Signs of duodenal ulcer disease. Signs of stomach and duodenal ulcers

Content

Among diseases of the gastrointestinal tract, ulcers are especially common. duodenum. About 10% of the population suffers from this disease, and the pathology is observed in men 2 times more often than in women. More often the disease occurs in chronic form, which is characterized by alternating periods of remission and exacerbation. The latter occur in spring or autumn. Pathology can be caused by bacteria. A common cause is poor nutrition. Regardless of the etiology, treatment of duodenal ulcers has several general principles.

What is duodenal ulcer

This disease is a lesion of the duodenum, which is accompanied by the formation of an ulcer on the mucous membrane of the organ and the subsequent formation of a scar. According to statistics, the pathology is observed in young and middle-aged people from 25 to 50 years. The duodenum is the initial section of the small intestine, which has the following main characteristics:

originates from the pylorus of the stomach and ends, flowing into the jejunum;
consists of 12 diameters of the finger, which is why it is called the duodenum;
This section of the intestine reaches 4.7 cm in diameter and 30 cm in length.

There are several sections of the duodenum (DU): upper, descending, horizontal, ascending. Everyone is involved in digestion. In general, the DPC performs the following functions:

Secretory, which ensures the secretion of intestinal juice with enzymes and hormones involved in digestion.
Motor, which consists in the final digestion of fats and carbohydrates.
Evacuation, which involves moving food to the next sections of the intestine.

When an ulcer develops, these functions are disrupted and digestive problems develop. The intestinal wall consists of several membranes: serous, muscular and mucous. An ulcer develops not only on the surface of the mucosa, which distinguishes it from erosive lesions. As the disease progresses, it can affect deeper and deeper layers of the intestinal walls, which can lead to perforation, severe bleeding and even death.

Reasons

The gastrointestinal tract is in a state of delicate balance between the production of aggressive hydrochloric acid and the action of protective mechanisms that prevent digestive juices from digesting the walls of the organs. There are factors that shift this balance towards the influence of acids. Most common cause This deviation is the bacterium Helicobacter Pylori. It is found in 80% of patients, but is not the cause of ulcer development in every case. The following actions of this microorganism lead to the formation of ulcerations:

production of specific enzymes during reproduction: protease, urease;
release of ammonia, which increases acidity.

In addition to the pathogenic effect of this bacterium, there are several other reasons for the development of duodenal ulcers. Their list includes the following diseases and conditions:

chronic fatigue, stress;
hereditary predisposition, in which the number of cells synthesizing hydrochloric acid is increased or the secretion of gastric mucus components is reduced;
increased acidity of gastric juice, which, when it enters the duodenum, irritates its mucous membrane;
duodenitis (chronic inflammation in the duodenum);
long-term use of painkillers, non-steroidal anti-inflammatory or antibacterial drugs;
smoking, alcohol abuse;
poor nutrition with an abundance of salty, sour, spicy foods in the diet;
gastrin-producing tumor.

Classification

There are many classifications of duodenal ulcer. One of the criteria for identifying the types of this pathology is the frequency of exacerbations, taking into account which the following are distinguished:

duodenal ulcer with frequent manifestations, in which exacerbations occur at least once a year;
duodenal ulcer with rare relapses, which are observed no more than once every 2 years.

One or more ulcerations may appear on the duodenal mucosa. In the first case, a single ulcer is diagnosed, in the second - multiple. The mucosal defect can be located in the bulbous part - the site of expansion of the duodenum, or in its post-bulb part. Taking into account the depth of damage to the organ walls, deep and superficial ulcers are distinguished. Taking into account the state of the defect, the pathology is divided into several stages: active exacerbation, remission and scarring. According to the broadest classification, taking into account the cause, peptic ulcer disease is divided into the following types:

Stressful. Associated with depression, stress and strong psycho-emotional experiences.
Shock. Develops as a result of burns, bruises or other injuries.
Hormonal. Formed due to long-term use medicines.

Symptoms of duodenal ulcer

The disease may not make itself felt for a long time. At an early stage, signs of a duodenal ulcer include only minor digestive problems and discomfort in the upper abdomen. The last symptom is observed in 75% of patients. As the disease progresses, pain and dyspeptic syndromes develop. The nature of pain with a duodenal ulcer varies. Their intensity is insignificant in approximately half of the patients. The remaining patients suffer from severe pain, having the following distinctive features:

appears 1.5-2 hours after eating food;
often develops at night, which is associated with increased secretion of hydrochloric acid after dinner;
has a piercing, cutting, compressive nature;
localized in the upper abdomen on the right or center;
may have a “hungry” character, i.e. occur after prolonged fasting and go away after eating;
decreases as a result of taking antacids.

The second characteristic symptom of duodenal ulcer is dyspeptic syndrome. It leads to loss of appetite and weight loss. Against the background of these signs, the patient may complain of the following symptoms:

nausea, vomiting;
bloating that cannot be relieved even with the most powerful medications;
constipation (defecation may be absent for up to a week);
heartburn;
blood in the stool;
belching.

Symptoms of exacerbation

The signs of duodenal ulcer appear more clearly during the period of exacerbation. The difference between this stage of pathology is the appearance of almost all of the listed symptoms, which torment a person continuously for several days or even weeks. More often, exacerbation occurs in spring or autumn. Pain and discomfort in this case are of the following nature:

arise in the upper part of the navel and “below the stomach” - exactly in the center of the junction of the ribs above the stomach;
pain radiates to the back and heart, which distorts the idea of the source of the symptom;
appear on an empty stomach, and subside after eating.

During an attack, a person tries to lean forward, bend and press his legs to his stomach. This helps to somehow reduce the pain. The patient complains to the doctor that he cannot sleep at night due to such long and severe attacks. In addition to pain, during an exacerbation other signs of duodenal ulcers often appear:

nausea, profuse vomiting;
belching sour;
flatulence;
chronic constipation lasting several weeks.

Possible complications

Peptic ulcer DPC is dangerous because it can lead to severe and even fatal complications. Their common name is acute abdomen, which represents a complex of symptoms in which serious damage to the abdominal organs has occurred. Such complications include the following dangerous conditions:

Ulcer penetration. It is a deep defect in which ulceration penetrates into adjacent organs: pancreas, liver. Accompanied by acute peritonitis.
Perforation (perforation) of the ulcer. This leads to the penetration of the contents of the duodenum into abdominal cavity and inflammation - peritonitis. The main symptom is acute stabbing pain in the abdomen.
Ulcer malignancy. This is a rare complication that involves malignancy of the mucosal cells at the site of the ulcer.
Duodenal stenosis. Formed as a result of swelling of damaged mucosa or scar formation. This prevents chyme from moving further through the intestines, causing intestinal obstruction.
Bleeding from an ulcer. Occurs when the walls of the vessel in the area of ulceration are corroded. This condition is indicated by the presence of blood in the stool.
Periduodenitis. Develops when inflammatory process reaches the serous membrane of the duodenum.

Diagnostics

The first stage of diagnosis is collecting a history of the disease. The doctor asks the patient how often the pain occurs, its location and nature. An important indicator The time of onset of the pain syndrome is also important - does it appear after eating and what helps to get rid of it. To confirm the diagnosis, the following procedures are performed:

General blood and urine analysis. Helps identify the inflammatory process in the body. The hemoglobin level indirectly indicates bleeding.
Determination of antibodies to Helicobacter Pylori. If they are identified, then this bacterium is the cause of the disease.
PH-metry. This is a procedure to determine the acidity of gastric juice.
X-ray examination. Helps identify the location of the ulcer and complications such as penetration, duodenal stenosis, perforation.
Endoscopic examination. Also called fibrogastroduodenoscopy. It involves inserting an endoscope through the mouth into the intestinal cavity, making it possible to identify the exact position and size of the ulcer.
Microscopic examination of a biopsy specimen of the duodenal mucosa. The material is collected during fibrogastroduodenoscopy.

Treatment

Duodenal ulcer requires an integrated approach to treatment. To confirm the diagnosis, you need to consult a gastroenterologist. Based on analyzes and instrumental studies, the specialist will prescribe effective treatment. The standard treatment regimen includes the following measures:

Taking medications. Medicines are selected taking into account the cause of the peptic ulcer. The drugs help reduce the aggressiveness of gastric juice, get rid of Helicobacter Pylori, and improve duodenal motility.
Diet. Aimed at protecting WPC from thermal, mechanical and chemical influences.
Surgical intervention. Indicated for the development of complications of peptic ulcer disease.
Traditional medicine. Used as an adjuvant treatment to reduce symptoms of the disease.

Treatment of stomach and duodenal ulcers with medications

During an exacerbation, treatment is carried out in a hospital setting. The patient is prescribed bed rest and emotional rest. Expansion of the regimen is possible from the second week of stay in the clinic. Treatment of duodenal ulcers with medications is determined taking into account the cause of the disease and symptoms. The doctor prescribes the following groups of drugs:

Antisecretory: H2-histamine receptor blockers (Famotidine, Ranitidine, Cimetidine), proton pump inhibitors (Omeprazole, Nexium, Pariet). Reduces the aggression of gastric juice.
Antibacterial and antiprotozoal: Amoxicillin, Metronidazole, Clarithromycin, Tetracycline. Inhibits the life activity of Helicobacter pylori.
Prokinetics: Trimetad, Cerucal, Motilium. Eliminate nausea and vomiting, improve duodenal motility.
Antacids: Maalox, Phosphalugel, Almagel, Vikalin. Helps get rid of heartburn, neutralizes hydrochloric acid.
Gastroprotective: Venter, De-nol. They envelop the mucous membrane of the duodenum, due to which it suffers less from the effects of hydrochloric acid.

Conservative treatment can also be carried out at home. Most patients have to take medications in courses throughout their lives, depending on the frequency of exacerbations. Judging by the reviews, the following medications are effective:

De-nol. Contains bismuth tripotassium dicitrate. It has gastroprotective and antiulcer effects. Advantage – it additionally exhibits antibacterial properties. Helps relieve symptoms of gastric and duodenal ulcers. Dosage – 1 tablet 4 times a day or 2 tablets, 2 times a day. Taking time: half an hour before meals. Side effects of the drug: nausea, vomiting, constipation, increased bowel movements. Contraindications: age under 4 years, pregnancy, renal failure, lactation.
Almagel. Contains algeldrate, benzocaine, magnesium hydroxide. The main effect is to reduce the activity of gastric juice during food digestion. Indications for use: gastritis, enteritis, peptic ulcer, duodenitis, reflux esophagitis. You need to take the medication half an hour before meals, 1-3 dosage spoons up to 3-4 times a day. Contraindications: kidney disease, Alzheimer's disease, taking sulfonamides, age less than 6 months. Adverse reactions: constipation, epigastric pain, vomiting, stomach cramps, nausea, drowsiness. The advantage is that even with long-term therapy it does not provoke the formation of stones in the urinary system.

Surgical treatment

This radical method of treatment is rarely used, only in case of complications: ulcer perforation, intestinal bleeding or severe stenosis of the duodenal pylorus. An indication for surgery is the ineffectiveness of conservative therapy when the defect does not heal within 4 months. Surgical treatment of ulcers is carried out using one of the following methods:

Resection. It is the excision of individual sections of the gastrointestinal tract where ulcers are present.
Vagotomy. During this operation, a branch of the vagus nerve is cut, which controls the process of stimulating gastric secretion.
Gastroenterostomy. It consists of creating a connection between the stomach and the small intestine, bypassing the duodenum and pylorus.

Diet

A patient with duodenal ulcer must adhere to a diet throughout his life. This helps reduce the frequency of exacerbations of pathology. A gentle therapeutic diet No. 1 has been specially developed for patients with ulcers. It involves split meals - up to 5-6 times a day in small portions of 200 g. Recommended products are presented in the following list:

lean fish - perch, pike perch;
meat – chicken, veal, rabbit;
dried bread;
light vegetable soups;
vegetables - beets, potatoes, carrots, zucchini;
fruits;
olive and sea buckthorn oil;
dairy products;
porridge – oatmeal, buckwheat, rice;
mint and lemon balm tea;
mineral water Essentuki No. 4, Borjomi.

Cooked food should be warm (neither hot nor cold). Foods need to be boiled, stewed or baked. The dish will be healthier if you puree the ingredients to make it easier to digest. The following foods should be completely eliminated from the diet:

fried, salty, spicy;
pork;
citrus;
tomatoes;
smoked meats;
canned food;
sauerkraut, tomatoes, cucumbers;
rye bread;
sour berries with thick skin;
soda, coffee.

Traditional treatment

Alternative medicine has several recipes, the use of which helps to significantly improve the condition of peptic ulcer disease, especially during exacerbation. It is important to understand that folk remedies are only an auxiliary treatment method that does not guarantee recovery. Before using them, you should also consult your doctor. List of effective folk remedies treatment of duodenal ulcers:

Take equal proportions of dandelion root and elecampane, chicory and shepherd's purse. Pour a tablespoon of herbal mixture into 400 ml cold water. Leave for an hour, then boil for 10 minutes. Before taking, strain the product. Consume 2 tbsp before each meal. l.
Grind about 150 g of propolis and pour in melted butter (1 kg). Place in a water bath, stir until a homogeneous consistency is obtained. Take 1 hour before meals, 1 tsp. decoction up to 3 times a day. The course of treatment should last 30 days.
Brew 10 g of plantain with 100 ml of boiling water. Infuse the product for about half an hour. Drink 1 hour before eating 1 tbsp. l. Repeat the procedure up to 3 times per day.

Prevention

Measures for the prevention of duodenal ulcer are aimed at preventing the development of Helicobacter pylori infection and increased secretion of hydrochloric acid. To this end, you must adhere to the following recommendations:

quit smoking and alcohol;
exclude spicy, fatty, salty foods from the diet;
avoid emotional stress;
use clean dishes;
treat chronic gastritis or duodenitis;
do not take medications without a doctor's prescription.

Video

Update: October 2018

Duodenal ulcers often begin gradually with sucking pain in the pit of the stomach, an increased feeling of hunger in the morning, and mild nausea.

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

If there is the slightest doubt about the presence of the disease, you should immediately contact a therapist or gastroenterologist with complaints, so as not to end up with a surgeon or, God forbid, a pathologist.

To help you navigate the variety of manifestations of duodenal ulcer, this article collects and highlights the main issues related to this disease.

What is an ulcer?

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

Peptic ulcer disease is the repeated formation of ulcerative defects in the wall of the duodenum, occurring with periods of exacerbation (the presence of an ulcer) and remission (the 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 a lot of scars are formed, they can deform or narrow the intestinal lumen.

About ten percent of the world's population suffers from duodenal ulcers. These are predominantly young and middle-aged people.

Why does she appear?

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

On the one hand, several years ago there was a very popular assumption that peptic ulcer disease is the result of the colonization of the stomach and intestines by a microbe such as Helicobacter pylori. The microbe infects cells that secrete mucus. During development, it quickly colonizes 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, blaming everything on infection is still wrong.
An earlier assumption was an imbalance between the ability of the mucous membrane to defend itself and aggressive factors in the form of gastric acid and pepsin, which enter the intestine when the function of the obturator muscle of the gastric outlet is insufficient. It was also believed that the intestine was scratched by rough food. Today, these assumptions have been supplemented by the fact that a decrease in protective prostaglandins has been found in the mucous membrane of patients with peptic ulcer disease.
A relationship has been found between the incidence of ulcers and blood type. Carriers of the first group with a Rh-positive factor are at greater risk.
Soviet physiology was of the opinion that ulcers develop in people with excessive irritation of the cerebral cortex against the background of chronic stress or nervous experiences, when through the autonomic nervous system the release of gastric juice and inflammatory mediators (gastrin) is stimulated.
Another interesting conclusion is associated with gastrin: prolonged exposure to the sun stimulates the release of this hormone and, accordingly, provokes an exacerbation of peptic ulcer disease or worsens its course.
Taking medications such as corticosteroids and non-steroidal anti-inflammatory drugs can provoke ulcerations of the intestinal mucosa.
Alcohol and nicotine worsen the condition of the mucous membrane, 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 the mucus. Alcohol directly damages mucosal cells.

What are the symptoms of a duodenal ulcer?

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

With ulcers, 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 type of such pain 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 pain is located in the right half of the epigastric region (bulb ulcer). They can radiate to the right hypochondrium or to the back. With an ulcer located at the end of the intestine, the pain moves more towards midline epigastrium or its left half. The basis of the pain is a violation of the integrity of the intestinal wall, inflammation and 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 mucous membrane.

Nausea and vomiting

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

Appetite disorders

can manifest itself as an increase (sucking in the stomach is somewhat smoothed out by food intake) or an aversion to food and fear of it, 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 may 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 a neighboring organ

Dysmorphic complications that change its structure:

malignancy - the development of a malignant tumor at the site of the ulcer
cicatricial deformation - a change in the structure of the walls and narrowing of the intestinal lumen until it is completely closed due to scars from ulcers.

Ulcers located on the anterior wall of the intestine are more likely to perforate. Ulcers of the posterior wall often penetrate the head of the pancreas.

Bleeding from the duodenum

Physical work and heavy lifting can provoke bleeding. But most often the cause is alcohol intake, if treatment with medications is not carried out or is inadequate. Therefore, up to 80% of this complication occurs in men. In this case, blood loss can be of different volumes.

When bleeding occurs, tar-colored stool or vomit appears like coffee grounds. Minor bleeding may only result in diarrhea or pasty, dark stools. At the same time, with heavy blood loss, rapidly increasing weakness, dizziness, and even vomiting will be added. Bleeding is an emergency that requires calling an ambulance or going to a hospital emergency room on your own.

Symptoms of a perforated duodenal ulcer

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

If acute stabbing pain in the abdomen occurs against the background of a peptic ulcer, you should immediately call ambulance. This pain appears more often in the right half of the epigastric region and can radiate to the right shoulder or scapula. 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, the person avoids any movement.

The most dangerous period is the period of imaginary well-being, which develops a few hours after the onset of perforation. Here the pain subsides somewhat, the patient begins to move and assures that he is feeling better. During this period, patients often unwisely refuse surgery that could save their life. But, if 6-12 hours pass from the onset of perforation, and the patient does not undergo surgery, his condition will sharply worsen:

vomiting appears
temperature rise
the pain will return
bloating will appear
pulse and heartbeat increase
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 duodenal ulcer follow one after another or the ulcerative defects are very large and deep, scars from ulcers can significantly deform or narrow the intestinal lumen. In this case, problems arise with the passage of food, and a narrowing (stenosis) of the intestine develops, which requires surgical treatment. Clinically, decompensated stenosis is manifested by vomiting, impaired passage of food and distension of the stomach. At the same time, disturbances in the content of salts and water in the body develop, which lead to lethargy, weakness, drowsiness, increased muscle tone, and a feeling of goosebumps running on the skin of the hands and feet.

Diagnostics

Today, the main and most informative method for identifying peptic ulcers 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, and take the mucous membrane for examination (biopsy) or conduct a rapid urease test for the presence of Helicobacter pylori.

X-ray diagnostics, which is indispensable in clarifying complications, is of auxiliary importance.

Patients are also prescribed a clinical blood test, blood biochemistry, and a stool test for the Gregersen reaction (detection of occult blood).

Treatment of duodenal ulcers

With timely detection of duodenal ulcer in the acute stage, treatment is reduced to the prescription of conservative therapy (prescription of tablets, less often injections or drips). The times when surgical treatment methods were used for uncomplicated peptic ulcers are a thing of the past. If the peptic ulcer is complicated, then hospitalization in a surgical hospital is mandatory, and refusal to do so can be fatal. This does not mean that any bleeding will be operated on, but timely observation is indicated for every complicated duodenal ulcer.

Previously, it was customary to conduct seasonal (spring and autumn) preventive treatment duodenal ulcer. Currently, this practice is not supported, as it has not brought 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 temperature sparing. It is recommended to eat 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 and smoking on an empty stomach are prohibited.

Preference is given to boiled, pureed food. Slimy porridges, non-rich creamy soups, mashed potatoes, pasta, rice and buckwheat are desirable. Steamed fish, poultry, boiled meat in the form of soufflé or minced meat and cutlets. Watermelons and bananas are allowed as fruits.
You will have to give up fried, spicy, rich meat and bone broths, marinades, soda, strong tea, coffee, and yeast baked goods. The greatest harm is caused by fruits and vegetables containing fiber. You will have to forget about tomatoes, cucumbers, apples, pears, cabbage, carrots, radishes and other garden delights until the ulcerative defect heals.
It is strictly forbidden to chew gum, which stimulates gastric secretion.
Milk in this situation becomes an ambiguous product. In some patients, whole milk can irritate ulcers due to calcium ions, while others drink it with pleasure, as it significantly reduces heartburn.

Drug treatment of duodenal ulcers

Peptic ulcer of the duodenum is currently treated with the following groups of drugs.

Medicines that reduce the production of gastric juice

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

Funds on base- omez, gastrozole, bioprazole, demeprazole, lomak, zerocid, krismel, zolser, omegast, lossek, omezol, omitox, omepar, zhelkizol, peptikum, omipix, promez, peptikum, ricek, orthanol, romsec, sopral, ultop, helicid, cisagast , helol.
Medicines based on pantoprazole- Controloc, Sanpraz, Nolpaza, Peptazol.
Lansoprazole preparations- helicol, lanzap, lansofed, lanzotope, epicure, lancid.
Based on rabeprazole- Zulbex, Zolispan, Pariet, Ontime, Khairabezol, Rabeloc.
Esomeprazole - Nexium.

H2-histamine receptor blockers have practically ceased to be used to treat peptic ulcers, as they cause withdrawal syndrome (with abrupt cessation of use, the symptoms of the disease return).

These are ranitidine (Gistac, Rannisan), famotidine (quamatel, ulfamid, gastrsidine), cimetidine (Belomet).

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

Agents that increase the protective properties of the mucous membrane

Sucralfate (Venter) forms a protective coating at the bottom of the ulcer.
Sodium carbenoxolone (Ventroxol, Biogastron, Kaved-s) accelerates the restoration of the epithelium of the mucous membrane.
Colloidal bismuth subcitrate () forms a film on the ulcer.
Synthetic prostaglandins (enprostil) stimulate mucus production and cell restoration.

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 for ulcers can take from two to six weeks, depending on the size of the defect and the general condition of the body.

It should be noted that a competent doctor who can monitor the treatment process and evaluate its results should prescribe treatment for duodenal ulcers, select medications and dosage regimens.

Treatment of duodenal ulcers with antibiotics

Antibiotic therapy for peptic ulcers has appeared since the undoubted participation of Helicobacter pylori microorganisms in the development of the disease was proven. In the early stages of the use of antibiotics, it was believed that the war should be waged until a victorious end, that is, the complete disappearance of the microbe, which was confirmed by culture, a urease test during FGDS, or a blood test for antibodies to the bacterium. 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 severe dysbiosis and inflammation.

Re-infection is also possible when using someone else's or shared utensils and the same FGDS, which therefore must be performed only according to strict indications.

However, today it is advisable to carry out one or two courses of therapy with antibacterial drugs (amoxicillin, clarithromycin or tetracycline) for proven Helicobacter infection. If after one course of antibiotics the bacteria are not killed, then this drug is not worth repeating. A different treatment regimen is selected.

Ulcer treatment regimen

First-line Helicobacter pylori eradication scheme:

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 2 times a day.
De-nol 240 mg twice a day.

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

Proton pump inhibitor in double dose 2 times a day (same as 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 urease breath test is not very informative.

The duration of eradication therapy is from 10 to 14 days. If treatment is ineffective with sequential regimens 1 and 2, Helicobacter pylori is typed and its sensitivity to drugs is determined.

Today, regimens with levofloxacin can only be used in regions of the Russian Federation where Helicobacter remains sensitive to this drug.

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

Alternative treatment for duodenal ulcers

Complete or partial distrust of traditional medicine, most likely, does not bode well for the ulcer sufferer. There are drugs for the treatment of ulcers, the effect of which has been proven in serious random studies in humans. Also, the effect of drugs is checked by everyday medical practice. Schemes are sharpened, revealed side effects drugs. At the same time, no one canceled the alternative possibility of being treated with folk remedies.

One of the most effective means traditional medicine for stomach and duodenal ulcers is considered freshly squeezed potato juice. It tastes rather unpleasant, but you can get used to it quite easily. It is better to use Morning Rose or American varieties, but any unspoiled potato tuber will do. Preparing juice is quite labor-intensive, given that you only need to drink it fresh and 3 times a day, but you can get used to it if you wish. The raw potato tuber is peeled, grated and squeezed through several layers of gauze. The juice should be drunk immediately, otherwise it turns black and loses its medicinal properties. The first 3 days only take a tablespoon before meals 30 minutes, preferably 3 times a day, then 3 days 2 tablespoons, gradually increasing to half a glass per dose and so on for 21-28 days. This requires adherence to a diet. After 2-3 weeks the course can be repeated. This really helps!

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

is a relapsing disease that is chronic in nature. In this case, an ulcerative defect appears in the stomach and/or duodenum. As a result, there is a significant imbalance between the protective properties of the gastroduodenal zone and aggression factors.

This disease is considered to be the most common lesion of the gastrointestinal tract. Statistics show that approximately 10% of the total population suffers from peptic ulcer disease. As a rule, the disease affects both young and middle-aged people. More often, peptic ulcer disease is diagnosed in men. Today, doctors note a characteristic “rejuvenation” of the disease, as well as a more frequent manifestation of a severe form of the disease and a decrease in the effectiveness of treatment.

Causes of peptic ulcer

As a rule, the disease develops as a consequence of the influence of several predisposing factors on the human body. The causes of the development of this disease are determined by errors in the activity of hormonal and nervous mechanisms that regulate the activity of the stomach and duodenum, as well as the lack of proper balance between the effects on these organs hydrochloric acid , pepsins etc. and protective factors, which include bicarbonates , mucus , cell regeneration . In particular, peptic ulcer disease develops in people who have a hereditary predisposition to its manifestation, as well as in those who regularly experience emotional stress and do not adhere to the rules healthy eating.

The causes of peptic ulcer disease are usually divided into predisposing and implementing. Predisposing causes include genetic factors. Some people have a genetically determined increased number of stomach cells that produce hydrochloric acid. As a result, the person suffers from increased acidity. In addition, there are other genetic characteristics that influence the development of peptic ulcers. There are also studies that suggest that peptic ulcers are more common in people who have first blood group .

An important factor is certain features of the neuropsychic state. Those who suffer from impaired functioning are more susceptible to illness autonomic nervous system .

The nutritional factor is also taken into account. The development of peptic ulcers can be facilitated by constant consumption of spicy foods, irregular meals, and the lack of nutritious hot meals in the diet. But to this day, there is no exact evidence of the direct impact of this factor on the manifestation of peptic ulcer disease.

Stomach ulcers can also be caused by long-term treatment with certain drugs. medications. These drugs include: non-steroidal drugs with anti-inflammatory effects , synthetic adrenal cortex . Taking these drugs can negatively affect the condition of the mucous membrane of the stomach and duodenum. In addition, they activate the aggression of gastric juice and at the same time reduce the protective function. If a person suffers from a chronic ulcer, then these drugs can provoke an exacerbation of the disease.

Availability bad habits can also lead to manifestations of peptic ulcer disease. Strong alcoholic drinks can damage the mucous membrane, and alcohol also increases secretion in the stomach. If alcohol is consumed regularly and for a long period, a person may develop chronic .

Smoking is no less dangerous, since nicotine, like alcohol, increases gastric secretion. At the same time, the blood supply to the stomach deteriorates. But, like the food factor, this reason is still not considered proven.

The underlying cause of gastric and duodenal ulcers is determined by the presence of Helicobacter pylori infection . Infection can occur from eating dirty food or from using poorly sterilized medical instruments.
Helicobacter pylori produces cytotoxins - substances that damage mucosal cells, which can ultimately cause the development of erosion and gastric ulcers. Even if these substances are not produced by Helicobacter, a person develops chronic gastritis.

Symptoms of peptic ulcer

Basically, peptic ulcer of the duodenum and stomach is manifested primarily by pain in the upper abdomen (that is, “in the pit of the stomach”). Most often, the pain becomes intense when a person feels hungry, it mainly manifests itself between meals. Sometimes attacks of pain bother the patient at night. During such attacks, a person has to get up to take medicine or food. In such a situation, help is provided by those drugs that reduce the secretion of hydrochloric acid in the stomach or completely neutralize it. As a rule, about half an hour after eating or the indicated medicines the pain becomes less intense and gradually subsides. In addition, symptoms of a peptic ulcer may include periodic nausea, a feeling of severe fullness in the stomach and a feeling of severe heaviness in it immediately after eating. In more rare cases, the patient suffers from bouts of vomiting, after which a feeling of relief appears. Sometimes a person experiences a noticeable decrease in body weight due to loss of appetite.

In general, the manifestation of symptoms of the disease and its overall clinical picture directly depend on where exactly the pathological process is localized and what stage of the disease occurs.

The first stage is considered to be a condition in which a fresh ulcer of the duodenum or stomach forms. In this case, the main symptom is the manifestation of pain in the epigastric region, which becomes more severe if the person is hungry, and can also appear several hours after the person has eaten. It is at this stage that night pain and severe symptoms appear. dyspeptic syndrome (belching , constipation , nausea ). The patient notes pain on palpation of the abdomen.

The second stage of the disease is the period of initial epithelization of the ulcerative defect. Pain in the epigastric region at this stage occurs mainly during the day. After eating, a person feels noticeable relief. During this period, dyspeptic manifestations are much less pronounced.

The third stage is the period of ulcer healing. At this time, the patient may feel pain exclusively during the manifestation of a feeling of hunger, while no dyspeptic manifestations are observed.

At the fourth stage of the disease, which is remission, the person feels relatively normal and does not express complaints. There is no pain on palpation of the abdomen.

Diagnosis of peptic ulcer

To establish the correct diagnosis, the doctor must familiarize himself with the medical history in order to study the evolution of the disease. When collecting anamnesis, it is important to take into account information about whether the patient has a digestive disorder. Sometimes an ulcer occurs without any visible symptoms, in which case signs of the disease are detected only when a complication of the disease appears.

During the diagnosis process, the patient is also examined. This takes into account whether the person’s body weight is reduced or whether there is pain in the epigastric region.

After this, a variety of paraclinical research methods are used. The simplest test is an x-ray, which can also be used to detect certain complications of the disease.

But if the patient has signs of complications of a peptic ulcer, then he undergoes a radiographic examination without contrast, fibrogastroduodenoscopy. To rule out cancer, histological analysis is performed on samples that are collected.

Sometimes it is advisable to diagnostic laparoscopy, which sometimes turns into laparotomy. As a result, an operation can be performed to eliminate the causes of ulcer complications.

During the diagnostic process, it is also important to determine the presence of Helicobacter pylori infection in the body. For this purpose, a special study of the patient’s blood is performed. When making a diagnosis, it is necessary to differentiate an ulcer from other ailments.

Treatment of peptic ulcer

It is important that the treatment of gastric and duodenal ulcers is carried out comprehensively and in certain stages. At the stage of exacerbation of the disease, its therapy is necessarily carried out in a hospital. Treatment begins immediately after diagnosis. Initially, the patient must adhere to bed rest for several days and strictly adhere to the principles. Complex therapy includes treatment with non-absorbable antacids , antisecretory drugsAnd . In addition, with the help of certain drugs (used, metoclopramide , hydrochloride , ) hypermotor dyskinesia in the gastroduodenal zone is eliminated. If Helicobacter pylori is detected in a patient, a special three-component therapy method is used, which lasts several weeks.

At the second stage, periodic anti-relapse therapy is carried out, a diet is followed, and treatment is performed. vitamin complexes .

At the third stage, it is advisable to conduct a course of sanatorium treatment, which is prescribed to the patient approximately four months after hospital therapy.

When treating peptic ulcers, it is important to adhere to some general principles that are extremely important for recovery. First of all, it is important for the patient to completely quit smoking. This step will contribute to more active scarring of ulcers and reduce the number of exacerbations. You should also reduce your consumption to a minimum. alcoholic drinks. If possible, it is recommended to avoid the use of non-steroidal anti-inflammatory drugs and steroids. If this is not possible, then the dose of the drug should be reduced as much as possible.

It is necessary to adhere to the principles of dietary nutrition. can significantly reduce the frequency of attacks of the disease. It is most important not to eat those foods that make the symptoms of peptic ulcers more intense.

In the treatment of peptic ulcers, herbal medicine has a fairly effective effect. Some herbal decoctions and infusions provide reliable protection to the mucous membrane, having an astringent and enveloping effect. In addition, they eliminate pain, promote faster tissue healing, and have an anti-inflammatory effect.

When compiling a collection of herbs for the treatment of peptic ulcers, you should definitely take into account the acidity level of a particular patient. In the treatment of ulcers, infusions of chamomile, calamus roots, licorice, bergenia, marshmallow, fennel fruit, and plantain leaves are used. Treatment with a decoction of St. John's wort, valerian root, chicory, etc. is also effective. A decoction of flax seeds has an effective enveloping effect on the mucous membrane of the stomach and duodenum. Herbal decoctions must be taken several times every day. The general course of treatment lasts at least two months.

Doctors

Medicines

Diet, nutrition for peptic ulcers

To this day, doctors claim that proper nutrition for peptic ulcer disease contributes to a more active cure. It is important that patients, especially those whose ulcers last a long time, take this point into account and adhere to the rules of a healthy diet during peptic ulcer disease. Due to the fact that the main damage, both in the stomach and in the duodenum, appears under the influence of hydrochloric acid, it is imperative to reduce the amount of foods in the diet that stimulate the secretion of gastric juice. If possible, it is better not to use them at all. Dietary food must necessarily contain sufficient quantity proteins, fats, vitamins. It is advisable to eat foods that weakly stimulate gastric secretion. These are milk and vegetable soups, boiled fish, and well-cooked meat. It is also recommended to include dairy products, eggs, day-old white bread, porridge with milk, and weak tea in the menu. At the same time, alcoholic and carbonated drinks, canned food, all spicy foods, strong tea and coffee, rich broths from meat, fish, and mushrooms greatly stimulate secretion in the stomach. Therefore, nutrition for peptic ulcer disease should not include these foods and drinks. In addition, those products that irritate the mucous membrane mechanically are also undesirable to consume. We are talking about radishes, turnips, asparagus, legumes, as well as unripe fruits and fruits with too hard skins. You should also not eat dishes made from products that contain coarse connective tissue - too stringy meat, skin, cartilage.

Prevention of peptic ulcers

Most often, the manifestation of peptic ulcer in humans is observed in autumn or spring. In order to avoid exacerbations, as well as completely prevent the manifestation of peptic ulcer disease, you should definitely ensure proper sleep - at least 6-8 hours a day, and do not eat fried, smoked and fatty foods too often. At the first symptoms of a gastrointestinal disease, you should undergo a full examination by visiting a specialist. It is equally important to carefully monitor the health of your teeth and avoid nervous strain. The disease can be triggered by drinking alcohol and smoking, so it is important to get rid of such bad habits in time. In general, a healthy and active lifestyle and the right attitude towards one’s own health are important for the prevention of peptic ulcer disease.

Complications of peptic ulcer

There is evidence from experts that complications of gastric and duodenal ulcers are more common in males. The most common complication of the disease is considered. Bleeding develops much more often in people with duodenal ulcers.

If the ulcer gradually enlarges, it may eventually expose the vessel wall, which is subsequently destroyed by the acid. After this, internal bleeding appears. Depending on the amount of blood loss, the patient exhibits certain symptoms. But the main signs of bleeding are a feeling of sudden severe weakness, fainting, vomiting, in which scarlet or coagulated blood is released, a sharp decrease in blood pressure. When a patient bleeds, the stool will be liquid and tarry.

It is important to note that bleeding can only be treated in the surgical department of a hospital. To determine exactly where the source of bleeding is located, the patient undergoes a gastroscopic examination. At the time of gastroscopy, the blood is stopped using specially prepared solutions. Also, a vessel that is bleeding can be stitched with paper clips specially used for this purpose. The patient is given intravenous medications that reduce the production of hydrochloric acid.

Even after the bleeding has stopped, the patient is advised to remain in the hospital for several more days under the close supervision of a doctor. If stopping the bleeding is impossible without surgery, the patient undergoes surgery, the type of which is determined by a specialist individually.

When a stomach ulcer develops, there is a risk of ulcer perforation . For this condition, which is also called perforation of the ulcer , characterized by the appearance of a through hole in the wall of the organ affected by the ulcer. Due to the formation of such an opening, part of the contents of the duodenum or stomach ends up in the abdominal cavity. As a result, development occurs peritonitis .

With this complication of the disease, the patient feels acute pain in the epigastric region. These sensations can be compared in intensity to a knife blow to the stomach. The pain is so severe that it threatens to develop a state of shock. Then the pain gradually spreads to one of the lateral sections of the abdomen. In this case, due to such strong pain, a person turns pale, becomes covered in sweat, and his consciousness may become clouded. During such an acute attack, he is forced to remain in a motionless lying position - the so-called “embryo” position. His body temperature rises and his tongue becomes dry.

This condition manifests itself in the patient in three stages: shock initially sets in, followed by a period of imaginary well-being, after which progressive peritonitis develops. Another distinctive symptom of this condition is the tense state of the muscles of the anterior abdominal wall.

Ulcer perforation occurs as a consequence of the progression of peptic ulcer disease. More often, perforation is diagnosed in men of working age. It is very important to promptly hospitalize a patient with such a complication, since without surgery the patient is at risk of death. It is impossible to cure the perforation without surgery.

There are also cases of covered perforated ulcer, in which after perforation, after about one hour, the hole is covered by an organ located nearby. But, as a rule, the hole is not tightly covered, so peritonitis still develops.

Its one complication of peptic ulcer is ulcer penetration . With this condition, a hole also appears in the wall of the duodenum or stomach. But at the same time, such a hole will not open into the abdominal cavity, but into those organs that are located nearby. Symptoms of such a complication appear in the patient depending on which organ in question.

However, there are also characteristic general symptoms. In particular, this is severe pain, which only becomes more intense over time and appears constantly. Such pain cannot be relieved with drugs - antacids . An increase in body temperature is characteristic. This pathology can only be treated surgically.

At stenosis of the pylorus and duodenum (this condition is also called obstruction of the pyloric stomach ) food from the stomach enters the intestines with significant difficulties, which arise as a consequence of scarring of the ulcer, which developed either in the initial part of the duodenum or in the final part of the stomach. If such a narrowing is insignificant, then it can be expressed by a feeling of heaviness for some time after consuming food. Periodically, the patient may experience vomiting, after which he notices relief. If stenosis develops further, then some of the food is already retained in the stomach, which, in turn, stretches. The person notes a putrid odor from the mouth, a constant urge to vomit, and severe pain in the abdomen. After some time, the disturbance in the digestive process progresses, and the person becomes noticeably exhausted, his body becomes dehydrated.

List of sources

V.T.Ivashkin. Recommendations for the diagnosis and treatment of peptic ulcer disease. A manual for doctors. - M.: 2002;
I.I. Dyagtereva. Clinical gastroenterology: a guide for doctors. - M.: MIA, 2004;
Ivashkin V.T., Lapina T.L. Gastroenterology: national guidelines. Moscow: GEOTAR-Media, 2008;
Isakov V. A., Domaradsky I. V. Helicobacteriosis. M.; 2003;
Grigoriev P.Ya., Yakovenko E.P. Diagnosis and treatment of diseases of the digestive system. - M.: Medicine, 1996.

Duodenal ulcer (DU) is a chronic disease and is characterized by the formation of an ulcerative defect on the mucous membrane of the organ. The course of the disease is undulating with periods of remission, when there are practically no symptoms, and periods of exacerbation. Most often, duodenal ulcer is diagnosed simultaneously with a gastric ulcer - in this case we are talking about a combined pathology.

Classification

In medicine, it is customary to classify duodenal ulcers into several types. All of them have their own characteristics and must be subject to individually selected treatment.

By frequency of exacerbations:

duodenal ulcer with rare exacerbations - the manifestation of acute symptoms occurs no more than once every two years;
duodenal ulcer with frequent manifestations - exacerbation occurs at least once a year.

According to the number of ulcers formed on the duodenal mucosa:

single;
multiple.

According to the location of the defective formation:

in the expanded part of the duodenum - the bulbous section;
in the post-bulb section.

According to the depth of damage to the duodenal wall:

deep ulcers;
superficial.

According to the state of the defective formation itself:

stage of active exacerbation;
remission stage;
scarring stage.

There are also differences in the types of duodenal ulcer, depending on the cause of the pathology:

hormonal ulcers - the disease developed due to long-term use medicines;
shock ulcers - a defective formation occurred against the background of bruises, burns and any injuries;
stress ulcers – develop against the background of stress, depression, and strong psycho-emotional experiences.

Causes of development of duodenal ulcer

The main cause of the development of the disease in question is Helicobacter pylori - pathogens that provoke the development of stomach ulcers. When a stomach ulcer lasts for a long time, bacteria inevitably reach the mucous membrane of the duodenum and an ulcer begins to form there. There are several factors that most often provoke the onset of development of duodenal ulcer, although this is not necessary. These include:

chronic fatigue, stress, constant irritation, depression, disturbances in the psycho-emotional background;
predisposition at the genetic level;
increased acidity of gastric juice - it enters the duodenum and irritates the mucous membrane;
inflammatory process in the duodenum, which is chronic in nature - duodenitis;
a significant decrease in immunity against the background of any other pathologies;
long-term use of certain medications - for example, steroidal anti-inflammatory/non-steroidal anti-inflammatory, antibacterial agents;
violation of the diet.

Symptoms of duodenal ulcer

If the disease is in remission, then nothing bothers the patient, he leads his usual lifestyle. In case of exacerbation of duodenal ulcer, the following symptoms can be expected:

. This is the most striking and constant sign of the disease in question. The pain is localized slightly above the navel, and can radiate to the scapula and heart area - this leads to a false diagnosis. The pain is intermittent and most often occurs in the evenings or at night - so-called “hunger” pain. The time for pain to develop is 2-3 hours after eating. The greatest intensity of the pain syndrome manifests itself when the diet is violated, taking medications, or drinking alcohol.
Heartburn and belching. They will not be too intense - many patients do not pay attention to these symptoms at all.
Bloating and nausea. The patient complains of too much fullness in the abdomen, when even the most powerful drugs do not reduce flatulence. Nausea is not present all the time, but only after eating.
Vomit. It immediately brings relief to the patient - the feeling of bloating disappears and the pain goes away. Some patients voluntarily induce vomiting.
Digestive system disorders. We are talking about constipation - the act of defecation may be quite absent long time, up to a week. Often an admixture of blood and thick mucus is found in the stool.
Psycho-emotional disorders– the person becomes irritable and is bothered by insomnia.
Weight loss. This symptom is present in any case, despite the patient’s excellent appetite.

Duodenal ulcer is characterized by precise seasonality - in the summer and winter months there are no manifestations of this pathology at all, but the peak of doctor visits for the above symptoms occurs in spring and autumn.

Diagnosis of duodenal ulcer

Despite the severity of the symptoms, the diagnosis of the disease in question should be carried out by a doctor. As part of diagnostic measures, the following procedures are carried out:

History of the disease. The patient is asked how often pain occurs, what it may be associated with (for example, food or physical activity), which helps relieve pain.
Life history. It is imperative to find out what pathologies were diagnosed earlier, whether any of the relatives suffered from duodenal ulcer, and whether the patient has duodenitis.
Laboratory research:
- general blood and urine tests;
- stool analysis;
- biochemical blood test;
- analysis of gastric juice - the level of acidity is determined.
Instrumental studies:
- the patient must undergo FEGDS - this helps the doctor to see the condition of the mucous membrane of the duodenum and stomach, to take a small fragment of the mucous membrane for study from a histological point of view (the nature of the defective formation is determined - malignant/benign);
- Ultrasound examination of the abdominal organs.

Treatment of duodenal ulcer

Treatment of the disease in question will be long-term, and the patient will have to follow a gentle diet throughout his life. Although not everything is so sad - doctors warn about the possibility of creating a zigzag diet: during periods of exacerbation, nutrition is limited as much as possible and represents the most gentle diet, and during long-term remission it is allowed to eat even harmful foods.

Diet for duodenal ulcers

If you have a diagnosed duodenal ulcer, you should know which foods increase the concentration of hydrochloric acid in the stomach:

carbonated and alcoholic drinks;
hot seasonings, spices and any, even quite spicy, sauces;
fried food (even vegetables and fish);
coffee and strong tea;
meat, fish and mushroom soups with primary broth (rich);
black bread and pastry.

The listed products should be removed from the diet not only during periods of exacerbation, but even during long-term remission. Preference should be given to:

milk and vegetable soups;
boiled meat and low-fat fish;
stale white bread;
cereal porridge.

The mucous membrane of both the stomach and duodenum is irritated by vegetables with indigestible fiber - white cabbage, radishes, radishes, asparagus, beans, peas, corn. Meat cartilage, fruits with hard skin and too dense pulp, and baked goods made from wholemeal flour can cause great harm.

Patients diagnosed with a duodenal ulcer need to remember a few important rules dietary nutrition:

In case of exacerbation of duodenal ulcer, doctors prescribe the most gentle diet possible - the diet includes only ground porridge, meat soufflés and steamed meatballs/cutlets, steamed fish. Vegetables and fruits are excluded during this period, and it is better to drink rosehip decoction as a drink.

Duodenal ulcer: treatment with medications

Patients with duodenal ulcers most often take medications during periods of exacerbation. Medicines include:

The duration of treatment for exacerbation of duodenal ulcer is 2-5 weeks, most often during this time patients are in the hospital. If the patient complains of severe pain, he may be prescribed antispasmodics (for example, no-spa), and in case of prolonged constipation, laxatives or an enema.

Traditional treatment of duodenal ulcer

Traditional medicine has several recipes that significantly alleviate the patient’s condition even during periods of exacerbation of duodenal ulcer. But it is important to understand that they are not a panacea and cannot guarantee that the pathology will enter a stage of remission or complete recovery.

Important:Before using any traditional medicine, you should consult your doctor.

Traditional medicine used in the treatment of duodenal ulcers:

Possible complications

Typically, the prognosis for the development of duodenal ulcer is favorable - it can not only be put into long-term remission, but also brought to the stage of scarring. If medical care was not found for the disease in question, this leads to serious consequences:

bleeding from the duodenum - characterized by “coffee grounds” vomiting, very dark and tarry stool, loss of consciousness;
perforation of an ulcer (rupture of the wall of the duodenum at the location of the ulcer) - characterized by acute dagger pain, nausea, vomiting and tense abdominal muscles;
peritonitis – inflammation of the peritoneum as a result of perforation of an ulcer;
development of chronic duodenitis (inflammatory process in the duodenum);
cicatricial narrowing of the duodenum;
malignancy - the growth of a malignant tumor in the intestine.

Duodenal ulcer is considered a fairly frequently diagnosed disease. Pathology requires extremely careful attention to yourself, because even a short-term violation of the diet, and even during periods of exacerbation, can lead to the rapid development of complications. But perforation of an ulcer, growth of a malignant tumor and bleeding from the duodenum can lead to death.

The duodenum is the part of the small intestine that follows immediately after the pylorus. The wall of the duodenum is called duodenum in Latin and consists of several layers: mucous, submucosal and muscular. It is the destruction of the mucous and submucosal layer that is called an ulcer. That is, a duodenal ulcer is a disease where the wall of the duodenum is affected by the formation of a defect (that is, an ulcer), and subsequently a scar is formed.

This type of ulcer is chronic and recurrent. Its distinctive feature is the presence of moments of exacerbation, as well as remission. Typically, exacerbation occurs in spring or autumn.

According to statistics, approximately 5% of the population is affected by this disease.

The main risk group is men from 25 to 50 years old. They develop the disease approximately 6 times more often than women. In children, duodenal ulcers are quite rare, affecting about 1%.

There is currently no consensus on the reasons that cause duodenal ulcers. There are several theories that describe various factors influencing the occurrence of this disease.

For a time, it was quite common to believe that ulcers were caused by the bacterium Helicobacter pylori, which appeared in the stomach. The microbe infects cells that secrete mucus using cytokines (substances that harm cells). Helicobacter pylori quite actively colonizes the stomach and intestines, thereby provoking the development of gastritis and ulcers.
There is also an assumption that aggressive substances in the form of pepsin, as well as stomach acid, cause ulcers if the mucous membrane is not able to defend itself.
In the USSR, it was believed that ulcers occur in those with chronic nervous diseases that irritate the cerebral cortex.
Taking certain medications can cause ulcers. Among them are corticosteroids and non-steroidal inflammatory drugs.
Alcohol and nicotine have a serious irritating effect on the walls of the stomach. They reduce the protective characteristics of mucus and change the secretion of pepsin along with hydrochloric acid.
One of the most common theories for the occurrence of ulcers is a violation of the diet. This means the use junk food, irregular meals, overeating.
There has been a correlation between a person’s blood type and the occurrence of ulcers. Scientists say that most often ulcers occur in carriers of the first blood group with a positive Rh factor.
Prolonged exposure to the sun causes the production of the hormone gastrin, which provokes the occurrence of ulcers.

Symptoms

Symptoms of this type of ulcer usually appear during an exacerbation of the disease, which occurs most often in the spring or autumn seasons.

Among them:

pain - can be stabbing, cutting, radiating under the ribs on the right side or in the back. It usually appears about a couple of hours after you eat, as food causes the secretion of juice in the stomach, which irritates the damaged mucous membrane. Nighttime ailments are common. In addition, there are hunger pains that subside after eating;
dyspeptic disorders - occur infrequently, but still occur. Among them: vomiting and the urge to vomit, nausea, heartburn, bloating, constipation;
lack of appetite – occurs due to dyspeptic disorders. Lead to weight loss and sudden weight loss.

It should be remembered that sometimes an ulcer manifests itself only as dyspeptic disorders, and there is no pain.

Complications

An ulcer is a fairly serious disease that can cause complications if left untreated. Among the complications:

bleeding - can open when a vessel located next to the ulcer is corroded. At the same time, blood appears in the stool, the stool itself becomes dark in color, and vomiting appears. Symptoms also include weakness, dizziness, fainting;
perforation is a perforation or the formation of a through hole in the gastric wall. The aggressive contents of the duodenum penetrate into the stomach, and the disease process is accompanied by peritonitis. Acute pain appears in the abdominal area, which can radiate either to the right shoulder or to the shoulder blade, and the skin turns pale. After some time, the condition improves, but if the operation is not performed within 12 hours, the patient’s condition will deteriorate greatly;
penetration is a complication when the ulcer penetrates directly into the pancreas, which most often appears on back wall intestines. This complication usually occurs along with acute pancreatitis, which is manifested by pain in the pit of the stomach, but can also manifest itself as girdle-type pain in cases where the inflammation is quite extensive. In addition, nausea, bilious vomiting, sticky sweat, belching, and a coating appears on the tongue. The skin becomes pale and even bluish. Temperature and blood pressure rise;
duodenal stenosis is a decrease in the lumen of the intestine, which appears due to ulcerative scars. Symptoms will be vomiting, problems with the passage of food, stretching of the stomach walls. In addition, weakness and drowsiness appear due to an imbalance of water and salt. When there is too much scarring, it leads to intestinal obstruction;
malignancy is the appearance of a tumor at the site of ulcer formation;
periduodenitis is an inflammation of the serous covering in the duodenum. In this case, the symptoms will be pain under the right ribs, in the epigastric zone. Sometimes there is a feeling of fullness in the upper abdomen.

Diagnostics

Diagnosis can be made by collecting information, that is, anamnesis. It is necessary to find out the nature of the pain, hereditary predisposition, associate seasonality with the disease, localization, determine chronic gastritis, as well as a history of duodenitis. The most accurate determination can be made using the following methods:

pH-metry is a technique for detecting the acidity of juice in the stomach. It identifies an important cause of ulcers due to excessive secretion of hydrochloric acid.
Determination of antibodies to Helicobacter pylori in the patient’s blood.
An x-ray of the duodenum helps identify typical signs of an ulcer. Among them: niche symptom, ulcerative shaft, cicatricial-ulcerative deformity, identification of various complications, index finger symptom.
Endoscopy or fibrogastroduodenoscopy is an examination of the mucous membrane with a fibrogastroduodenoscope. This method helps determine the location of the ulcer, its size, and the complications it causes.
Microscopic examination is carried out after fibrogastroduodenoscopy, where a biopsy of the mucous membrane is taken from the patient. It allows you to determine the presence of Helicobacter pylori microbes.

In addition, the patient is prescribed a biochemical blood test, as well as a stool test for the Gregersen reaction.

Treatment

If you experience symptoms of an ulcer, consult your doctor immediately. This will help avoid complications, which are much more difficult to treat. An individual treatment plan is selected for each patient, usually lasting two weeks.

Drug treatment

Group of drugs	Name	Purpose
Antibiotics: macrolides, penicillins, nitroimidazoles	Clarithromycin, Ampiox, Metronidazole	Used to get rid of Helicobacter pylori
Antacids	Almagel, Maalox, Almagel A	Medicines that relieve stomach pain and envelop the intestinal walls
Bismuth preparations, H2 inhibitors, proton pump inhibitors	De-nol, Ranitidine, Omeprazole	Preparations to eliminate pain by reducing hydrochloric acid

Surgical treatment

Surgery for this type of ulcer is rarely used. More often it is necessary if serious complications have already appeared. The operation consists of truncation of the part of the intestine that has been affected.

Remember that self-medication is not only harmful, but also dangerous.

Sometimes, after taking the drug, the pain goes away and the patient feels much better, but it is at this time that a serious complication can develop, which leads to serious consequences and can only be eliminated through surgery.

Diet

Diet is an integral element of ulcer treatment. All patients must follow a certain diet. Food should be coarse, finely chopped, normal temperature. You cannot add salt, spices, large amounts of oil and fat to it. For patients with ulcers, five meals a day are provided in small portions. At the same time, the daily calorie content should not exceed 2000 calories.

The best option would be boiled or steamed food.

Useful liquids include hydrocarbonate waters (for example, Borjomi or Essentuki No4), soothing teas (for example, mint, lemon balm).

dairy products - these include low-fat cottage cheese, milk, low-fat sour cream, kefir;
lean meat - chicken, rabbit, turkey, veal;
low-fat fish - perch, pike perch, pollock, cod;
cereals – buckwheat, oatmeal, rice and others;
vegetables (potatoes, zucchini, beets);
fruits;
dried bread or crackers;
light soups based on vegetables;
dishes made with vegetable fat (sunflower, olive oil).

The following types of products should not be consumed:

fatty meat - pork, lamb;
smoked products;
spicy dishes;
salt dishes;
fried food;
canned food;
fruits and vegetables that increase acidity (citrus fruits, tomatoes);
fermented dishes and pickles (cabbage, pickles);
muffins and rye bread;
sweet soda, coffee.

Chewing gum has a harsh effect negative influence on the condition of the ulcer, so its use should be avoided.

Video - Peptic ulcer of the stomach and duodenum

Prevention

Prevention is aimed at two main goals: preventing infection with Helicobacter pylori bacteria that cause ulcers, and normalizing the secretion of hydrochloric acid. To achieve the second goal, you need to give up or limit your intake of alcohol and cigarettes, monitor your emotional health, avoiding nervous breakdowns or depression, and monitor your diet. To avoid contracting Helicobacter pylori infection, you need to use only clean cutlery, do not drink from someone else’s mug and do not take other people’s cutlery, even in the family. If there is gastritis or duodenitis, it is necessary to treat them in a timely manner, avoiding complications.