Peptic ulcer 12 p. Prevention of duodenal ulcer

A trophic local formation that appears as a result of the destruction of the mucous layer of the stomach or duodenum by bile and aggressive substances of digestive juice is called peptic ulcer in medicine (PUD). As a rule, ulceration is sporadic and rarely reaches a size greater than 15 mm. However, there are cases when multiple ulcers arise, capable of merging into one giant one as they get closer to each other.

PUD and PUD can develop in people of different age categories, but more often the pathology is diagnosed in adults around 30-40 years of age. At the same time, ulcers of the gastrointestinal tract are characterized by a wave-like course, that is, periods of calm are replaced by phases of exacerbation, and, consequently, the symptoms of the disease at each stage of its development are somewhat distinctive.

Symptoms at different stages

Since the symptoms of an ulcer certainly depend on the severity of the pathological condition, it is advisable to highlight them and give each a detailed description of the clinical picture.

1. Fresh ulceration - the first symptom of the formation of ulceration is the appearance of pain in the epigastric zone, the intensity of which increases when a person is hungry. Dyspeptic disorders are also noted here: nausea, burning sensation in the chest, belching, abdominal discomfort, constipation (constipation) or diarrhea.

2. Epithelization of the defect - at this stage, pain usually subsides (occurs only during the day and is quickly eliminated after eating) just like manifestations of dyspepsia. However, due to additional symptoms (severe swelling and accumulation of air mass to the right of the diaphragm, dry mouth, slightly elevated temperature and rapid pulse), it becomes quite possible to recognize this disease of the stomach and duodenum.

3. Healing of ulcers - the feeling of pain occurs only on an empty stomach. There are no flatulence, vomiting or other signs of digestive system disorders.

4. Remission - the patient does not express any complaints, and even when palpating the abdomen, he does not experience pain.

During an exacerbation of an ulcer of the duodenum and body of the stomach, pain in the epigastric region with possible irradiation to the lower back, thoracic region, spine, scapula, and arm is characteristic. In addition to pain, the ulcer suffers from halitosis (bad breath), coated tongue, as well as severe dyspeptic symptoms: stool instability, excessive gas formation, heartburn, nausea, ending with vomit coming out, which brings obvious relief to the patient.

It is worth noting that all of the listed symptoms are characteristic of uncomplicated forms, so in case of progression, the clinical picture may be completely different. Thus, when an ulcer penetrates (spread of the pathological process into organs adjacent to the stomach and duodenum), the sufferer experiences a painful attack, characterized by consistency and increasing intensity over time. In addition to pain, body temperature rises, and swelling of the lower back may be present. Also, the symptoms will depend on which organ was affected: if the pancreas, then a clinical picture of acute pancreatitis will appear; biliary tract - symptoms of cholangitis; intestinal segments – symptoms of colitis or duodenitis; liver – manifestations of hepatitis.

In the case of a complication of a duodenal and/or gastric ulcer, such as bleeding caused by exposure of the vessel wall, a person experiences the following clinical condition:

a sharp drop in blood pressure;
vomiting mixed with scarlet or coagulated blood;
sudden weakness;
fainting or the presence of pre-fainting symptoms (dizziness, tinnitus, feeling of lightheadedness, sweating, blurred vision);
stool disorder: it has become liquid and tarry.

It is also extremely important to know and recognize the signs of a stomach ulcer in adults with perforation (perforation), since this complex form of pathology can lead to peritonitis - inflammation of the lining of the abdominal cavity.

Symptoms of perforated peptic ulcer and peptic ulcer:

pain in the epigastrium, similar to a knife blow;
gradual spread of pain to one of the lateral sections of the abdomen;
pale skin + cold sweat;
possible clouding of consciousness;
increase in body temperature;
dry tongue;
abdominal muscle tension.

The only position that allows you to endure a painful attack in case of a stomach ulcer with perforation until the ambulance arrives is the “embryo” position.

How do you know when it’s time to see a gastroenterologist?

Of course, it is better to consult a doctor at the first symptoms of a stomach and duodenal ulcer, that is, with a combination of such phenomena as dyspepsia, pain, heaviness and discomfort in the abdomen, and flatulence. However, there are symptoms of peptic ulcer and peptic ulcer, in the presence of even one of which, calling a doctor at home or an independent visit to the hospital is urgent. This:

vomiting "coffee grounds";
feces with blood, pus;
piercing pain in the stomach;
fainting due to hypotension.

Diagnostics

The following diagnostic methods allow recognizing erosive and peptic ulcer disease of the stomach and/or duodenum in adults:

1. questioning the patient and studying the anamnesis;

2. X-ray examination – necessary to identify functional and morphological changes in organs;

3. gastroscopy – helps to determine the level of acidity of gastric juice, assess the condition of the mucous surface, and determine the nature of ulceration;

4. laboratory techniques (analysis of blood, feces, gastric secretions, as well as serological, histological, bacteriological studies carried out to detect the pathogenic microorganism Helicobacter pylori - the culprit of the ulcerative process in the stomach);

5. differentiation - carried out with diseases such as diaphragmatic hernia, atrophic and diffuse gastritis, pancreatitis, cholecystitis, cholelithiasis, appendicitis, cancer, tabetic crisis, gastroptosis;

6. physical examination - palpation, percussion of the abdomen, examination of the oral cavity and other measures also play a significant role in determining gastric ulcer.

Therapy and diet

Treatment of GU and DU must be carried out in a complex and step-by-step manner. For example, during the acute phase of an ulcer of the duodenum or stomach, the patient may be prescribed:

antacids;
enveloping and adsorbing means;
cytoprotective drugs;
reparants (to improve the regenerative abilities of the mucous membrane);
anti-Helicobacter drugs (if stomach disease has developed due to a harmful bacterium);
medications that relax muscles and speed up bowel movements;
vitamins.

If there is no effect from conservative therapy, elective surgery may be performed. Emergency surgical intervention is indicated in case of gastric bleeding, penetration and perforation of the ulcerated defect. Regardless of the form and complexity of the duodenal ulcer and/or stomach, all patients (adults and children) are required to be prescribed a diet that can not only cure the pathology, but also prevent or reduce the number of relapses.

Principles of dietary nutrition for peptic ulcer and peptic ulcer:

1. eating should be frequent (about every 4 hours) and in small portions;

2. dishes are prepared only in pureed and liquid form, served moderately heated (so as not to cause mechanical and thermal irritation);

3. calorie intake should reach 3000 kcal per day;

4. products with a strong juice effect are excluded;

5. It is prohibited to consume fried, salty, fatty foods, baked goods, mushrooms in any variations, canned food, marinades, coffee, soda, alcohol and other food and drinks that have a negative impact on the state of the digestive system.

If a stomach or duodenal ulcer was diagnosed on time, then the likelihood of a complete recovery for the patient is very high. An unfavorable prognosis is possible if complications develop. Particularly dangerous is perforation of the ulceration into the free abdominal cavity, since without urgent surgical intervention death occurs.

is a chronic pathology in which one or more ulcerative defects form on the intestinal wall. The disease occurs at any age, but more often in men under 40 years of age. 10% of the population of developed countries suffers from peptic ulcer disease. Without treatment, it progresses and leads to serious complications.

The disease progresses in waves. Exacerbations alternate with periods of well-being. Well-being worsens in spring or autumn under the influence of provoking factors: stress, alcohol, errors in diet.

Typical signs

In the classic course of peptic ulcer disease, patients present the following complaints:

Atypical signs

Sometimes complaints arise that are not characteristic of a duodenal ulcer. This makes diagnosis very difficult.

Causes

Food soaked in gastric juice enters the duodenum. Hydrochloric acid and enzymes have a powerful irritant effect. Normally, substances are produced that protect the mucous membrane: mucus, prostaglandins, endorphins. Damaged cells are renewed every 3-5 days. If the balance between the factors of aggression and defense is disturbed, ulcerative defects are formed.

The disease develops due to a combination of several reasons:

Diagnostics

The diagnosis and treatment of peptic ulcers is carried out by a therapist and gastroenterologist. In case of complications, consultation with a surgeon is indicated.

History taking and examination

At the first stage, the doctor clarifies the nature of the pain, its duration, conditions of occurrence, and asks about other complaints. During the conversation, he finds out the possible causes of the disease.

The next stage is a general inspection. The doctor assesses the condition and color of the skin and mucous membranes, identifies swelling, measures height, weight, and blood pressure. Then he listens to the heart and lungs. With peptic ulcers, patients often experience disruptions in the functioning of the autonomic nervous system:

cold damp palms;
“marbling” of the skin;
rare pulse;
low blood pressure.

soreness and tension in the abdominal muscles under the xiphoid process on the right;
pain in this area when tapping with bent fingers.

Laboratory research

Instrumental methods

Complications

Complications arise against the background of exacerbation of the disease:

L treatment

Treatment of uncomplicated peptic ulcer is carried out in a clinic. The main goals of therapy: elimination of symptoms, suppression of Helicobacter pylori, scarring of the ulcer. In case of severe pain, ineffectiveness of outpatient therapy, or development of complications, hospitalization is indicated.

Diet

Proper nutrition is the basis for the treatment of duodenal ulcer.

General principles

List of products and dishes

Allowed	Forbidden
porridge: oatmeal, buckwheat, rice, semolina; boiled vegetables: zucchini, potatoes, cauliflower, carrots; slimy soups; bananas, baked apples, pears; lean fish and meat in the form of meatballs, steam cutlets, souffle; milk and fermented milk products; steam omelette, soft-boiled eggs; pasta, noodles; dry biscuit, biscuits; jelly, compotes of sweet berries and fruits, weak tea.	strong meat, bone, fish broths; raw vegetables and fruits; sour fruit and berry juices; citrus; smoked meats, marinades, all types of canned food; hot seasonings, spices: garlic, onion, black pepper, mustard; coffee, strong tea, cocoa, chocolate; baked goods; black bread; carbonated drinks; chips, crackers; mayonnaise, ketchup; alcohol.

Medications

For peptic ulcers, anti-Helicobacter therapy is always prescribed: a combination of several drugs that suppress the activity of the microbe Helicobacter pylori, promoting the healing of the ulcer. The regimen and duration of medication intake are determined individually.

4-6 weeks after completion of the course of treatment, a control test for Helicobacter is carried out.

Other drugs are also used in the treatment of peptic ulcers:

To monitor the effectiveness of treatment, FGDS is performed once every 2 weeks.

Folk remedies

Use traditional medicine recipes in addition to the main treatment after consulting a doctor.

Potato juice

Potatoes without sprouts and green spots, rinse well, peel, chop in a blender or grate on a fine grater, squeeze out the juice using gauze. Take half a glass half an hour before meals for at least 10 days.

Cabbage juice

Rinse the cabbage leaves well, chop them using a food processor or meat grinder, and squeeze out the juice. Take half a glass three times a day half an hour before meals for a week. Then take a break for 3 weeks and repeat the course.

Surgery

Surgery for peptic ulcer disease is performed routinely or urgently (according to health reasons).

Indications for surgery

Emergency surgery is performed when life-threatening complications develop.

Planned surgery - in the following situations:

ineffectiveness of conservative treatment, frequent relapses;
repeated bleeding;
multiple ulcers;
drug intolerance;
narrowing of the duodenum.

Types of operations

Suturing an ulcerative defect is performed when the ulcer is perforated, if the patient’s condition or the surgeon’s qualifications do not allow radical surgery to be performed.
Gastric resection - the lower 2/3 of the stomach is removed, the remaining part is connected to the duodenum end to end (according to Billroth 1) or to the jejunum end to side (according to Billroth 2).
Trunk vagotomy - the trunk of the vagus nerve is crossed, and pyloric plastic surgery is performed.
Selective proximal vagotomy - the branches of the vagus nerve are crossed.

Recovery period

To prevent postoperative complications, patients are recommended early activation:

The duration of treatment in hospital is 2 weeks.

Prevention

There are two groups of preventive measures: primary and secondary.

Primary activities

Primary preventive measures reduce the risk of peptic ulcer disease in people with a hereditary predisposition.

quitting smoking and alcohol;
stress management;
proper nutrition;
good sleep;
examination for Helicobacter in chronic gastritis.

Secondary events

Secondary measures reduce the risk of exacerbations and complications if the diagnosis has already been established. Patients with peptic ulcer disease are monitored by a general practitioner and a gastroenterologist. Every year they undergo FGDS and examination for Helicobacter pylori.

Forecast

The following factors influence the results of treatment:

the nature of changes in the mucous membrane - the number, size of ulcers;
management tactics - selection of the optimal drug therapy regimen, laboratory and FGDS - control; unreasonably low doses of drugs and a short period of treatment contribute to the exacerbation of the disease.
individual characteristics of the body - in elderly patients with concomitant chronic diseases, ulcers take longer to heal;
adherence to treatment - following a diet, eliminating risk factors, taking medications accelerates the healing of the ulcer.

When Helicobacter pylori is removed from the body, the risk of relapse does not exceed 7%.

A disease of its mucous membrane, accompanied by an inflammatory process and the formation of damage in the form of ulcers. It has a chronic character, proceeds for quite a long time, alternating periods of exacerbations and remissions. This pathology occurs in 15% of people, more often in men after 30-40 years.

Causes

In the 12th duodenum (DVK), both protective factors and aggression factors are present at the same time.

Protective ones include:

nutrition of cells, allowing them to quickly recover if damaged;
neutralization of hydrochloric acid by an alkaline reaction;
protection of cells from bacteria (secretion of mucus).

Also in the intestine there are aggression factors that provoke the development of peptic ulcer. It can be:

increased release of enzymes for digestion, destroying membrane cells;
increased motility and stomach acidity.

If the above aggression factors are significantly greater than the protective factors, then the development of a duodenal ulcer is possible. Basically, there are several reasons for its formation.

The bacterium Helicobacter pylori. The main reason for the development of duodenal ulcer. It is found in almost 70% of patients. The inflammatory process of the intestinal mucosa is provoked by catalase and urease secreted by the bacterium, which protect it itself from hydrochloric acid. But the presence of Helicobacter pylori may not always cause the development of an ulcer. Sometimes pathology is formed as a result of the influence of other factors. For example:

genetic predisposition;
long periods of fasting;
sudden overeating, overloading the duodenum;
impaired motor function of the stomach;
stress leading to spasms of the arterial circulation vessels;
consumption of fatty, peppery and smoked foods;
irregular meals;
drinking alcohol;
smoking (especially on an empty stomach);
complications of gastrointestinal diseases;
presence of gastrinoma (DVK tumor).

Also, duodenal ulcer can develop after long-term use of non-steroidal anti-inflammatory drugs (diclofenac, aspirin, analgin).

How does it manifest?

The main symptoms of the disease are pain under the sternum in the upper abdomen. In this case, the patient himself can indicate their exact location. In most cases, pain occurs after a long period of fasting, ie. when the stomach is empty for several hours. The severity of the pain syndrome is always different - it depends on the degree of development of the pathology. The patient becomes much better after taking antacid drugs or after eating. Often the pain goes away on its own. Unpleasant sensations can occur just in 2-3 weeks, and several times a day. But after a few months of such relapses, the intensity of pain increases, and the time between them decreases.

In addition to pain, duodenal ulcers are characterized by the following symptoms:

diarrhea;
occasional nausea;
vomiting, which brings significant relief;
abdominal distension;
accumulation of large amounts of gases.

Exacerbation of the disease (relapses) occurs in the off-season periods - in autumn and spring. In the elderly and children, symptoms of peptic ulcer disease may be mild or absent. This greatly aggravates the situation, since complications can develop if left untreated.

Classification of the disease

According to the clinical form, a duodenal ulcer can be:

identified for the first time;
chronic.

According to the nature of the pain and the number of relapses:

latent – absence of symptoms;
mild – relapses less than once a year;
moderate - 1-2 times a year;
severe – 3 or more exacerbations per year.

For concomitant dysfunctions of the gastroduodenal system:

secretory;
tow truck;
motor.

Diagnostics

Diagnosis of duodenal ulcer is performed using several methods. But first, a survey of the patient is carried out, during which the nature of the pain, the time of its onset (after or before meals), the seasonality of relapses and other symptoms are clarified.

The main method for identifying peptic ulcers is gastroscopy - a procedure that allows you to examine the mucous membranes of the intestines and stomach using a special device - an endoscope. Thanks to this method, it is possible to accurately determine the location of the ulcer, the presence of internal bleeding, and perform a tissue biopsy for further histological examination.

If there are assumptions about the development of the disease as a result of infection with Chylacobacteria, the doctor prescribes PCR diagnostics. This is a study of biological material (blood, saliva, feces, biopsy samples) to identify this bacterium. This diagnostic has accuracy, sensitivity and speed of obtaining results.

An X-ray of the duodenum using a contrast agent allows you to see the so-called wall defect - penetration of the barium mixture into the ulcer. Also, the results of the study may show penetration and perforation of the ulcer, intestinal stenosis.

Duodenal intubation - examination of the duodenum with a duodenal probe. Allows you to take the contents of the intestine (intestinal and pancreatic juice, bile) and examine it for specific gravity, chemical composition and bacteriological picture.

If internal bleeding is suspected, blood tests are performed to look for signs of anemia.

How to cope with pathology?

Treatment of duodenal ulcer depends on the cause of the disease and is carried out strictly as prescribed by a gastroenterologist.

If Chylacobacteria are detected, treatment consists of 2 weeks of antibacterial therapy. The following drugs are used for this:

amoxicillin;
clarithromycin;
metronidazole.

For treatment aimed at reducing the acidity of gastric juice, the following is used:

Rennie;
Maalox;
phosphalugel;
gastal;
almagel.

To protect the lining of the duodenum, your doctor may prescribe:

de-nol;
misoprostol;
Venter.

For treatment to reduce the secretory activity of the stomach, the following is prescribed:

omeprazole;
rabeprozole;
lansoprazole;
esomeprazole.

If after the prescribed time of taking the medications the patient does not feel any improvement, surgery becomes the main method of treating the pathology. It consists of excision of the duodenum or its suturing.

Nutrition

When a duodenal ulcer is detected, treatment must include adherence to a strict diet. It is divided into three periods - from 1 to 12 days of exacerbation of the disease, from 13 to 24 days, from 25 days.

The diet from days 1 to 12 consists of the following nutritional principles:

eat at least 5-6 times a day;
maximum weight of food consumed – 2.5 kg;
carbohydrates per day should be no more than 200 g;
fats and proteins – up to 100 g;
no more than 4 g of table salt is allowed.

With this diet you are allowed to eat:

jelly;
steamed omelettes;
milk;
soft-boiled eggs;
slimy soups (rice, oatmeal, semolina);
liquid porridges (except wheat).

From the 13th day from the start of the diet, you can add to the diet:

soups with milk;
steamed fish or poultry cutlets;
crackers from wheat bread (no more than 100 g per day).

Diet from 24 days after exacerbation of the disease:

amount of proteins – 100 g, carbohydrates – up to 400 g, fats – 90 g;
fractional meals;
salt - up to 10 g;
water - about 1.5 l;
weight of food eaten – no more than 3 kg.

Dishes allowed to be included in the diet:

vegetable puree;
non-acidic berries and fruits;
stale wheat bread;
vegetable soups pureed through a sieve;
boiled vermicelli;
boiled meat, fish, poultry, cooked in pieces without seasoning;
beet juice;
cottage cheese;
cracker;
greenery.

When following a diet for duodenal ulcers, it is necessary to exclude from the diet:

smoked;
rich meat and fish broth;
pickled;
spicy;
strong tea;
fat;
fresh black bread;
canned food;
coffee;
alcohol.

All products that stimulate gastric secretion are excluded.

During remission, the diet should be based on regular meals at least 4 times a day. If remission is persistent and the disease does not return for quite a long time, the patient is allowed to “step away” from the diet and eat like a healthy person.

Complications

If a duodenal ulcer is not treated in a timely manner, the disease can cause: bleeding, perforation and penetration of the intestine, and narrowing of its lumen.

Perforation of an ulcer is the formation of a gap through which the entire contents of the intestine penetrates into the abdominal cavity and causes the development of an inflammatory process - peritonitis. It is characterized by the appearance of a sharp stabbing pain, which intensifies when changing body position or during pressure on the abdominal wall. When these symptoms appear, the patient needs urgent hospitalization, and in most cases, surgical intervention.

Ulcer bleeding is a consequence of the involvement of mucosal vessels in the pathological process. Hidden bleeding may be characterized by anemia. If it is more pronounced, then blood may appear in the stool and vomit. Stopping bleeding is possible by correcting iron deficiency or cauterizing its source during endoscopic examination. For large and deep ulcers, treatment will be surgical.

Penetration of an ulcer is characterized by penetration into adjacent organs through a defect affecting the intestine. It appears as a stabbing pain that radiates to the back. Treatment is conservative, if it does not help - surgical.

Disturbances in the normal functioning of the digestive organs are characterized by the following symptoms:

The appearance of flatulence, bloating.
The appearance of sour belching.
Nausea and profuse vomiting, after which the patient feels better. In some cases, patients, trying to get rid of painful sensations, induce vomiting on their own.
Chronic constipation, lasting several weeks.
The appearance of blood or occult blood in the stool.

General deterioration

Since exacerbation of peptic ulcer disease is severe and affects the general condition, patients become irritable and tired, complaining of insomnia and depression. Having said that, patients' appetite rarely suffers. Reducing the amount of food taken is due to the fear of pain after eating. The signs of increasing asthenic syndrome are described.

Principles of treatment

Treatment of duodenal ulcer is carried out using conservative or surgical methods.

Conservative treatment includes following a strict diet, taking medications, and, if desired, alternative medicine. In case of exacerbation, when the listed symptoms appear, treatment is carried out in a hospital setting.

If drug therapy turns out to be ineffective over a long period of time, or the patient develops serious complications, doctors decide to perform surgery on the small intestine. Often operations are performed for severe cicatricial deformities.

If the patient is in a state of stable remission, he leads his usual lifestyle. At the same time, it is advisable to protect yourself from stress and overload, avoid alcohol and smoking. Under the current conditions, if a duodenal ulcer worsens, treatment proceeds much faster and healing occurs more intensively.

Diet for peptic ulcers

If a person is diagnosed with a duodenal ulcer in the acute stage, it is important to know the list of foods that will have to be abandoned. Such products have an irritating effect on the mucous membrane of the stomach and intestines and worsen the condition.

Alcoholic, highly carbonated, sweet drinks.
Hot spices, seasonings, savory sauces.
Any fried foods, including vegetables and fish dishes.
Coffee and caffeinated drinks.
Rich mushroom or meat broths.
Coarse black bread, fresh baked goods.

The above list is subject to exclusion from the daily diet during an exacerbation, in a state of stable remission.

Below is a list of dishes and foods that are preferable for ulcers.
Vegetable and milk soups.
Boiled lean meat, boiled or baked fish.
You should eat yesterday's bread.
Cereal dishes.

Principles of therapeutic nutrition

The nutrition of patients suffering from peptic ulcers is based on the rules.

The number of meals during the day is at least five.
The amount of food per serving should not exceed the volume of the saucer.
Food temperature 30-35 degrees. You should not eat cold or too hot food.
The amount of salt in the diet is reduced to a minimum or it is abandoned.
A prerequisite for nutrition in the acute stage is a mechanically gentle consistency of food - dishes must be ground.
Fruits and berries, completely ripe, with soft skin or peeled, are allowed in small quantities.
Concentrated sweet juices are diluted with water.

Drug treatment

When the disease worsens, doctors prescribe groups of drugs:

Antacids - reduce the acidity of gastric juice, create protection for the gastric mucosa.
Medicinal substances that reduce gastric secretory activity - proton pump inhibitors, histamine receptor blockers.
Antibacterial drugs to destroy the causative agent of peptic ulcer disease.

The duration of intensive therapy in the acute period ranges from 2 weeks to 2 months. The patient may be hospitalized in the department of gastroenterology, surgery or therapy. In cases of severe pain, myotropic antispasmodic drugs and analgesics are prescribed. For prolonged constipation, laxatives are prescribed. It is necessary to treat an exacerbation of an ulcer with medication only under the supervision of a doctor. Self-indulgence in such matters leads to disastrous consequences. Instead of improvement, you can achieve a situation where the ulcer begins to worsen much more often.

It is allowed to use alternative medicine in complex therapy - they shorten the time of scarring of the ulcer, reduce pain and discomfort in the abdomen.

For treatment, you can use honey; it is enough to consume the delicacy in its pure form in small quantities. A mixture of honey and olive oil is considered a more effective remedy. Should be stored in a cool place.

A number of medicinal plants are beneficial - calendula, plantain decoction, yarrow. You can prepare special medicinal mixtures from dried herbs for treatment.

Most often, exacerbation of duodenal ulcers occurs due to gross neglect of diet, abuse of alcohol and junk food that irritates the intestinal mucosa, as well as exposure to stress and fatigue.

Signs of exacerbation are mainly diagnosed in the off-season - spring and autumn. This is due to the deterioration of general immunity during this period. The course of the disease is characterized by cyclicity, when periods of stable remission alternate with exacerbations of the pathology.

Forms of the disease

Exacerbation of duodenal ulcer, its symptoms and treatment depend on the form of the disease.

The disease is classified according to the following features:

By relapse rate:

a form that has exacerbations from one to three times a year;
a disease that recurs more than three times in a year.

According to the location and depth of the lesion:

superficial or deep ulceration;
an ulcer located in the area of the bulb or in the post-bulb area.

By the number of mucosal lesions:

single outbreak;
multiple foci.

Acute duodenal ulcer gives a very pronounced clinical picture with vivid symptoms, making it difficult to confuse it with any other disease. The chronic form of duodenal ulcer without exacerbation may not produce symptoms at all and proceed hidden.

Causes of duodenal ulcers

The causes of the disease may be due to family history, dietary habits and bad habits. In some cases, the disease is caused by the bacterium Helicobacter pylori, which affects the lining of the stomach and intestines.

Without adequate and timely treatment, the ulcer may undergo malignant degeneration.

The most likely factors for the occurrence of the disease are the following:

abuse of alcohol and tobacco products, which leads to impaired blood circulation in organs, as well as irritation of the mucous membranes of the gastrointestinal tract;
irregular meals with long intervals between meals, as well as a predominance in the diet of foods that are fried in fat, too sour, fatty and pickled. Food including canned, smoked foods and sauces;
prolonged and uncontrolled use of NSAIDs, which led to inflammation of the intestinal lining;
prolonged stress and fatigue can cause duodenal ulcers in people with an unbalanced psyche and mild excitability of the nervous system.

In the first stages, the disease does not always produce noticeable symptoms, so the patient often sees a doctor with an advanced form of the disease. The trigger mechanism for the disease can also be existing pathologies of the endocrine system, liver and kidneys, and infectious diseases.

Tuberculosis, diabetes, hepatitis, pancreatitis lead to intestinal irritation and can provoke duodenal ulcer. The causes of the disease can also be mechanical damage due to surgery.

Symptoms of relapse of the disease

Clinical symptoms of duodenal pathology do not appear immediately; often, at the very beginning, the disease proceeds latently. An advanced form of peptic ulcer disease can suddenly manifest itself with life-threatening symptoms. In a third of people with this pathology, the presence of the disease is determined after a post-mortem autopsy.

The main diagnostic signs of duodenal ulcers:

epigastric pain;
symptoms of gastrointestinal dysfunction;
neurological symptoms.

The main symptom of the disease is pain in the pit of the stomach or in the upper part of the navel. Relapse often provokes pain in the back and heart area. This is due to the fact that it can radiate from its localization site to other parts of the body, distorting ideas about the real source of pain. Therefore, gastroenterologists primarily focus on discomfort in the navel area.

All painful sensations occur on an empty stomach, and immediately after eating the abdominal pain subsides. But if the patient overeats or consumes foods prohibited by the nutritionist, the pain may intensify.

Often, the symptoms of exacerbation of a duodenal ulcer exhaust the patient, not allowing him to fully rest at night. This occurs due to excessive production of acid, which irritates the diseased area of the intestinal mucosa.

Even during stable remission, a stressful situation, a violation of the diet and the use of pharmacological drugs (hormones or NSAIDs) can lead to a worsening of the condition, pain and nausea.

The second most important sign of duodenal ulcer is gastrointestinal dysfunction, characterized by the ability to bring relief to the patient:

constant long-term constipation;
bloating, belching and flatulence;
dark stool indicating the presence of blood.

The third most important are neurological symptoms. Signs of exacerbation of duodenal ulcer may include: irritability, sleep disturbance, depressed mood, and weight loss.

Diet for exacerbation of duodenal ulcers

Nutrition for gastrointestinal pathologies is of paramount importance. In the first days of the disease, nutrition is limited to a small amount of pureed food. Vegetable and bakery products are excluded.

After 5 days, you are allowed to eat vegetarian soups in which white crackers can be soaked. In addition, puree or soufflé from boiled poultry and fish fillets is allowed; for dessert you can eat fruit jelly.

In the second week, meat dishes are added to the treatment menu, which must be steamed; these can be poultry or fish meatballs. In addition, you should eat eggs in the form of an omelet or boiled, milk porridge with a small amount of butter, as well as mashed carrots or potatoes.

Contraindicated in case of exacerbation of duodenal ulcer:

mushroom, meat broth;
confectionery and baked goods;
dishes that are fried in fat;
too fatty foods;
fresh fruits and vegetables;
fatty sea fish;
alcohol-containing products;
any lean meat;
spices, sauces and marinades.

To neutralize the aggressive effects of hydrochloric acid, you should eat little and often. It is better to treat duodenal ulcers in a hospital setting, and dietary table No. 1-a or 1-b is indicated; such nutrition should last 4 months. After discharge, you can follow diet No. 5.

Pathology therapy

Duodenal ulcers, depending on the severity of clinical manifestations, can be treated conservatively and surgically.

The impact method includes the following set of measures:

therapeutic nutrition;
pharmacological agents (antibiotics, antacids and antisecretory drugs);
herbal decoctions;
Surgical treatment is indicated only if conventional methods are ineffective. Most often, the patient needs surgical help after constant exacerbations of the disease, with impaired ulcer healing and severe scarring.

When Helicobacter pylori is detected, treatment should include a complex of several antibiotics with antiprotozoal and bactericidal effects:

Amoxicillin;
Tetracycline;
Clarithromycin;
Metronidazole.

In order to neutralize the acidity of gastric juice, antacids are used:

Maalox;
Rennie;
Phosphalugel;
Almagel;
Gastal.

To improve the healing of the duodenal membrane, antiulcer drugs are prescribed:

De-nol;
Venter;
Misoprostol.

In addition, prescribe antisecretory agents:

Rabeprozole;
Omeprazole;
Esomeprazole;
Lanzoprazole.

When, after taking medications for a long time under the supervision of a doctor, the patient does not feel any improvement, then it is advisable to agree to surgical intervention, which will consist of removing the affected area or suturing the duodenum.

Complications of duodenal ulcers

If duodenal ulcers are treated incorrectly, the pathology can periodically worsen and ultimately cause serious complications.

If blood vessels are involved in the process, the disease can be complicated by hemorrhage. Hidden bleeding can be identified by such a characteristic sign as anemia. If hemorrhage is profuse, it can be determined by the type of stool (they turn black).
- this is the appearance of a hole in the wall of the duodenum. This complication can be determined by the occurrence of acute pain during palpation or a change in body position.
Narrowing of the duodenal lumen occurs as a result of edema or scar. Identified by bloating, uncontrollable vomiting, and lack of stool.
– penetration into neighboring organs through a defect in the duodenum. The main symptom is pain radiating to the back.

A duodenal ulcer can worsen during the off-season (autumn, spring) and is most often triggered by poor diet or stress. The main symptom is pain in the navel area. To avoid this, you need to remember about preventive measures, compliance with all the conditions prescribed by a specialist, including strengthening the immune system and following a diet.