Treatment of stomach and duodenal ulcers. Assortment of medicines for stomach and duodenal ulcers. Causes of duodenal ulcer formation

Stomach and duodenal ulcers - this is a wound, ulceration, i.e. deep defect in the wall of the duodenum or stomach. The ulcer can reach the deep layers (can penetrate into the muscle layer and even deeper) of the wall of the duodenum and stomach; it is often complicated by bleeding, as well as perforation of the walls of the duodenum and stomach, which is fraught with serious consequences.

In most cases, peptic ulcer disease occurs against the background of existing gastritis (gastroduodenitis), which, like peptic ulcer disease, develops due to exposure to the bacterium Helicobacter pylori (Helicobacter pylori).

If a person gets gastritis, cracks (so-called erosions) form on the surface of the mucous membrane of his stomach. If appropriate treatment has not been carried out, they deepen and reach the muscular layer of the stomach, after which they turn into ulcers.

The main symptom of peptic ulcer the same as with gastritis - pain in the epigastric region on the left side. With a peptic ulcer, they differ in frequency - they can fade and appear again (the so-called relapse, or exacerbation of a peptic ulcer). In most cases The appearance of peptic ulcer symptoms depends on the time of year: more often it worsens in autumn and spring. This is what distinguishes it from gastritis, which is not seasonal, and the occurrence of discomfort in the stomach with it is associated mainly with the quality of food consumed and diet. At the same time, it is possible to find out for certain what the patient is sick with - gastritis or peptic ulcer, and a diagnosis can be made only after the FGDS procedure - fibrogastroduodenoscopy.

Causes of peptic ulcer

Main role The bacteria Helicobacter pylori play a role in the appearance of peptic ulcers, as well as taking them for a long time ( 30 days) in a standard dosage of nonspecific anti-inflammatory drugs (for example, aspirin), cytostatics and corticosteroids (prednisolone). They damage the mucous membrane of the duodenum and stomach, reduce the protective factors of the mucous membrane and increase the factors of aggression (increase the content of hydrochloric acid, disrupt gastric motility).

Risk factors represent only the background that prepares the necessary soil for the development of all kinds of diseases. These factors have Negative influence on the course of the disease, often leading to relapses.

Factors that can be influenced (modifying):
Disturbed nutrition.
Drinking alcohol, smoking.
Neuropsychic factors. Gastric motility and gastric secretion are related to the condition nervous system. U 50-60 % Patients experience neuroses and depression.

Factors that cannot be influenced (non-modifying):
Gender and age of the patient.
Genetic predisposition.

Among all patients diagnosed "peptic ulcer" The ratio of men to women is 4 to 1. There are versions that the female body is protected from the appearance of ulcers by sex hormones. The ratio evens out in women who have reached menopause. Young people are characterized by the appearance of peptic ulcers of the duodenum, and representatives of the older generation - gastric ulcers.

Main symptoms and signs of duodenal and gastric ulcers

The main signs of the disease are these are painful sensations and dyspeptic syndrome (sour belching, heartburn, vomiting and nausea).

Pain appears in the upper abdomen, in the navel area. The pain is bursting, paroxysmal, burning in nature, characteristic of the so-called. hunger pains (occurring on an empty stomach) or those that appear later 2-3 hours after eating (typical for patients with duodenal ulcers), subside after eating. In patients diagnosed with a gastric ulcer, pain manifests itself through 30 minutes - 1 an hour after eating. Patients often complain of pain at night.

Due to the fact that the contents of the stomach are thrown into the esophagus, heartburn occurs, which is characterized by a burning sensation behind the sternum. It may appear after eating.

Vomiting and nausea occur due to increased tone of the vagus nerve, increased hypersecretion of hydrochloric acid and gastric motility. Vomiting occurs at the moment when the pain is most pronounced. After vomiting, a feeling of relief comes, the pain noticeably decreases or disappears altogether.

A large number of patients suffer from constipation.

If the disease lasts for a long enough time, emotional lability and asthenia develop (insomnia, malaise, weakness). Body weight may decrease, which is explained by restrictions on food intake that the patient sets for fear of pain.

Over the past ten years, the symptoms of peptic ulcer disease have undergone changes. A large number of atypical and asymptomatic varieties of ulcers have emerged. The localization of pain is often characteristic of the right hypochondrium, in the projection of the gallbladder; pain can appear in the lumbar region, they resemble renal pathology (urolithiasis, pyelonephritis), behind the sternum, in the region of the heart, as in heart diseases (myocardial infarction, angina pectoris). In some cases, the disease may manifest itself without pain, only heartburn. IN 10 cases from 100 the disease does not show clinical symptoms, they appear only when complications arise.

The reason for immediately contacting a doctor - a gastroenterologist or therapist - to undergo an examination in order to prevent complications and the emergence of concomitant diseases is: the appearance of severe weakness, diarrhea, frequent cases of vomiting, the presence of blood impurities in the stool.

What is the danger of peptic ulcer disease? What are its complications?

Peptic ulcer is an extremely dangerous disease.

The main danger of such a disease is its complications:
The most dangerous and common complication of peptic ulcer disease is bleeding. It develops due to the corrosion of the walls of the arteries, which are located in the ulcerative bottom, by gastric juice. Bleeding can be either heavy or light (hidden). If a patient has severe stomach bleeding from an ulcer, he will vomit dark blood, the color of which resembles coffee grounds. Another option is that the patient develops melena (tarry, black stool), which is formed as a result of blood entering further through the intestines. Cases of bleeding from a duodenal ulcer are five times more common than bleeding from a gastric ulcer.
Pilostenosis, pyloric stenosis – This is a blockage (stenosis, obstruction) of the outlet of the stomach. Conventionally, the stomach can be divided into several parts: the very top of the stomach - the bottom, the body of the stomach and the narrow exit from it - the pyloric (or antrum) section. When the ulcer is localized in the area of the inlet, deformation and inflammation of this area cause blocking of the outlet, as a result of which it becomes impossible for the contents of the stomach to move further through the intestine. The main symptoms of pyloric stenosis are nausea, which progresses over time, vomiting, a feeling of fullness, belching after eating, and bloating. In such a situation it is recommended planned surgical intervention.
Perforation (perforation) of the ulcer. When the ulcer becomes very deep, it can cause the stomach or duodenal wall to rupture into the peritoneal cavity. The main concomitant of perforation of an ulcer is unbearable pain in the abdomen (“dagger-like”). A patient with a perforation must be hospitalized urgently, as it can lead to an inflammatory process in the peritoneum (peritonitis). Acute bleeding and perforated ulcer require urgent surgical intervention.
Repeated exacerbation (relapse) of peptic ulcer. Ulcers belong to the group of chronic diseases and has a high tendency to relapse. The occurrence of exacerbations is facilitated by factors such as drinking alcohol, aspirin and other nonspecific anti-inflammatory drugs, and smoking.
Cancer of the duodenum and stomach. The causative agent of peptic ulcer Helicobacter pylori secretes a number of substances, the so-called. carcinogens that trigger the formation of a tumor in the affected area and the transformation of an ulcer into cancer. With duodenal ulcers, cancer almost never occurs.

In most cases, existing stomach cancer may be indicated by symptoms such as changes in the sense of smell and taste, and a feeling of disgust for certain food groups (usually meat products).

Diagnosis of peptic ulcer

Detection of peptic ulcer disease is based on several basic studies that are aimed at determining the location, size and other characteristics of the ulcer, and also includes tests for intestinal acidity and Helictobacter. A special diagnostic method - FGDS (fibrogastroduodenoscopy) - involves a doctor examining the mucous membrane of the stomach and duodenum using a probe that is inserted into the stomach through the esophagus.

This method helps to distinguish gastritis (or gastroduodenitis, which is a superficial inflammation of the mucous membrane of the duodenum and stomach) from an ulcer, which, as a rule, appears to be small sizes(up to several centimeters in diameter) is a rounded formation, at the edges of which there is an elevation, indicating intense inflammation (inflammatory shaft). When performing FGDS, in many cases tissue scrapings are performed from suspicious areas, which are then checked under a microscope for the presence of the causative agent of peptic ulcer disease - Helicobacter pylori.

Two main methods are used to detect helicobacteriosis:
identification of microbes in scrapings of the gastric mucosa using a microscope,
determination of antibodies against Helicobacter pylori in the patient's serum.

It is necessary to diagnose helicobacteriosis in order to determine the composition of the treatment and monitor the success of the therapy.

During fibrogastroduodenoscopy, pH measurements are performed to determine the acidity of the stomach. Such money is needed in order to choose the right course of treatment.

Treatment of peptic ulcer

The main components of the treatment of peptic ulcer:
treatment aimed at eliminating Helicobacter pylori infection,
treatment aimed at reducing stomach acidity and stimulating ulcer healing,
dieting.

If you have a stomach ulcer, it is necessary to exclude from your diet coffee, alcoholic beverages, too hot or cold foods, fried, spicy, rough, salty foods (for example, rough meat, mushrooms). Meals should be frequent (every four hours), and you should eat small portions. It is allowed to eat vegetable soups and vegetable purees, milk and dairy products, yoghurts, cereals, and eggs. In addition, to speed up the healing process of ulcers, you need to eat foods that contain proteins and vitamins. In the past, patients were fed exclusively by prescription, but modern stage development of medicine has established that a sufficient measure is to exclude irritating factors.

Treatment of peptic ulcers with medications is carried out according to standard regimens, which include bismuth preparations, antibiotics, proton pump inhibitors ( pantoprazole, omeprazole, esomeprazole, rabeprazole). Only a specialist - a gastroenterologist or therapist - can choose a treatment regimen, its duration and dosage of drugs.

Surgical treatment of ulcers (surgery for ulcers)

In a number of emergency cases, such as perforation of an ulcer, severe gastrointestinal bleeding, obstruction of the pyloric canal, resort to surgical treatment. IN in this case two types of operations are performed:
gastric resection – this is deletion 2/3 the stomach and the connection of its remaining part with the intestines;
vagotomy – intersection of nerves that stimulate gastric secretion and lead to relapses of peptic ulcer.

Often, when performing resection, a vagotomy is also performed.

For peptic ulcers, surgical intervention is indicated only in special cases, since complications often occur (inflammatory processes, bleeding, severe metabolic disorders).

Rehabilitation after treatment

An important rehabilitation event - Spa treatment, which is prescribed when the disease is in an inactive stage. There are contraindications: such treatment is not carried out in the first two months after surgery, with complications of a peptic ulcer (pyloric stenosis, malignant degeneration, bleeding - during the last six months), with concomitant severe pathology. Sanatorium-resort treatment involves a large number of physiotherapeutic measures, the use mineral waters, which normalize the function of not only the gastroduodenal region, but also the entire body.

An ulcer of the duodenum and stomach can cause severe pain in the abdominal cavity. In the absence of adequate therapy, serious complications are possible. Conservative treatment methods include medications, dietary food, physiotherapy and folk remedies. In some cases, surgical intervention is required, and its effectiveness also depends on the etiology of the disease.

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Symptoms

Duodenal and gastric ulcers usually manifest acute pain in the projection of these organs, which can be transmitted to the lumbar region. Typically, pain occurs after eating - typical for a defect in the gastric mucosa. With a duodenal ulcer, discomfort is observed on an empty stomach or mainly at night.

Sometimes the patient has other additional clinical signs:

nausea;
vomit;
heartburn;
constipation

In rare cases, bleeding may occur during a bowel movement and the stool may be black in color. There is a so-called silent ulcer, which causes characteristic symptoms only in the later stages, when bleeding is already observed.

For any category of patients, the clinical signs of gastric and duodenal ulcers are the same. Typically, the disease worsens during spring-autumn period. The pain is provoked by a spasm of the stomach, irritation of its walls, on which there are ulcers. Moreover, the degree of damage to the mucous membrane can vary greatly depending on the duration of the disease.

Conservative treatment

It is quite difficult to cure this disease forever. For gastric and duodenal ulcers, the patient is given comprehensive treatment. It includes drug therapy, dietary nutrition and physical therapy. Traditional medicine can be used.

In case of exacerbations of the disease, treatment is recommended in a hospital setting. In order for ulcerative defects in the mucous membrane of the stomach and intestines to heal faster during periods of exacerbation, the patient needs to maintain bed rest and emotional peace. This is usually set at 2 weeks of treatment.

Medicines

Drug treatment is determined by the attending physician and is established based on the examination. Treatment tactics can vary greatly depending on the detection of Helicobacter pylori in the gastrointestinal mucosa.

Typically, gastroenterologists prescribe the following groups of drugs:

Antisecretory - inhibit gastric secretion, thereby reducing the aggressive effects of gastric juice. There are several subgroups of medications with a similar effect:
- proton pump inhibitors (Pariet, Omeprazole, Omez, Nexium);
- anticholinergics (Gastrocepin);
- H2-histamine receptor blockers (Cimetidine, Ranitidine, Famotidine).
2. Bismuth-containing tablets (Vicair, Vikalin, De-Nol). They are used for duodenal and gastric ulcers caused by Helicobacter pylori. Drugs in this group inhibit the activity of bacteria. Form on the surface of the mucous membrane protective film, protecting the walls from the effects of hydrochloric acid.
3. Antibacterial and antiprotozoal (Metronidazole, Clarithromycin, Amoxicillin, Tetracycline). Also prescribed to eliminate pathogenic bacteria.
4. Prokinetics (Motilium, Cerucal, Trimedat). Improves duodenal motility and helps eliminate nausea and vomiting. They are indicated for use in cases of heaviness in the stomach and heartburn.
5. Antacids (Maalox, Almagel, Phosphalugel). Symptomatic medications aimed at suppressing heartburn. They neutralize acidity in the stomach, thereby protecting the mucous membrane from the effects of gastric juice. In addition, they have an astringent and adsorbing effect.
6. Gastroprotective agents (Venter). Envelop the affected mucous membrane, protect it from the effects of digestive enzymes and hydrochloric acid.

To relieve pain, patients are prescribed analgesics and antispasmodics. To improve nutrition of the intestinal mucosa and stomach - B vitamins and Actovegin.

Diet

Peptic ulcer disease, according to statistics, is diagnosed in almost 10% of the population. In this case, an ulcer of the duodenal bulb is observed 4 times more often than damage to the gastric mucosa. This disease predominantly occurs in men. Experts give a simple explanation for this. Men do not control their diet as carefully as women. They tend to eat spicy and fatty foods. Therefore, dietary nutrition is on a par with drug treatment.

If you have a peptic ulcer, you must adhere to the following rules:

1. Food must be well boiled, prepared from pureed products, have comfortable temperature, do not contain components that stimulate the production of gastric juice. This will avoid excessive irritation of the mucous membrane of the gastrointestinal tract and speed up the healing process of ulcers.
2. Meals should be fractional. It is advisable that there be a gap of no more than three hours between two meals (the night is not taken into account). By reducing the time break, you will need to reduce the portion sizes. In addition, it is worth considering the rate of digestion of previously consumed food.
3. Daily calorie content must be at least 3000 kcal. To do this, you need to eat approximately 100 g of protein, 100 g of fat and 450 g of carbohydrates. You need to choose those foods that are rich in vitamins, especially A, C, B1.

For peptic ulcers, table No. 1 is prescribed. It includes:

boiled porridge;
slimy soups;
pasta;
fruit and vegetable purees;
lean meat and fish;
eggs;
casseroles;
jelly, pudding, jelly;
milk, cream;
crackers, dried white bread.

During the day, the patient should consume at least 1.5 liters of fluid. It is recommended to drink still medicinal mineral water, weak tea and rosehip decoction.

When preparing dishes, you cannot use the methods of frying, marinating, baking until golden brown, or breading. Steaming and boiling are preferred. It is desirable that all ingredients are natural and fresh. It is necessary to strictly control the presence of vegetable fats, preservatives, and flavoring additives.

Permitted for use:

fresh milk, sour cream, low-fat cottage cheese and cream;
lean meat (beef, turkey, veal, rabbit);
lean fish;
cereals (oatmeal, buckwheat, semolina, rice);
vegetables (beets, potatoes, cauliflower, pumpkin, carrots);
butter and olive oil;
scrambled eggs;
pasta and vermicelli;
white bread (yesterday's), dried biscuit;
sweet fruits and berries.

Prohibited:

dishes containing spices, fats and salt in large quantities;
spicy vegetables (radish, garlic, horseradish, onion);
legumes;
fatty meat (duck, goose, pork, lamb);
rich broths;
mushrooms;
wholemeal bread;
baked goods;
pickles, marinades, smoked, canned food;
sour fruits and berries;
nuts, seeds;
dried fruits;
alcohol, tonic drinks, strong tea and coffee.

Physiotherapy

Physiotherapeutic treatment is established to increase the effectiveness of drug therapy. In the acute stage of the disease, the following methods can be used:

1. Electrotherapy. Sinusoidal modulated currents relieve inflammation, relieve pain, and improve blood circulation in the gastrointestinal tract.
2. Ultrasound/microwave therapy and electrophoresis with the use of drugs (Papaverine, Novocaine). They have analgesic and antisecretory effects.

Heat treatment can be used to relieve pain at home. To do this, use a semi-alcohol compress, which improves blood circulation, warms and relieves discomfort.

Folk remedies

To relieve symptoms and speed up the healing process of ulcerative defects, you can use traditional methods. However, before doing this, you should consult with your doctor.

The following recipes are effective:

1. Propolis infusion. Take one glass of raw material, fill it with alcohol or vodka (100 ml), and leave for three days. Take 20 drops before each meal.
2. Decoction of common yarrow. You need to take 50 grams of herb, add a glass of boiling water, and let the product stand in a dark place for an hour. The resulting drink is taken 100 ml before bedtime.
3. Honey with nuts. Need 0.5 kg butter mix with the same volume of honey (both ingredients must be in liquid state). Separately, grind the walnut partitions and add them to the prepared mixture. The resulting product is eaten 1 tablespoon on an empty stomach.
4. Aloe juice. This remedy is used as a preventive measure. You need to take 1 leaf of the plant, chew it, swallow the juice, and spit out the sides of the leaf. This is done half an hour before meals for 3 months.
5. Take potato tubers and turn them into pulp. The juice is consumed before breakfast and lunch.
6. Flax seeds. You can buy the extract at pharmacies or prepare your own decoction. To do this, take 1 teaspoon of seeds, pour a glass boiled water and cook for 10-15 minutes. After cooling, strain the broth and consume completely.
7. Sea buckthorn oil. You need to take 1 teaspoon of the product 3 times a day. Within two weeks you can feel a significant improvement in your condition, and it is advisable to continue treatment with sea buckthorn oil for a month. After this, a break is taken for 2-3 weeks, after which the course is repeated if necessary.

Surgery

The operation is prescribed only in extreme cases. Usually the indication for it is ineffectiveness drug treatment, the presence of scar changes in the stomach.

X surgical treatment is performed in the following cases:

Profuse bleeding occurs that does not stop with appropriate therapy;
perforated ulcers are observed;
there are malignant ulcers;
decompensated pyloric stenosis was diagnosed;
covered perforations are noted.

Surgical intervention consists of removing the area of mucosa affected by the ulcer. This operation is quite complicated. It can lead to negative consequences that appear immediately or after a certain time. Inflammation and bleeding often occur after surgery.

Stomach ulcer. This is serious. Complications of a stomach ulcer sound no less, or rather more menacing: a cancerous tumor or perforation (or perforation). What to do to recognize an ulcer in time and prevent complications? The therapist will tell you Evgenia Anatolyevna Kuznetsova.

Stomach ulcer- this is first of all chronic illness, which has periods of exacerbation and remission, the main symptom of which is the formation of a defect (ulcer) in the wall of the stomach. The formation of a defect cannot always occur only in the stomach; it happens that a stomach ulcer is combined with an ulcer in the duodenum. Other organs and digestive systems are often involved in the pathological process, which can lead to dangerous complications and sometimes to the death of the patient.

In Russia, it is customary to combine peptic ulcers of the stomach and duodenum, this is due to the similarity of the mechanisms of occurrence.

The main mechanism of this disease is an imbalance between protective and aggressive factors in the mucous membrane of the stomach and duodenum. Next we will analyze these factors.

In this image we see an endoscopic picture of an ulcer of the antrum of the stomach; the photograph was taken during an endoscopic examination.

Protective factors who guard the health of the stomach are, firstly, slime, which is produced by cells of the gastric mucosa. The necessary balance is also maintained normal blood circulation. Cells of the mucous membrane of the stomach and duodenum normally regenerate very quickly. Exactly this active regeneration and protects the mucous membrane from damage.

What factors are aggressive for the gastric mucosa? In first place, of course, hydrochloric acid. It is produced by stomach cells to digest incoming food. Bile acids are also “aggressors”. they are produced by the liver and then enter the duodenum. It can also happen cast the contents of the duodenum with these same bile acids into the stomach.

Bacterial infection Helicobacter pylori (Hp) can also cause stomach and duodenal ulcers.

But infection does not always lead to stomach and duodenal ulcers (as well as gastritis); asymptomatic carriage often occurs HP. The reason that not all carriers get sick HP may be: the state of general and local immunity, as well as nonspecific factors of protection of the gastric mucosa, such as the secretion of bicarbonates, protective mucus.

There are so-called risk factors that can contribute to the occurrence of the disease. Risk factors may include:

The presence of a patient with high acidity of gastric juice or gastroduodenitis
Long-term stress
Taking certain medications, for example, non-steroidal anti-inflammatory drugs (“popularly” so-called painkillers)
Smoking, drinking alcohol
Drinking strong tea, coffee, spicy foods
Genetic predisposition

But there is also rare causes , which can lead to peptic ulcers of the stomach and duodenum, these include: tumors of the stomach and duodenum, diabetes mellitus, Crohn's disease, foreign body in the stomach, tuberculosis, syphilis, HIV infection.

Symptoms of stomach and duodenal ulcers

What symptoms bother a patient with a peptic ulcer? Let's look at the clinical picture of the disease.

It should be noted that symptoms appear during an exacerbation of stomach and duodenal ulcers; outside of the exacerbation, patients most often do not worry about anything. During an exacerbation, the first thing that appears is pain in the upper abdomen, which radiates, depending on the location of the ulcerative defect, to the left half of the chest, scapula, thoracic and lumbar spine, left and right hypochondrium, and various parts of the abdomen.

About 75% of patients with peptic ulcer disease complain of pain, 1/3 of patients experience intense pain, and 2/3 experience mild pain.

The pain is often associated with eating, and the timing of the pain depends on the location of the defect. When the ulcer is localized in the upper part of the stomach (otherwise called cardiac), pain occurs 1-1.5 hours after eating

(see Fig. 2)

With an ulcer in the lower part (pyloric) and an ulcer of the duodenal bulb, pain occurs 2 to 3 hours after eating, and the patient may also be bothered by “hungry” pain, which occurs on an “empty stomach” and goes away after eating, and night pain (see. Fig. 3).

In addition to pain, the patient is worried , sour belching, nausea, vomiting at the height of pain, bringing relief, tendency to constipation . The disease is characterized by autumn-spring exacerbations.

An ulcer can lead to such serious complications as:

stomach bleeding, in which the vomit is bloody or looks like coffee grounds, and the stool becomes black and tarry. The person turns pale, cold sweats and other signs of collapse appear.
perforation (perforation) ulcerative defect (Fig. 4). during perforation, the patient experiences the so-called. “dagger” pain, followed by vomiting.
cancerous degeneration- the pain is constant, the appetite disappears, the patient feels sick, he turns away from meat, there is weight loss.

At the first symptoms indicating a possible stomach and/or duodenal ulcer, an urgent visit to a doctor is necessary. And also, if a patient is diagnosed with gastritis or gastroduodenitis, then it is worthwhile to treat these diseases in a timely manner, as well as follow the diet necessary for these diseases.

Diagnosis of gastric and duodenal ulcers

Diagnosis of a patient with a peptic ulcer must begin with the collection of complaints and medical history, and it is also necessary to conduct a physical examination (a method of examining a patient by a doctor using the senses) and additional research methods.

Clinical blood test often remains unchanged, but a decrease in hemoglobin is rarely observed, which indicates obvious or hidden bleeding; in complicated forms of peptic ulcer, leukocytes and ESR may increase.

Also carried out stool occult blood test, it is positive for bleeding from an ulcer.

The most important and informative of additional methods research is gastroduodenoscopy(endoscopic examination of the stomach and duodenum), during this study, a special probe (endoscope) is inserted into the stomach, with the help of which the doctor is able to detect an ulcerative defect, establish its depth, determine its location, and take a biopsy (tissue collection from the altered area for diagnostic purposes).

Also carry out X-ray examination stomach to identify ulcer niche (this is an ulcerative defect of the mucous membrane into which the barium suspension used in x-ray examination enters) (see Fig. 5)

IntragastricpH-metry has important diagnostic value, because allows you to determine gastric secretion indicators depending on the location of the ulcer.

And finally, blood tests for Helicobacter pylori.

It should be noted that there may be asymptomatic carriage of Helicobacter pylori. Only if tests are positive HP are combined with the clinical picture of peptic ulcer disease (or gastritis), as well as endoscopic examination data, then HP requires eradication.

In order to prevent infection of the body by Helicobacter pylori, a method is used PCR diagnostics or polymerase chain reaction. The method consists in identifying Helicobacter pylori DNA sections in the collected material (biopsy) of the gastric and duodenal mucosa.

Method ELISA diagnostics, which stands for enzyme immunoassay blood test, is also intended to help with diagnosis. Antibodies IgA, IgM and IgG (immunoglobulins) to Helicobacter pylori are determined in the blood. If IgA and IgM are detected, we can say about early infection - the patient became infected several days ago. If there are IgG antibodies, then they speak of late infection - already a month after infection.

I would also like to say about the widely used breathing urease test for Helicobacter pylori. Helicobacterрylorі produces the enzyme urease during its life. A special device helps to compare the level of gas composition in the initial state, in the normal state, and also with high urease activity.

Treatment of stomach and duodenal ulcers

A special place in the treatment of peptic ulcers is occupied by diet.

Patients with peptic ulcers should eat boiled meat, boiled fish, soups from pureed cereals (rolled oats, rice), steamed food
Eat less foods that promote flatulence - cabbage, legumes, milk
For patients with peptic ulcer it is necessary to exclude fried foods, rich meat and fish broths, do not overeat, eat 5 - 6 times a day
Do not consume foods that contribute to heartburn: strong tea, coffee, chocolate, carbonated drinks, alcohol, onion, garlic, butter

Treatment is aimed at eliminating the cause, suppressing the symptoms of peptic ulcer disease and regeneration during the recovery period.

During an exacerbation, the patient needs bed rest for 1 - 3 weeks, since this mode reduces the motor activity of the stomach. In addition, an ulcer often occurs against a background of stress, and bed rest, speaking in simple language, calms the nervous system.

Medicines for the treatment of stomach ulcers are prescribed by a competent doctor. There are certain treatment regimens. Each patient requires an individual approach, since the causes of ulcers vary for each patient. Attention, self-medication of peptic ulcer is ineffective and dangerous.

Local antacids are used that reduce gastric acidity, astringents and enveloping drugs that increase the resistance of the gastric mucosa to aggressive factors. Among antacids, preference is given to drugs such as Gaviscon and Rennie, which contain carbonates, in contrast to Almagel and Maalox, which contain aluminum.

Also, drugs that reduce the acidity of gastric juice are used to treat peptic ulcers. – proton pump inhibitors .

They are divided into five generations.

Omeprazole (Omez)
Lansoprazole (Lanzap),
Pantoprazole (Nolpaza, Zypantol)
Rabeprazole (Pariet)
Esomeprazole (Nexium)

H2-histamine receptor blockers are also used for peptic ulcers. Despite their similarity in sound to antihistamines, they do not cure allergies, but reduce the production of gastric juice. These are, for example, drugs based on Ranitidine (ranitidine itself is rarely used now, it is considered obsolete): Zantac; Ranital; Gistak; Novo-Ranitidine. However, preference is given to proton pump inhibitors.

To treat peptic ulcers associated with Helicobacter pylori, antibiotics sensitive to this bacterium are used.

A month after eradication of Helicobacter pylori, it is necessary to take a repeat blood test and, if necessary, resolve the issue of repeated eradication, taking into account the patient’s complaints.

To eliminate motor disorders gastrointestinal tract who experience symptoms of nausea and vomiting, use drugs such as Metoclopramide (Cerucal) and Domperidone (Motilium). However, the drug Cerucal is not recommended for use on its own, because it is necessary to exclude vomiting of infectious origin.

Also widely used is the drug De-nol, which has gastroprotective, antiulcer and antibacterial effect. This drug forms a protective film on the surface of the stomach and duodenum, and it also increases the resistance of the gastric and duodenal mucosa to aggressive factors, is effective against HP and has an astringent effect. Regarding HP, it is used only in combination with antibiotics. This drug is also prescribed only by a doctor.

During the recovery period, regenerating drugs are prescribed, for example, methyluracil.

Dispensary observation of patients with gastric and duodenal ulcers

Patients with gastric and duodenal ulcers are examined 2–3 times a year, when exacerbations occur frequently. Also, such patients are regularly examined by a therapist or gastroenterologist - at least 4 times a year. In case of stable remission, when symptoms of the disease do not appear, it is necessary to be examined and examined by a specialist once a year.

Be healthy!

Therapist E.A. Kuznetsova

Ulcerative lesions occur for various reasons, from poor nutrition to genetic predisposition. It is very important to control this disease, as it can quickly develop into a cancerous tumor or reach the stage of perforation, when all the fluid of the duodenum or stomach comes out into the abdominal cavity. Duodenal ulcers, which mainly affect male patients aged 20 to 50 years, can be recognized by various characteristic features, after which it is necessary to immediately begin therapy to eliminate the pathology.

Signs of duodenal ulcer, symptoms

The main signs of the disease include the following manifestations:

Localization of pain in duodenal ulcer

Attention! The described symptoms affect the patient only in the acute stage. If the duodenal ulcer is mild or in remission, the maximum that will bother the patient is nausea and rare pain.

Causes of duodenal ulcer

The disease occurs for various reasons, the main ones being the following:

a large number of bacteria of the Helicobacter type, which multiply especially actively during inflammatory processes and failure to comply with basic rules of personal hygiene;
poor psycho-emotional background, which can be characterized prolonged depressions, breakdowns, panic attacks and stress;
a hereditary factor, which is especially often transmitted only through the male line;
excessive acidity of gastric juice, which, due to improper nutrition, actively enters the duodenum;
chronic inflammatory processes in the duodenum, which can have stages of remission and exacerbation;
a strong decrease in the body’s protective functions due to the presence or transmission of other diseases, including colds;
poor quality food, with big amount fatty and spicy foods;
excessive consumption of alcoholic beverages;
constant use of drugs to combat pathogenic bacteria and the use of steroids.

Symptoms of duodenal ulcer

Attention! It is possible that the patient’s duodenal ulcer was caused by several factors at once, which only a competent specialist can help figure out.

Drug treatment of ulcers

Talcid

Talcid is a powerful antacid medicinal product

A powerful antacid drug that is taken one hour after meals. Typically, adults are prescribed two tablets of the drug, and the number of daily doses is four. It is recommended to chew the pills thoroughly and then wash them down a small amount any liquid except coffee and alcohol. IN childhood you can take 0.5-1 tablet per dose three times a day. The duration of therapy is approximately one month.

Relzer

You can take the medication in the form of a suspension or tablets. It is recommended to drink Relzer an hour after meals, as well as before going to bed, to prevent the occurrence of night hunger pains. Adult patients and children over 15 years of age should take 1-2 scoops of the drug four times a day. In tablet form, after 15 years, the drug is taken in two doses, also four times a day. The recommended duration of therapy is approximately two weeks; treatment should not be terminated earlier, even if symptoms disappear.

No-Shpa

No-Shpa tablets for duodenal ulcers

It is taken for severe pain for three to five days. The patient can take up to four tablets per day. There is no need to chew or divide them, just drink them down clean water. You can take the recommended dose of the antispasmodic at any time, without taking into account food intake. If within three days the pain does not decrease, a mandatory additional examination is required to exclude bleeding and perforation of the ulcer.

Omez

Belongs to a class of antibiotics that contain the active substance omeprazole. Quickly relieves pain, inflammation and severe pain associated with duodenal ulcers. If there is an ulcerative lesion, the patient is recommended to take 20 mg of the active substance twice a day for three weeks. If the ulcer has already caused serious health complications, Omez is taken by intravenous infusion of 40 mg per day. The duration of such therapy is strictly individual.

Famotidine

A medication whose action is aimed at reducing the acidity of gastric juice, which helps prevent damage to the mucous membrane of the stomach and duodenum. Take 20 mg twice a day for four to eight weeks. If necessary, the patient may be advised to take 40 mg of the active substance once a day just before going to bed. The duration of therapy in this case is also 1-2 months.

Attention! Antacids are strictly prohibited from being mixed with other medications. If it is necessary to take several medications at once, antacids are taken two hours earlier or later.

Treatment of duodenal ulcer with folk remedies

Honey and olive oil

For cooking medicine you need to take 250 ml of pure linden honey and the same amount vegetable oil. Since honey quickly sugars, before mixing it is necessary to melt it in a water bath, bringing it to a temperature no higher than +65 degrees; the lower the temperature of the mixture, the better. After this, the oil and honey are carefully mixed and stored strictly in the refrigerator for 14 days. It is recommended that the patient consume a tablespoon of the mixture 15 minutes before meals. Since a patient with an ulcer must eat at least five times a day in small portions, the honey-olive mixture should also be taken at least five times. The maximum permissible daily dose is seven tablespoons. The duration of therapy is two weeks.

Plantain seeds

To prepare the medicinal mixture, you need to take a level tablespoon of the plant mixture. It is added to 100 ml of boiling water, covered tightly and left to infuse overnight, it is advisable to keep the mixture for at least 10 hours. After this, the plantain seeds are removed using clean gauze and taken ready solution 15 ml strictly one hour before meals three times a day. It is better to postpone the last appointment to the evening. The duration of therapy is approximately 5-10 days, it all depends on the tolerability of treatment and the severity of the patient’s condition. Used only during periods of exacerbation.

Propolis with oil

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

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

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

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

The manifestation of the disease is facilitated by:

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

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

Symptoms

When the disease progresses, the following symptoms occur:

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

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

Complications

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

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

Drug therapy

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

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

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

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

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

Folk recipes

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

Products with sea buckthorn oil

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

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

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

Traditional preparations with aloe

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

The following preparations are prepared based on aloe:

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

Recipes with honey

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

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

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

Herbal infusions

Can duodenal ulcers be treated? folk remedies on herbs. Symptoms of the disease will disappear if you take decoctions of the following medicinal plants:

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

Mineral water

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

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

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

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

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

If secretion is reduced, drink cool water before meals. Between medical procedure and eating food, maintain an interval of 30 minutes.

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

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