Duodenal ulcer symptoms and treatment. Diagnosis of duodenal ulcer

The duodenum is the section of the gastrointestinal tract from the stomach to the jejunum. The organ received such an unusual name because of its length of 12 fingers located across. A duodenal ulcer (DU) is a disease of a relapsing nature, in which the mucous membrane of the organ is damaged with its further scarring. Characteristic is the alternation of the period of exacerbation and remission.

Types of ulcerative conditions of the duodenum in the acute stage can be as follows:

• with bleeding,
• with perforation,
• without complications in the form of bleeding and perforation,
• with bleeding and perforation.

A duodenal ulcer in the chronic stage has the same subspecies.

Why does duodenal ulcer form?

The main causes of duodenal ulcers are reduced to a long course of duodenitis - inflammation of its mucosa without the necessary treatment.

The disease develops due to two main factors:

1. Effects of hydrochloric acid due to increased acidity of the stomach. An aggressive effect occurs after acidic gastric juice enters the duodenum, is characterized by inflammation and further formation of an ulcer.
2. Infection with Helicobacter pylori leads to long-term asymptomatic development of peptic ulcer. The bacterium enters the gastrointestinal tract, attaches to the walls of the stomach and duodenum, multiplies, releasing harmful substances that can lead to the death of mucous membrane cells. There is also an increase in acidity due to the release of ammonia by the bacterium.

It is believed that the disease affects young men more often due to the neglect of a healthy lifestyle, in particular:

• Abuse of alcoholic beverages and smoking, as well as large amounts of coffee and coffee drinks,
• Disturbed diet with long intervals,
• Eating too many foods that irritate the mucous membrane - salty, spicy, smoked and sour foods,
• The presence of chronic inflammation - gastritis and duodenitis,
• Unstable emotional situation, psychological overstrain,
• Genetic predisposition to this disease due to increased secretory function of the stomach.
• Frequent use of medications - anti-inflammatory nonsteroidal drugs and glucocorticosteroids. The first group includes aspirin, ibuprofen, etc., the second - prednisolone.

How to suspect duodenal ulcer

Symptoms of a duodenal ulcer are most often clearly seen during an exacerbation. As a rule, it is spring and autumn. They appear as:

• Pain syndrome of a stabbing or cutting nature. Pain is often localized in the upper abdomen below the sternum, under the right rib, in the back. These sensations depend on eating. Most often they appear on an empty stomach, as well as a couple of hours after eating. Pain in a duodenal ulcer will disappear after eating. This is due to the irritating effect of gastric juice on the mucous membrane. Almost all patients experience pain at night. This is easily explained by the fact that most of the hydrochloric acid is produced around 2 am.
• The emergence of a feeling of hunger after a short period of time from the last meal.
• Dyspepsia, characteristic of stomach ulcers, is less pronounced with duodenal ulcers. It appears as:
  • nausea,
  • vomiting,
  • belching,
  • heartburn,
  • swelling.
• Lack of appetite due to severe pain syndrome. The result is weight loss.
• With inadequate treatment, as well as its absence, internal bleeding or perforation of the ulcer may occur. The first is accompanied by the release of black feces. The second is the presence of severe pain in the stomach.
• In rare cases, there may be no symptoms in a duodenal ulcer. This is especially true for the elderly.

There are no clear signs of a duodenal ulcer that allow you to accurately determine the presence of the disease without diagnostic measures.

How is duodenal ulcer diagnosed and treated?

When a patient contacts with complaints characteristic of peptic ulcer, the doctor begins the diagnosis by collecting data. To do this, it turns out the nature and location of pain, history, heredity, comparison with seasonality. During a visual examination, the doctor performs palpation of the abdomen in the region of the duodenum.

Diagnosis of a duodenal ulcer includes:

• Determination of Helicobacter pylori in the blood by counting antibodies.
• Measurement of the acidity of gastric juice, which allows to determine the main cause of the development of the disease - excessive secretion of hydrochloric acid,
• X-ray of the duodenum with a contrast agent, allows you to identify the following pathological conditions:
  • mucosal defect - with a delay of a contrast agent in any area,
  • retraction of the mucosa on the opposite side of the ulcer,
  • scarring of the ulcer - the folds are arranged in the form of a star,
  • enhanced or delayed release of the contents of the duodenum.
• FGS - endoscopic examination using a special apparatus. A modern method that allows you to personally determine the location and size of ulcers, bleeding and other complications. An approximate picture obtained by a diagnostic doctor during this examination is visible in the photo of a duodenal ulcer.
• Examination of the duodenal mucosa material for the presence of Helicobacter Pylori.
• As a result of determining the localization, the cause of the appearance and size, the doctor prescribes the treatment of duodenal ulcers. It may include 3-4 components and proceed within 2-3 weeks.

The main medicines for the treatment of ulcers are:

• Antibiotics and antibacterial drugs - to eliminate Helicobacter pylori infection inside the body

• • macrolides. These include erythromycin and clarithromycin. In the case of the use of the latter in tablet form, it is necessary to adhere to a two-time intake after meals.
  • penicillin antibiotics. Ampiox is administered every 6 hours after meals.
  • metronidazole is applied every 8 hours.
• The reduction of the secretory function of the stomach with a decrease in acidity and the elimination of pain is achieved by taking the following drugs:
  • remedies for duodenal ulcers based on bismuth. A striking example of such a drug is De-nol with an antibacterial effect on Helicobacter Pylori and an astringent property of the gastric mucosa. Reception is carried out before meals for 30 minutes in the amount of 4 times.
  • Omeprazole is taken before meals 2 times a day.
  • inhibitor of H2 - receptors - ranitidine - a couple of times a day, also before meals.
• Elimination of pain with the help of a protective film on the duodenal mucosa. These types of drugs include antacids:
  • almagel, maalox - a spoon half an hour before meals.

In addition to medication, it is possible to treat the duodenum with the help of surgical methods. They become necessary when complications of a duodenal ulcer occur. These main conditions include:

• Perforation of the ulcer is a through hole in the wall of the duodenum, which ensures the release of its contents into the abdominal cavity with the further development of peritonitis. This condition can be determined by the presence of acute shooting pain in the abdomen.
• Ulcerative bleeding - as a result of corroding the walls, vessels suffer, which can begin to bleed. The main symptom is the presence of occult blood in the stool.
• Ulcer penetration - the passage of an ulcer from the duodenum into the pancreas. This condition is characterized by acute pancreatitis.
• Duodenal stenosis - the occurrence of a large scar in the duodenum. There is a delay in the movement of the contents into the following sections of the gastrointestinal tract, accompanied by vomiting.
• Ulcer malignancy is a rare phenomenon, accompanied by malignancy of mucosal cells in the area of ​​the ulcer and further development of the tumor.

As a rule, they resort to them very rarely. To do this, the area of ​​the gastrointestinal tract affected by the ulcer or the area where the nerve endings of the vagus nerve intersect is removed.

An exacerbation of a duodenal ulcer will become less likely if you follow a strict diet and diet with no addictions - alcohol, smoking. A stable emotional background is also necessary.

Diet for duodenal ulcer

Speaking of diet, food should be soft and well-chopped, have an average heating temperature - not too cold or hot. According to its characteristics, it should not be too salty, oily and spicy. The calorie content of the daily food intake consumed should be 2000. The number of meals should be 5. Thus, eating in small portions that are easily digested in the gastrointestinal tract is achieved. Food should be cooked by boiling or steaming. As drinks, it is desirable to use medicinal mineral waters without gases - Essentuki and Borjomi, as well as teas with mint and lemon balm have a positive effect on the duodenal mucosa.

Peptic ulcer of the duodenum involves the use of the following products:

• Dairy products with a low fat content - milk, cottage cheese, sour cream, kefir.
• Lean varieties of fish - pike perch, perch.
• Lean meats - white meat chicken, rabbit, veal.
• Various types of cereals - rice, buckwheat, oatmeal.
• Dried bread after 1-2 days from production or crackers.
• Boiled and steamed vegetables and fruits - beets, carrots, zucchini, eggplant, potatoes.
• The use of various vegetable oils for food - olive, sea buckthorn, sunflower, corn.
• Light pureed vegetable soups.

Both acute and chronic duodenal ulcer implies an absolute prohibition of the use of:

• Fried, salty, as well as spicy and too spicy dishes,
• Fruits with a high content of acid - pineapples, lemons, tomatoes, a number of citrus fruits.
• Smoked meats and canned food,
• Fatty meat - pork and lamb,
• Fatty fish - salmon,
• Pickled dishes - cabbage, cucumbers and tomatoes,
• Fresh rye bread and muffins.

Preventive measures to prevent duodenal ulcer

The main measures to prevent such a painful condition are:

1. Prevention of infection with Helicobacter Pylori infection - use only your own utensils due to the fact that infection occurs through saliva.
2. Measures to prevent excessive release of hydrochloric acid in the area of ​​​​the stomach and duodenum - the rejection of habits harmful to the body - smoking and alcohol, the elimination of emotionally unstable conditions, adherence to diet and diet.
3. Timely treatment of gastritis and duodenitis.

If you suspect a duodenal ulcer, you should consult a gastroenterologist who will help you get examined and tell you how to treat a duodenal ulcer. If there is a possibility of perforation or bleeding from the site of the ulcer, it is necessary to urgently seek help from emergency doctors with subsequent hospitalization.

Peptic ulcer of the stomach and duodenum is a fairly common pathology. According to statistics, 5-10% of the population of various countries suffer from it, and men are 3-4 times more likely than women. An unpleasant feature of this disease is that it often affects people of a young, working age, for some, and quite a long time, depriving them of their ability to work. 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 a peptic ulcer?

Peptic ulcer disease is characterized by the formation of a deep defect in the wall of the stomach or duodenum. Its main cause is the H. pylori bacterium.

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

The peak incidence occurs at the age 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 the 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 the mucosal protection 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 (non-steroidal anti-inflammatory drugs, steroid hormones);
• irregular meals;
• bad habits (smoking, drinking alcohol);
• acute and chronic stress;
• heredity.

Symptoms

For peptic ulcer of the stomach and duodenum, a chronic, undulating course is characteristic, that is, from time to time the period of remission is replaced by an exacerbation (the latter are noted mainly in the spring and autumn period). Patients complain during the period of exacerbation, the duration of which can vary within 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 a gross error in the diet, excessive physical activity, stress, infection, and taking certain medications.

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

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

• “early” pains (appear immediately after eating, decrease 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” pains (occur about 2 hours after eating) disturb people suffering from an antral ulcer;
• "Hunger" or night pains (occur on an empty stomach, often at night and decrease after eating) are a sign of duodenal ulcer.

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

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

Approximately half of the patients complain of belching. This is a non-specific symptom, arising from the weakness of the cardiac sphincter of the esophagus, combined with the phenomena of anti-peristalsis (movements against the course of food) of the stomach. Belching is often sour, accompanied by salivation and regurgitation.

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

As for appetite, in persons suffering from peptic ulcer, it is often not changed 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 a pain syndrome - sitophobia. This symptom can lead to severe weight loss of the patient.

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

Diagnosis and treatment of peptic ulcer

The leading method for diagnosing peptic ulcer of the stomach and duodenum is fibrogastroduodenoscopy (FGDS).

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

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

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

Which doctor to contact

Treatment of peptic ulcer of the stomach and duodenum is carried out by a gastroenterologist, and in case of complications (for example, bleeding or perforation of the 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 a course of physiotherapy, consult a psychologist and learn how to properly cope with stressful situations.

• 1Causes of illness
• 2Signs of pathology
• 3Diagnostic methods
• 4Healing procedures
• 5 Diet therapy
• 6Surgical treatment
• 7Physiotherapy
• 8Therapeutic exercise

1Causes of illness

Now scientists say that there are two main reasons for the development of duodenal ulcers (duodenal ulcers):

1. Infection with the bacterium Helicobacter pylori, which over time and under certain factors provokes inflammation and erosion of the walls of the stomach and duodenum. Helicobacter pylori infection occurs from person to person through a kiss, shared utensils, cutlery and personal hygiene items. After entering the stomach, the bacterium begins to actively multiply, producing urease and protease. These enzymes destroy the protective layer of the walls of the stomach and duodenum, as a result, defects appear in the mucosa and peptic ulcer begins. A metabolic disorder develops in damaged tissues, mucosal cells do not work properly and secrete less mucus.
2. A stomach ulcer develops due to a decrease in the protective properties of the mucous membrane, which is no longer able to withstand the corrosive action of gastric juice. The increased aggressiveness of pepsin and hydrochloric acid against the background of pathological structural changes in tissues leads to the appearance of mucosal defects and duodenal ulcers.

It is worth considering the predisposing factors:

1. Heredity. At the gene level, parents pass on to their children an excessive number of cells that produce hydrochloric acid or a reduced secretion of protective mucus components.
2. Excitable nervous system. Peptic ulcers are more common in highly excitable people who tend to keep the effects of stress and problems to themselves.
3. Wrong nutrition. It is very harmful to eat dry food and on the run, especially when eating semi-finished products and fast food. The abuse of spicy, smoked, fried, salty foods and seasonings leads to irritation of the gastrointestinal mucosa and disruption of the production of gastric juice.
4. Taking analgesics and non-steroidal anti-inflammatory drugs. Ibuprofen, Acetylsalicylic acid, Ortofen have a strong irritating effect on the gastric mucosa and duodenum.
5. Bad habits. Heavy smokers and those who like to skip a glass of vodka are also at risk for stomach and duodenal ulcers.

Rare causes that provoke duodenal ulcer are: amyloidosis, celiac disease, Crohn's disease, cirrhosis of the liver, chronic obstructive bronchitis, diseases of the nervous system, HIV infection and the germination of pancreatic cancer.

2Signs of pathology

The first symptoms of a duodenal ulcer are pains that systematically appear in the upper abdomen. Pain at night and the so-called "hungry" pains are considered a characteristic sign, when the patient needs to eat at least crackers so that they recede. With a duodenal ulcer, the symptoms have their own rhythm - pain occurs 1.5-3 hours after eating, when the patient feels hungry, and disappears after eating and antacids (Maalox, Almagel).

Painful sensations are localized above the navel or in the epigastric region. They can give in the back, under the shoulder blade and in the region of the heart. The use of food that does not fit into the diet, food excesses, carbonated drinks and alcohol can provoke a clear increase in pain.

It is noteworthy that 2-3 hours after eating, heartburn occurs in patients with gastric and duodenal ulcers. Not all patients have nausea, vomiting, belching with a sour taste and constipation.

People with peptic ulcers have a normal or even increased appetite, but they still experience weight loss. Against the background of night hunger and pain, nervousness, poor sleep and unstable mood develop.

In an advanced stage, duodenal ulcer without appropriate treatment can manifest itself by vomiting with blood. Blood in the stool is noticed by a change in the color of the stool, it becomes black. These signs are the reason for urgent hospitalization, as the patient began internal bleeding, fraught with death. Please note that the symptoms of intestinal ulcers do not always appear, without treatment, the mucosal defect will become deeper, and this is dangerous by perforation, bleeding and blood poisoning.

3Diagnostic methods

1. Endoscopy is the most informative way to examine the internal state of the stomach and duodenum. With the help of endoscopic equipment during esogastroduodenoscopy, the doctor not only sees enlarged data on the mucosa on the screen, but can also take a sample of ulcerative tissue and a sample of gastric contents, for the subsequent detection of Helicobacter Pylori microbes and the study of gastric acidity.
2. The search for Helicobacter Pylori bacteria is carried out in all available biomaterials - blood, feces, vomit, and a sample obtained from an EGDS biopsy.
3. X-ray examination of the duodenum. At present, the technique is rarely used.
4. Palpation. This method is used by talented diagnosticians to make a preliminary diagnosis.

4Healing procedures

You need to prepare for the fact that the treatment of duodenal ulcers will be long and complex. This includes medication, diet, physiotherapy, exercise therapy and systematic spa treatment.

How to treat a duodenal ulcer in the acute stage? The answer is unequivocal - in a hospital setting.

To relieve pain and speedy scarring of the ulcer, the patient needs bed rest, complete emotional peace and a strict diet.

The treatment regimen is compiled in accordance with the identified pathologies and test results. If helicobacteria were found on the mucous membrane of the stomach and duodenum, the emphasis will be on the use of antibiotics to destroy microorganisms.

In general, the treatment of duodenal ulcers includes the following groups of drugs:

1. Antibiotics and antiprotozoal agents aimed at inhibiting the vital activity of Helicobacter pylori. These drugs include Metronidazole, Tetracycline, Amoxicillin, Clarithromycin.
2. Complex preparations containing bismuth subnitrate or bismuth subcitrate - De-nol, Vikair, Vikalin. They have a bactericidal effect on Helicobacter pylori and contribute to the formation of a protective film on the walls of the stomach and duodenum. In addition, these preparations contain magnesium salts, which reduce the acidity of gastric juice and reduce the activity of pepsin.
3. Antisecretory drugs designed to reduce the production and reduce the aggressiveness of gastric juice. This group included proton pump inhibitors (Pariet, Omeprazole, Pantoprazole, Rabeprazole, Esomeprazole), H2-histamine receptor blockers (Roxatidine, Ranitidine, Nizatidine, Famotidine, Kvamatel), drugs blocking M-cholinergic receptors (Gastrocepin, Buscopan, Pirenzepine).
4. Prokinetics - drugs that improve the motility of the stomach and intestines, treatment with Trimedat simultaneously relieves the tone of the esophagus and affects the receptors of the large intestine, which leads to its rapid emptying. Cerucal and Motilium help to get rid of nausea and vomiting, epigastric pain, heartburn, belching, feelings of early fullness in the abdomen, etc.
5. Antacids (Maalox, Almagel, Phosphalugel, Keal) reduce the acidity of the stomach, adsorb excess acid and gases, envelop the walls of the stomach and intestines, thereby reducing pain in the upper abdomen for several hours.
6. Gastroprotectors (Sucralphate, Venter) accelerate the healing of peptic ulcers of the intestine and stomach, protect the gastric mucosa and duodenum from the effects of hydrochloric acid and pepsin. Venter reduces the activity of pepsin by almost 1/3, but does not affect the acidity of gastric juice. The active substance of both drugs - Sucralfate binds to proteins at the site of the ulcer, resulting in a protective film. Thus, the drug speeds up the restoration of damaged tissues, speeding up the process of scarring, and prevents the development of relapses of peptic ulcer.
7. Auxiliary drugs - antispasmodics and analgesics: Baralgin relieves spasm of the stomach and intestines and reduces pain. Drotaverine eliminates spasm of smooth muscles and relieves spastic pain by expanding the lumen of the vessels and improving the supply of oxygen to the tissues.
8. Means for improving the nutrition of the intestinal mucosa. Most often, vitamins of group B and Actovegin are prescribed. The latter remedy has a stimulating effect on the metabolism and the process of assimilation of useful substances, and also enhances blood circulation.

5 Diet therapy

How to treat a duodenal ulcer is now clear. There are a lot of drugs, so the appointment should be made exclusively by a doctor. Please note that diet plays an important role in the treatment of peptic ulcer. It should exclude chemical, mechanical and thermal irritation of the stomach and duodenum. During the period of exacerbation, a special diet No. 1 is shown, which implies fractional meals in small portions, that is, 5-6 times a day. It includes low-fat boiled meat and fish, unleavened dairy products, mashed boiled vegetables (not containing insoluble vegetable fiber), boiled, baked or mashed fruits and berries, liquid cereals, yesterday's white bread, rosehip broth, and cocoa on milk, weak tea and coffee.

The ban applies to pickled, salted, smoked and fried foods, canned food, sour berries and fruits, dairy products, bran, legumes, cabbage, beets, radishes, radishes, fatty meats and fish, strong coffee, sour fruit juices and carbonated drinks. . Food should be warm, hot and cold food is contraindicated for patients.

6Surgical treatment

If the ulcer of the intestine or stomach is perforated, bleeding has appeared, or pyloric stenosis of the duodenum has developed, urgent surgical intervention is required. Surgical treatment of the ulcer is recommended for patients whose benign ulcer has not healed after 4 months of conservative therapy.

7Physiotherapy

At the stage of exacerbation, physiotherapy increases the effectiveness of drugs. So ultrasound and microwave therapy, electrophoresis with papaverine and novocaine relieve pain and reduce the production of gastric juice.

Modulated sinusoidal currents are used to relieve pain and reduce inflammation. All of these procedures improve blood circulation in the digestive system.

8Therapeutic exercise

Simple physical therapy exercises help to normalize the secretory function of the duodenum, as well as improve motility and general blood supply to the intestines. Exercise therapy is useful for people after inpatient treatment and prolonged bed rest.

Patients with peptic ulcer can receive specialized treatment in the conditions of resort-type sanatoriums Morshyn, Kvitka Polonina (in Transcarpathia), Truskavets, Borjomi, Essentuki, Zheleznovodsk. In normal times, people with stomach and duodenal ulcers are recommended to drink mineral water Jermuk, Borjomi, Essentuki No. 4. Peptic ulcer of the duodenum is treated with a whole range of measures, entrust the prescription of drugs to an experienced doctor, but remember that diet is very important for recovery.

Update: October 2018

Peptic ulcer of the duodenum often begins gradually with sucking pains in the stomach, increased hunger in the morning, mild nausea.

But just as often, these signals that the body gives are not taken seriously. A person simply does not realize the scale of the impending problem. After all, persistent pain syndrome, as well as formidable complications of this disease, develop much later.

If there is the slightest doubt about the presence of the disease, you should immediately file complaints with a general practitioner or gastroenterologist, so as not to subsequently end up on the table with a surgeon or, God forbid, a pathologist.

To help you navigate the variety of manifestations of duodenal ulcer, this article has collected and highlighted the main issues associated with this disease.

What is an ulcer?

The wall of the duodenum, which in Latin is called the duodenum, consists of mucous, submucosal and muscular layers. An ulcer is a wall defect, the bottom of which is located in the muscle layer, that is, the mucosa and submucosa are destroyed.

In the duodenum, an ulcer is most often located in the initial section (bulb or bulb), since here the most favorable conditions for the reflux of acidic gastric contents and a wonderful place for the reproduction of bacteria that provoke peptic ulcer. Sometimes not one ulcer of the duodenal bulb is formed, but several at once. More often these are paired, located opposite each other, “kissing” ulcers.

Peptic ulcer is a recurring formation of ulcerative defects in the wall of the duodenum, proceeding with periods of exacerbation (presence of an ulcer) and remission (absence of an open defect in the intestinal wall). Since the ulcer heals with the formation of a scar, even in remission, scar defects remain on the mucous membrane. If exacerbations are frequent, and there are many scars, they can deform or narrow the intestinal lumen.

Peptic ulcer of the duodenum affects about ten percent of the world's population. Mostly these are young and middle-aged people.

Why does she appear?

There is no single view on the occurrence and development of duodenum ulcers. There are several equivalent theories of the occurrence of ulcers.

• On the one hand, a very popular assumption a few years ago was that peptic ulcer is the result of colonization of the stomach and intestines by such a microbe as Helicobacter pylori. The microbe infects cells that secrete mucus. With development, it quickly populates the stomach and duodenum, stimulating the release of gastrin and releasing cytokines (substances that damage cells). Later it turned out that not all types of this microorganism living in humans cause disease. Therefore, it is still wrong to blame everything on the infection.
• An earlier assumption was an imbalance between the ability of the mucosa to defend itself and aggressive factors in the form of gastric acid and pepsin, which enter the intestine with insufficient function of the obturator muscle of the gastric outlet. It was also believed that the intestine is scratched by rough food. Today, these assumptions are supplemented by the fact that a decrease in protective prostaglandins was found in the mucous membrane of patients with peptic ulcer.
• A relationship was found between the incidence of ulcers and blood type. Carriers of the first group with an Rh-positive factor are at greater risk.
• Soviet physiology was of the opinion that an ulcer develops in people with excessive irritation of the cerebral cortex against the background of chronic stress or nervous experiences, when the release of gastric juice and inflammatory mediators (gastrin) is stimulated through the autonomic nervous system.
• Another interesting conclusion is connected with gastrin: prolonged exposure to the sun stimulates the release of this hormone and, accordingly, provokes an exacerbation of peptic ulcer or worsens its course.
• Taking medications such as corticosteroids, non-steroidal anti-inflammatory drugs can provoke ulceration of the intestinal mucosa.
• Alcohol and nicotine worsen the condition of the mucosa, change the nature of the secretion of hydrochloric acid and pepsin by the stomach, affect the level of gastrin and somatostatin, and also reduce the protective properties of mucus. Alcohol directly damages the cells of the mucosa.

What are the symptoms of a duodenal ulcer

Symptoms of gastric and duodenal ulcers are very close to each other. These are: pain, heartburn, nausea, vomiting, appetite disorders.

With an ulcer, the duodenum is called late. They occur an hour and a half after eating. Hunger pains that occur if food has not been received for more than 4 hours are also characteristic. A variety of such pains is night or early morning, similar to very acute hunger and sucking in the right hypochondrium. The nature of pain may vary from patient to patient. There are stabbing, aching, cutting, sucking or spasmodic pains of varying intensity and duration. In this case, the pains are located in the right half of the epigastric region (bulbous ulcer). They can give in the right hypochondrium or in the back. With an ulcer located at the end of the intestine, the pain is more shifted to the midline of the epigastrium or to its left half. At the heart of the pain is a violation of the integrity of the intestinal wall, inflammation and the accumulation of under-oxidized metabolic products.

• Heartburn

accompanies about a third of duodenal ulcers. It is due to the fact that the acidic contents of the stomach are thrown into the esophagus against the background of impaired motor activity of the stomach and intestines and inflammatory changes in the mucosa.

• Nausea and vomiting

eaten food or gastric contents are characteristic of high duodenal ulcers. With the development of secondary inflammation of the pancreas or gallbladder against the background of peptic ulcer, bile vomiting may occur.

• Appetite disorders

can manifest as its increase (sucking in the abdomen is somewhat smoothed out by eating) or aversion to food and its fear, since in the presence of an ulcer, food can provoke pain.

Complications of peptic ulcer

If the ulcer is not detected and treated in a timely manner, it can heal on its own. However, there is a high risk of developing a number of complications, which not only aggravate the course of the disease, but complicate treatment and worsen the prognosis for the patient. All complications are divided into:

Destructive - destroying the intestine:

• it's bleeding
• perforation - perforation
• penetration - penetration into an adjacent organ

Dysmorphic complications that change its structure:

• malignancy - the development of a malignant tumor at the site of an ulcer
• cicatricial deformity - a change in the structure of the walls and narrowing of the intestinal lumen up to its complete closure due to scars from ulcers.

More often perforate ulcers located on the anterior wall of the intestine. Posterior wall ulcers often penetrate the head of the pancreas.

Bleeding from the duodenum

Provoke bleeding can physical work, lifting weights. But most often the cause is the intake of alcohol if medication is not carried out or inadequately treated. Therefore, up to 80% of this complication occurs in men. In this case, blood loss can be of different volumes.

Bleeding results in tar-colored stools or coffee-ground-colored vomit. Minor bleeding may be manifested only by diarrhea or mushy dark stools. At the same time, with abundant blood loss, rapidly increasing weakness, dizziness, and even vomiting will be added to the vomiting. Bleeding is an emergency situation that requires calling an ambulance or self-treatment in the emergency room of a hospital.

Symptoms of a perforated duodenal ulcer

Perforation of an ulcer is not only bleeding, but also the entry into the abdominal cavity of the contents of the duodenum, where pancreatic enzymes and bile are secreted. These are rather aggressive substances that quickly cause irritation of the peritoneum and lead to inflammation of the abdominal cavity (peritonitis).

If acute dagger pains in the abdomen occur against the background of peptic ulcer, you should immediately call an ambulance. Such pain appears more often in the right half of the epigastric region, may radiate to the right shoulder or shoulder blade. The pain is so severe that the patient takes a forced position, lying on his side or back with his legs brought to his stomach. At the same time, the skin becomes very pale. The abdominal muscles tense up, the person avoids any movement.

The period of imaginary well-being, which develops a few hours after the onset of perforation, becomes the most dangerous. Here the pain subsides somewhat, the patient begins to move and assures that he is better. During this period, patients often inadvertently refuse an operation that could save their life. But, if 6-12 hours pass from the onset of perforation, and the patient is not operated on, then his condition will worsen dramatically:

• vomiting will appear
• temperature rise
• pain will return
• bloating will appear
• increased heart rate and heart rate
• peritonitis will develop, which will need to be operated on, and the prognosis for which at this stage is already worse.

Cicatricial stenosis of the duodenum

If exacerbations of peptic ulcer of the duodenum follow one after another or ulcerative defects are very large and deep, scars from ulcers can significantly deform or narrow the intestinal lumen. In this case, there are problems with the passage of food, a narrowing (stenosis) of the intestine develops, which requires surgical treatment. Clinically, decompensated stenosis is manifested by vomiting, impaired passage of food, and distention of the stomach. At the same time, such violations of the content of salts and water in the body develop, which lead to lethargy, weakness, drowsiness, increased muscle tone, and a feeling of goosebumps on the skin of the hands and feet.

Diagnostics

Today, the main and most informative method for detecting peptic ulcer disease is FGDS (fibrogastrodudenoscopy), in which, by inserting an endoscope (optical probe) into the stomach and duodenum, you can see the ulcer, assess its size and depth, take the mucous membrane for examination (biopsy) or do a rapid urease test for Helicobacter pylori.

Auxiliary importance is given to X-ray diagnostics, which is indispensable in clarifying complications.

Also, patients are prescribed a clinical blood test, blood biochemistry, a fecal test for the Gregersen reaction (detection of occult blood).

Treatment of duodenal ulcer

With the timely detection of peptic ulcer of the duodenum in the acute stage, treatment is reduced to the appointment of conservative therapy (prescription of tablets, less often injectable or drip drugs). Gone are the days when surgical treatments were used for uncomplicated peptic ulcer disease. If the peptic ulcer is complicated, then hospitalization in a surgical hospital is mandatory, and refusing it is fraught with a fatal outcome. This does not mean that any bleeding will be operated on, but timely observation is indicated for each complicated duodenal ulcer.

Previously, it was customary to carry out seasonal (spring and autumn) prophylactic treatment of duodenal ulcer. Currently, this practice is not supported, as it did not bring the expected results. Treatment is prescribed for the period of exacerbation of duodenal ulcer.

Diet for ulcers

In case of duodenal ulcer, a 4g diet is prescribed for the period of exacerbation, which involves mechanical, chemical and thermal sparing. Recommended 5-6 meals a day in small portions. Food should be heated to a temperature of 36-37 degrees. Hot, cold and dry food are excluded (see). Alcohol, fasting smoking is prohibited.

• Preference is given to boiled, pureed food. Mucous cereals, hateful mashed soups, mashed potatoes, pasta, rice and buckwheat are desirable. Steam fish, poultry, boiled meat in the form of soufflé or minced meat and cutlets. Of fruits, watermelons and bananas are allowed.
• You will have to give up fried, spicy, rich meat and bone broths, marinades, soda, strong tea, coffee, yeast pastries. Fruits and vegetables that contain fiber are the most harmful. You will have to forget about tomatoes, cucumbers, apples, pears, cabbage, carrots, radishes and other garden delights until the scarring of the ulcerative defect.
• It is strictly forbidden to chew gum that stimulates gastric secretion.
• Milk in this situation becomes an ambiguous product. In some patients, whole milk can irritate the ulcer due to calcium ions, while others drink it with pleasure, as it significantly reduces heartburn.

Drug treatment of duodenal ulcer

Peptic ulcer of the duodenum is treated today by the following groups of drugs.

Medications that reduce stomach acid production

The leading positions in this group are in proton pump blockers, which slow down the secretion of hydrochloric acid:

• Funds on the basis- omez, gastrozole, bioprazole, demeprazole, lomak, zerocid, krismel, zolser, omegast, losek, omezol, omitoks, omepar, jelkizol, pepticum, omipiks, promez, pepticum, risek, ortanol, romsek, sopral, ultop, helicid, cisagast , helol.
• Medicines based on pantoprazole- control, sanpraz, nolpaza, peptazole.
• Lansoprazole preparations- helicol, lanzap, lansofed, lanzotop, epikur, lancid.
• based on rabeprazole- zulbex, zolispan, pariet, ontime, hairabezol, rabelok.
• Esomeprazole - Nexium.

Blockers of H2-histamine receptors have practically ceased to treat peptic ulcer, as they cause a withdrawal syndrome (with a sharp cessation of taking the symptoms of the disease return).

• These are ranitidine (gistak, rannisan), famotidine (kvamatel, ulfamide, gastrcidin), cimetidine (belomet).

Selective blockers of M-cholinergic receptors (gastrocepin, pirencipin) reduce the production of pepsin and hydrochloric acid. They are used as auxiliary medicines for severe pain. May cause palpitations and.

Means that increase the protective properties of the mucous membrane

• Sucralfate (venter) forms a protective coating on the bottom of the ulcer.
• Sodium carbenoxolone (ventroxol, biogastron, caved-s) accelerates the recovery of the mucosal epithelium.
• Colloidal bismuth subcitrate () forms a film on the ulcer.
• Synthetic prostaglandins (enprostil) stimulate mucus formation and cell regeneration.

Other drugs

• Medicines that calm the central nervous system. Tranquilizers (seduxen, elenium, tazepam), (amitriptyline), sedatives (tenoten, valerian preparations, see).
• Blockers of central dopamine receptors (metoclopramide, raglan, cerucal) normalize the motor activity of the intestine.

The course of treatment of an ulcer can take from two to six weeks, depending on the size of the defect, the general condition of the body.

It should be noted that a competent doctor who can control the treatment process and evaluate its results should prescribe the treatment of duodenal ulcers, select drugs and their regimens.

Treatment of duodenal ulcer with antibiotics

Therapy of peptic ulcer with antibiotics has appeared since the undoubted participation in the development of the disease of microorganisms Helicobacter pylori was proved. In the early stages of the use of antibiotics, it was believed that the war should be fought to the bitter end, that is, the complete disappearance of the microbe, which was confirmed by culture, urease test during FGDS, or a blood test for antibodies to bacteria. Later it turned out that not all types of Helicobacter cause disease, that it is unrealistic to destroy all Helicobacter, since when it dies in the stomach and duodenum, it moves to the lower intestines, causing powerful dysbacteriosis and inflammation.

Re-infection is also possible when using someone else's or common dishes and the same FGDS, which therefore must be performed only under strict indications.

However, today it is advisable to conduct one or two courses of therapy with antibacterial drugs (amoxicillin, clarithromycin or tetracycline) with proven infection with Helicobacter. If after one course of antibiotics the bacterium did not die, then this drug should not be repeated. Another treatment regimen is chosen.

Ulcer treatment regimen

Helicobacter pylori eradication scheme of the first line:

• Double dose proton pump inhibitor twice daily (eg 40 mg omeprazole or esomeprazole twice).
• Clarithromycin 500 mg twice daily or Josamycin 1000 mg twice daily.
• Amoxicillin 1000 mg twice a day.
• De-nol 240 mg twice a day.

Scheme of the second row (in the absence of FGDS-dynamics of the size of the ulcer)

• Double dose proton pump inhibitor twice a day (similar to scheme 1)
• De-nol 240 mg twice a day.
• Metronidazole 500 mg three times a day.
• Tetracycline 500 mg 4 times a day.

Before starting therapy, Helicobacter pylori is detected using an immunological blood test (antibodies to the pathogen). Control - detection of Helicobacter antigens in feces. The breath urease test is not very informative.

The duration of eradication therapy is from 10 to 14 days. With the ineffectiveness of treatment sequentially with 1 and 2 schemes, Helicobacter pylori typing is carried out and its sensitivity to drugs is established.

Schemes with levofloxacin today are possible for use only in regions of the Russian Federation where the sensitivity of Helicobacter remains to this drug.

If duodenal ulcer is not associated with Helicobacter pylori infection, then treatment is carried out with drugs that reduce the production of gastric juice. After 7-14 days of combination therapy, treatment is given for another five weeks.

Alternative treatment of duodenal ulcer

Complete or partial distrust of traditional medicine, most likely, does not bode well for the ulcer. There are drugs to treat ulcers that have been shown to work in large randomized human trials. Also, the effect of drugs is checked by everyday medical practice. Schemes are perfected, side effects of drugs are revealed. At the same time, no one canceled the alternative opportunity to be treated with folk remedies.

One of the most effective traditional medicine for stomach ulcers and duodenal ulcers is considered freshly squeezed potato juice. It doesn't taste good enough, but it's easy enough to get used to. It is better to use varieties Morning rose or American, but any unspoiled potato tuber will do. Making juice is quite laborious, given that it should be drunk only fresh and 3 times a day, but you can adapt if you wish. A raw potato tuber is peeled, grated and squeezed through several layers of gauze. Juice should be drunk immediately, otherwise it turns black and loses its medicinal properties. The first 3 days, only a tablespoon before meals for 30 minutes, preferably 3 times a day, then 3 days, 2 tablespoons, gradually bringing to half a glass at the reception, and so on for 21-28 days. This requires a diet. After 2-3 weeks, the course can be repeated. It really helps!

You can resort to traditional medicine, use either (1 dessert spoon on an empty stomach for 3 months), honey, propolis, herbs (, plantain,), after sitting on a duodenal-sparing diet and taking 20 mg of omeprazole twice a day.

Like many diseases, duodenal ulcer progresses imperceptibly. It all starts with mild pain in the pit of the stomach, increased appetite in the morning and nausea. This is how the body signals the development of the disease, but many people simply do not take it seriously, underestimating the scale of the upcoming problems. Severe pain and other signs of the disease appear much later.

Even if the slightest changes in the state of health are detected, it is necessary to immediately contact a qualified gastroenterologist or therapist. Signs of stomach and duodenal ulcers, symptoms that should cause alarm, we will describe in detail below.

What is an ulcer?

The shell of the duodenum consists of three layers: muscular, submucosal and mucous. Damage to the wall with the destruction of the last 2 is called an ulcer. In most cases, the disease develops in the initial part of the intestine. This is explained by the fact that it is there that the most suitable environment reigns for the entry of acidic stomach contents and the spread of pathogenic microflora that causes the disease.

Sometimes not one, but several ulcers are formed at the same time. As a rule, they are located on opposite sides of each other, and then they are called "kissing". The disease can be manifested by the recurring formation of defects in the intestinal lining, which is accompanied by deterioration and remissions.

Treatment of the disease leads to the healing of ulcers. However, scars remain. In the event that exacerbations occur frequently, then a lot of wounds appear in the duodenum that can change and narrow its lumen.

According to statistics, and the duodenum is observed in almost 10% of the world's population. As a rule, these are young people, as well as middle-aged people.

Causes of an ulcer

The activity of the digestive tract is constantly carried out on the basis of a balance between the formation of aggressive hydrochloric acid and factors that protect the walls of organs from juices. In some situations, the balance is disturbed towards acids. It turns out that the signs of peptic ulcer causes the body itself.

The most common cause of the disease is a bacterium Helicobacter pylori found in 8 out of 10 patients. It is not difficult to get infected, because it is transmitted through any contacts: kisses, handshakes, especially in conditions of non-compliance with hygiene standards. But not always this microorganism causes the progression of peptic ulcer.

Helicobacter pylori forms special enzymes that destroy the mucosal membrane. As a result, the process of mucus formation is disrupted, which leads to damage.

In addition to pathogens, there are other causes of ulcer formation.

• Neurosis, frequent stress and other emotional disorders. Such features lead to problems in the functioning of the autonomic nervous system. This causes dominance of the vagus nerve tone. The vessels that cover the stomach spasm, impairing the natural supply of tissues with the necessary substances. The influence of hydrochloric acid and spicy foods provokes the formation of inflammation and ulcers.
• Wrong nutrition. If the diet is dominated by carbonated drinks, spicy smoked dishes, acidic foods, this can cause peptic ulcer. Another reason is the consumption of food with a lot of fiber against the background of the development of gastritis.
• Abuse of alcoholic beverages, which in themselves are dangerous substances. In addition, alcohol negatively affects the central nervous system, suppresses the human will, which often leads to overeating and consumption of junk food.
• Smoking increases the formation of hydrochloric acid. As a result, the gastrointestinal tract begins to malfunction.
• Working at night almost doubles the risk of developing the disease.
• Heredity. Often, stomach problems are a family problem. Predisposition to the disease can be inherited from parents.
• Taking certain drugs adversely affects the intestinal mucosa. These include anti-inflammatory nonsteroidal drugs that have been used for a long time.

The presence of several conditions will almost certainly lead to the formation of ulcers.

Symptoms

Signs of a duodenal ulcer are very close to each other. The most significant are the following:

Unpleasant sensations usually arise after 1 - 1.5 hours after eating. There are also pains that appear if the patient has not eaten anything for more than 4 hours, for example, at night and in the morning. Discomfort occurs in the right hypochondrium and resembles an acute feeling of hunger. Each patient's pain is different. There are stabbing, cutting, aching and sucking varieties with different duration and power.

In the presence of a bulbous ulcer, the manifestation of pain is observed on the right side of the epigastric region. Sometimes they are given in the back or in the right hypochondrium. There are pain in connection with the inflammatory process, the destruction of the intestinal lining and the impact of not fully oxidized metabolic substances.

The pain syndrome is periodic. Also, duodenal ulcer symptoms can be quite specific. In the event of an exacerbation, discomfort can last for 6 to 8 weeks or only a few days, after which relief occurs. During periods of calm, patients may practically not complain about their health, even if the diet is not followed.

Taking drugs prescribed by a qualified specialist eliminates the symptoms of an exacerbation of a duodenal ulcer in 7 days. So quick will be the treatment of a simple form of the disease without complications.

• Heartburn

Statistical data indicate that such a symptom is observed in 30 - 80% of patients. Heartburn occurs due to the fact that the acidic contents of the stomach are in the esophagus, and this happens against the background of inflammation in the mucosa and impaired functioning of digestion. Often heartburn appears along with pain and is associated with eating. In some cases, this symptom is considered the only signal of a peptic ulcer, which appears a couple of years before other signs.

Unfortunately, it is impossible to diagnose the disease only by heartburn. It is also characteristic of other pathologies of the digestive system: cholelithiasis, chronic pancreatitis, gastroduodenitis. Often heartburn appears, and then gradually increases, turning into a pain syndrome. For this reason, many patients find it difficult to separate these two symptoms.

• Vomit

It is characterized by the fact that it appears without nausea, at the very moment when the pain reaches its highest levels. Sometimes it occurs on an empty stomach, during the intensive production of gastric juices. For vomit, a sour smell is characteristic, the content of particles of undigested food, especially if a little time has passed after eating. With a simple form of peptic ulcer, sporadic vomiting is observed, however. If this symptom torments the patient every day, you should consult a doctor. Often this indicates the development of complications, the treatment of which should be timely. After vomiting, the patient will feel better.

• Belching

Such a symptom with a duodenal ulcer is not considered characteristic, but is observed in almost 50% of patients. In most cases, the eructation is sour with an increased number of regurgitations. There is also the so-called "empty" eructation, which is accompanied by the swallowing of air during meals.

• Constipation

This symptom occurs in many patients with stomach ulcers. Constipation occurs during an exacerbation of the disease and is very severe, sometimes they cause more discomfort than pain. The cause of the problem is: a dietary diet with an insufficient content of coarse fiber, a minimal manifestation of physical activity, and some types of medications. Sometimes patients suffer from diarrhea, which is not a characteristic symptom of the disease. This symptom appears after prolonged constipation against the background of an irritated, inflamed large intestine.

• Problems with appetite

The first signs of the disease are mild pain in the pit of the stomach, an aggravated feeling of hunger, slight nausea. In most cases, ulcers eat food quite often, because the appetite is increased. Its decrease occurs only when a relapse occurs, when there is a strong pain syndrome. Many patients suffer from the manifestation of a phobia due to the fact that eating food will cause severe pain. In this regard, there is a decrease in body weight.

Features of the diet

Ulcer treatment will be effective and faster if a special diet is followed. In moments of exacerbation, it is necessary to eat food at least 5-6 times a day in small portions. Food must be heated to a comfortable temperature. Dishes should not be cold or hot, dry food is prohibited, as well as the use of alcoholic beverages.

Diet therapy involves eating boiled, thoroughly ground food. It is recommended to eat cereals from rice and buckwheat, nutritious soups, mashed potatoes, vegetables, boiled pasta. From fruits, preference should be given to bananas, as well as watermelons.

What products are prohibited? Ulcers will have to give up fried, spicy foods, soda, pickled foods, yeast dough pastries, strong coffee and tea. The most dangerous are fruits and vegetables that are high in fiber. Before scarring of ulcers, you should not eat cabbage, pears, tomatoes, cucumbers, apples, carrots. Experts recommend completely abandoning chewing gum, as it activates the formation of gastric juice.

Knowing the symptoms that accompany a duodenal ulcer will help pay attention to changes in the functioning of the body. Timely treatment will avoid the development of complications, alleviate the patient's condition, achieve a speedy recovery.