomach, at night and 1.5–2 hours after eating (late). The pain usually subsides after eating.
2. Often observed Heartburn.

Ulcers of the pyloric canal of the gastric pylorus.

Pyloric canal - the excretory section of the stomach, which passes into the duodenum. This is a very sensitive neuromuscular area of ​​the stomach., therefore, with ulcers located in this section, the symptoms are quite pronounced.
The typical symptoms here arePyloric Triad:
1. Pain syndrome, quite stubborn. Painradiates to the right hypochondrium, back.
2. Frequent vomiting and, against this background
3. Weight loss.

Pain There are several types. On the one side, classic version -- During the day after eating, pain occurs 1 hour later.
Sometimes the occurrence of pain does not depend on food intake, it occurs paroxysmal or wave-like pain.
Along with pain there is vomit, up to 5-10 times during an exacerbation, the first 10 days. These ulcers are very difficult to treat. In 50% of these patients, after a long period of treatment, the ulcers do not close. In 1/3 of patients, after healing, the ulcers soon open again.

Bulbar ulcers of the duodenum.

When localizing ulcers in the duodenal bulb (bulbar area) characteristic:
1. Pain nocturnal, hungry. At the location of the ulcer on the posterior wall of the duodenal bulb the pain radiates to the lumbar region. The pain disappears immediately after eating.
2. Heartburn.

Postbulbar ulcers of the duodenum.

The pain is localizednot in the epigastrium, but in right hypochondrium, in the right upper quadrant of the abdomen,radiates to the back, under the right shoulder blade.The pain may be paroxysmal, reminiscent of hepatic or renal colic.
Jaundice may appear if the ulcer is located in the area of ​​the nipple of Vater, since the pathological process involvesbiliary tract, pancreas. All this gives a picture of cholecystitis and hepatitis.

Very often, 70% of these ulcers bleed. With ulcers in other areas, only 10% bleed. After scarring of the ulcers, there may be compression of the portal vein, followed by ascites. If ascites of unknown etiology in women, one must think about either adnexal cancer or scarring of ulcers in the area of ​​the portal vein. If the pain subsides immediately after eating, then these are bulbar ulcers, and if 20-30 minutes after eating the pain does not go away, then these are postbulbar ulcers.

Diagnosis of Peptic Ulcer.

• Esophagogastroduodenoscopy (EGD) with biopsy
• X-ray
• Testing for Helicobacter Pylori (stool, vomit, blood or endoscopy biopsy).
• Palpation.

TREATMENT OF ULCER DISEASE.

Conservative treatment is used in the majority who do not have a complicated course (no, etc.)
A conservative approach is not only the correct medicinal approach, but also dietary nutrition, the elimination of bad habits, the correct organization of work and rest, taking into account age, duration of the course, the effectiveness of previous treatment, as well as the location and size of the ulcer, the nature of HCI secretion, the state of gastric motility and duodenum and associated diseases.

Diet.

• Frequent, small meals, 3-4 times a day.
• Food must have buffering and antacid properties. Food should be soft, gentle, easily digestible, be a buffer - protein-fat, less carbohydrates.
• 100-120g protein, 100-120g fat, no more than 400g carbohydrates per day.
• Vitamins: rosehip juice, sea buckthorn oil, but not recommended for concomitant calculous cholecystitis, bacterial cholecystitis, gastritis, duodenitis, since bile enters the duodenum and stomach, causing excessive irritation of the mucous membrane.
• Milk, bread, and meat have antacid buffering properties from products. Table No. 1 is recommended, but depending on the condition it is adjusted by the doctor

Drug therapy.

• Antacids -- the purpose is to buffer the environment, that is, HCI binding.
  Non-absorbable Long-acting antacids do not disturb the electrolyte balance; they contain Al and Mg salts. Long-acting antacids are prescribed during inter-digestive periods, 2.5 hours after meals or 30 minutes before meals.
  Antacids --- Almagel, Maalox, Mailanta, Gastal, Phospholugel, Polysilane, Bedelix, Supralox, Mutesa, Rogel, Normogastrin, Gelusil-varnish, Riopan-plas.
• H2 blockers:
  1st generation drugs:
  Cimetidine, 200 mg 3 times a day, immediately after meals and 2 tablets. at night It works well for patients with bleeding.
  The solution can be administered intravenously to achieve a hemostatic effect. Antacids have the same hemostatic effect.

  2nd generation drugs:
  Group Zantac or A-Zantac. Synonyms - Pectoran, Ranisa, Raniplex, Ranitidine.

  3rd generation drugs (most purified group):
  GroupFamotidina - Axid, Kvamatel. All these drugs are prescribed 1 tablet 2 times a day, 1 tablet in the morning, 2 tablets at night. If the patient is especially restless at night, then you can immediately give 2 tablets at night.
  Group Thiotidine- also an H2 blocker.
• Sucralfate group -Venter, Ulkar, Keal, block the reverse diffusion of hydrogen ions into the mucosa, form a good protective shell, and have an affinity for granulation tissue.
  A special indication for the use of sucralfate is hyperphosphatemia in patients with uremia who are on dialysis.
• Bismuth preparations - Vikair, Vikalin, Denol.
  Vikair, vikalin nare prescribed 40 minutes after meals if the patient eats 3 times a day. For the first 1-2 weeks, it is advisable to take antacids and bismuth preparations together. These drugs can cause stones to form.
  Denol -- forms a protective film, has cytoprotective properties, and also suppresses Helikobakter Pilory; antacids should not be prescribed at the same time as De-Nol, and it should not be washed down with milk.

• Drugs regulating motor-evacuation activity.
  Raglan, Cerucal.
  Also prescribed Motilium, Perinorm, Debridat, Peridis, Duspatalin, Dicetel.
  Nauzekam, Nausein, Eglanil (Dogmatil, Sulpiil).
  Most cause drowsiness, lethargy, and act at the level of the central structures of the brain, the reticular formation.
  Eglonil-- solution, in the form of injections at night, 2 ml. for 10 days (during exacerbations and severe pain), then 1 tablet. 2-3 times a day.
• Anticholinergics -- Atropine, Platiphylline, Metacin, Gastrocepin. Gastrocepin -- injections 1 amp 1-2 times a day IM or 10-50 mg 1 tablet 2 times a day, prescribed more often in older age groups.
• Solcoseryl group or Actovegin - - act on blood microcirculation.
• Cytoprotectors - -Misoprastol, Cytotec. They increase the cytoprotective properties of the gastric and duodenal mucosa, increase the barrier function,improve blood flow in the gastric mucosa and also have fairly high antisecretory activity. Prescribed auxiliary for difficult-to-heal ulcers or treatment and prevention of gastroduodenal erosive and ulcerative lesions caused by NSAIDs.
• Antibiotics - prescribed for inflammation, deformation, infiltration, and in the presence of Helicobacter Pilory.

TREATMENT SCHEME FOR STOMACH AND DUODENAL ULCERS.

HelicobacterРylori ,
used before 2000

• Colloidal Bismuth subcitrate (De-nol, Ventrixol, Pilocid) 120 mg 4 times a day, 14 days + Metronidazole(trichopolum and other synonyms) 250 mg 4 times a day, 14 days + Tetracycline 0.5 g 4 times a day, 14 days + Gastrocepin 50 mg 2 times a day, 8 weeks for PUD and 16 weeks for PUD.
• K colloidal bismuth subcitrate (De-nol) 108 mg 5 times a day, 10 days + Metronidazole 200 mg 5 times a day, 10 days + Tetracycline 250 mg 5 times a day, 10 days (the combination corresponds to the drug "gastrostat") + Losec (Omeprazole) 20 mg 2 times a day, 10 days and 20 mg 1 time a day, 4 weeks for PUD and 6 weeks for PUD.
• Losec (omeprazole) 20 mg 2 times a day, 7 days and 20 mg 1 time a day for 4 weeks for PUD and 6 weeks for PUD + + Amoxicillin 0.5 g 4 times a day or Klacid 250 mg 4 times a day, 7 days
• Zantac (ranitidine, raniberl) 150 mg 2 times a day, 7 days and 300 mg 1 time a day, 8 weeks for PUD and 16 weeks for PUD + Metronidazole (Trichopolum, etc.) 250 mg 4 times a day, 7 days + Amoxicillin 0.5 g 4 times a day or Klacid 250 mg 2 times a day, 7 days.
• Famotidine (quamatel, ulfamid and other synonyms) 20 mg 2 times a day, 7 days and 40 mg 1 time a day, 8 weeks for PUD and 16 weeks for PUD + Metronidazole (Trichopolum, etc.) 250 mg 4 times a day, 7 days + Amoxicillin 0.5 g 4 times a day or Klacid 250 mg 2 times a day, 7 days.

With the first combination, infection of the mucous membrane is eliminated on average in 80% of cases, and with the rest - up to 90% or more.

Treatment regimens for ulcer associated with Helicobacter pylori,
according to the Maastricht Agreement.

Duration of treatment is 7-14 days.
1st line therapy.
Triple therapy

• Omeprazole 20 mg 2 times a day or Lansoprazole 30 mg 2 times a day or Pantoprazole 40 mg 2 times a day + Clarithromycin 500 mg 2 times a day + Amoxicillin 1000 mg 2 times a day
• Omeprazole 20 mg 2 times a day or Lansoprazole 30 mg 2 times a day or Pantoprazole 40 mg 2 times a day + Clarithromycin 500 mg 2 times a day + Metronidazole 500 mg 2 times a day.
• Ranitidine bismuth citrate 400 mg 2 times a day + Clarithromycin 500 mg 2 times a day + Amoxicillin 1000 mg 2 times a day.
• Ranitidine bismuth citrate 400 mg 2 times a day + Clarithromycin 500 mg 2 times a day + Metronidazole 500 mg 2 times a day.

2nd line therapy.
Quad therapy

• Omeprazole 20 mg 2 times a day 1 20 mg 4 times a day + Metronidazole 500 mg 3 times a day + Tetracycline 500 mg 4 times a day.
• Lansoprazole 30 mg 2 times a day + Bismuth subsalicylate/subcitrate 120 mg 4 times a day + Metronidazole 500 mg 3 times a day + Tetracycline 500 mg 4 times a day.
• Pantoprazole 40 mg 2 times a day + Bismuth subsalicylate/subcitrate 120 mg 4 times a day + Metronidazole 500 mg 3 times a day + Tetracycline 500 mg 4 times a day.

Triple therapy regimens based on De-nol (Colloidal Bismuth Subcitrate).

• De-nol 240 mg 2 times a day + Tetracycline 2000mg per day + Metronidazole 1000-1600 mg per day.
• De-nol 240 mg 2 times a day + Amoxicillin 2000 mg per day + Metronidazole 1000-1600 mg per day.
• De-nol 240 mg 2 times a day + Amoxicillin 2000 mg per day + Clarithromycin 500 mg per day.
• De-nol 240 mg 2 times a day + Clarithromycin 500 mg per day + Metronidazole 1000-1600 mg per day.
• De-nol 240 mg 2 times a day + Amoxicillin 2000 mg per day + Furozolidone 400 mg per day.
• De-nol 240 mg 2 times a day + Clarithromycin 500 mg per day + Furozolidone 400 mg per day.

After completing a 7- or 14-day course of eradication therapy, treatment continues with one Antisecretory drug, included in the combination.
Accept half the daily dose once(For example, De-Nol 240 mg 1 time per day or Omeprazole 20 mg per day) for 8 weeks for PU and 5 weeks for DU.

Occasionally used as a symptomatic remedy for a short period Antacids(phosphalugel, Maalox, etc.) and
Prokinetics (Motilium, Coordinax, etc.) with impaired motor skills accompanying peptic ulcer disease.

Russian doctors often use bismuth-based triple therapy regimens as first-line treatment.
For example: Colloidal bismuth subcitrate + Amoxicillin + Furazolidone.

To prevent exacerbations of ulcerative disease, 2 types of treatment are recommended.

• Carry out long-term (months and even years) maintenance therapy with an antisecretory drug at half the dose, e.g. famotodine-- 20 mg each, or omeprazole-- 10 mg or gastrocepin-- 50 mg each.
• If symptoms characteristic of ulcer appear, resume antiulcer therapy with one of the antisecretory drugs during the first 3-4 days at the full daily dose, and for the next 2 weeks at a maintenance dose.

Indications for continuous maintenance therapy for ulcerative disease are:
1. Unsuccessful use of intermittent course of antiulcer treatment, after which 3 or more exacerbations occur per year.
2. Complicated course of ulcer (history of bleeding or perforation).
3. The presence of concomitant diseases requiring the use of non-steroidal anti-inflammatory and other drugs.
4. Concomitant ulcerative ulcerative reflux esophagitis.
5. In the presence of gross cicatricial changes in the walls of the affected organ.
6. Patients over 60 years of age.
7. The presence of gastroduodenitis and HP in the mucus.

Indications for the use of intermittent “on demand” treatment are:
1. Newly diagnosed DU.
2. Uncomplicated course of PUD with a short history (no more than 4 years).
3. The recurrence rate of duodenal ulcers is no more than 2 per year.
4. The presence of typical pain and a benign ulcerative defect at the last exacerbation without gross deformation of the wall of the affected organ.
5. Absence of active gastroduodenitis and HP in the mucus.

Table 1. SCHEMES FOR ERADICATION THERAPY OF Helicobacter pylori INFECTION
under the Maastricht Agreement (2000)