Peptic ulcer 12 p. Prevention of duodenal ulcer

A trophic local formation that appeared as a result of the destruction of the mucous layer of the stomach or duodenum by bile and aggressive substances of the digestive juice is called peptic ulcer in medicine (GU, DU). As a rule, ulceration is of a single nature and rarely reaches a size of more than 15 mm. However, there are cases when multiple ulcers occur, capable of merging into one giant as they approach each other.

GU and DU can develop in people of different age categories, but more often the pathology is still diagnosed in adults in the region of 30-40 years. At the same time, ulcers of the gastrointestinal tract are characterized by an undulating course, that is, periods of calm are replaced by exacerbation phases, and, therefore, 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 single them out and give each a detailed description of the clinical picture.

1. Fresh ulceration - the first symptom of the formation of PUD 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 behind the sternum, belching, abdominal discomfort, constipation (constipation) or diarrhea.

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

3. Ulcer healing - the feeling of pain occurs only on an empty stomach. Flatulence, vomiting and other signs of a violation of the digestive system are absent.

4. Remission - the patient does not complain, and even with palpation of the abdomen, pain does not occur.

During the period of exacerbation of the duodenal ulcer and the body of the stomach, the appearance of pain in the epigastric region with possible irradiation to the lower back, thoracic region, spine, scapula, arm is characteristic. In addition to pain, the ulcer has halitosis (bad breath), tongue coating, as well as pronounced dyspeptic phenomena: stool instability, excessive gas formation, heartburn, nausea, ending in the release of vomit to the outside, which brings the patient clear relief.

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

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

a sharp drop in blood pressure;
vomiting with an admixture of scarlet or clotted blood;
sudden weakness;
fainting or the presence of pre-syncope symptoms (dizziness, tinnitus, feeling of lightheadedness, sweat protrusion, rippling in the eyes);
stool disorder: it became 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 GU and DU:

cutting in the epigastrium, like a knife blow;
gradual spread of pain in one of the lateral parts of the abdomen;
pale skin + cold sweat;
possible clouding of consciousness;
increase in body temperature;
dry tongue;
tension in the abdominal muscles.

The only position that allows you to endure a painful attack in case of gastric ulcer with perforation before the arrival of an ambulance is the “embryo” position.

How do you know 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, soreness, heaviness and discomfort in the abdomen, flatulence. However, there are symptoms of GU and DU, in the case of the presence of even one of which, a doctor's call to the house 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 to recognize erosive and peptic ulcer 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, establish the nature of ulceration;

4. laboratory methods (analysis of blood, feces, gastric secretion, as well as serological, histological, bacteriological studies conducted to detect the pathogen Helicobacter pylori - the culprit of the ulcerative process in the stomach);

5. differentiation - carried out with such diseases as a hernia of the diaphragm, 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 activities 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. So, for example, in the phase of exacerbation of an ulcer of the duodenum or stomach, the patient can be prescribed:

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

In the absence of the effect of conservative therapy, a planned operation is possible. Emergency surgical intervention is indicated in case of gastric bleeding, penetration and perforation of an ulcerated defect. Regardless of the form and complexity of the course of a duodenal ulcer and / or stomach ulcer, all patients (adults and children) are prescribed a diet that can not only cure the pathology, but also prevent or reduce the number of relapses.

Principles of dietary nutrition for GU and DU:

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. the calorie content of the diet should reach up to 3000 kcal per day;

4. products with a strong juice effect are excluded;

5. it is forbidden to use fried, salty, fatty, muffins, mushrooms in any variations, canned food, marinades, coffee, soda, alcohol and other food and drinks that have a negative effect on the state of the digestive system.

If a stomach or duodenal ulcer was diagnosed on time, then the probability of a complete recovery of the patient is very high. An unfavorable prognosis is possible with the development of complications. Especially dangerous is the perforation of ulceration in the free abdominal cavity, since without urgent surgical intervention a fatal outcome occurs.

- This 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 in developed countries suffer from peptic ulcer disease. Without treatment, it progresses and leads to serious complications.

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

Typical signs

In the classic course of peptic ulcer, patients present with such complaints:

Atypical signs

Sometimes there are complaints 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 irritating 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

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

History taking and examination

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

The next step is a general inspection. The doctor evaluates the condition and color of the skin, mucous membranes, detects edema, measures height, weight, and blood pressure. Then he listens to the heart, lungs. With peptic ulcer, patients often experience malfunctions of the autonomic nervous system:

cold wet palms;
"marbling" of the skin;
rare pulse;
low blood pressure.

soreness and tension of the abdominal muscles under the xiphoid process on the right;
soreness of this zone when tapping with bent fingers.

Laboratory research

Instrumental Methods

Complications

Complications occur against the background of an exacerbation of the disease:

L treatment

Treatment of uncomplicated peptic ulcer is carried out in the clinic. The main goals of therapy: elimination of symptoms, suppression of Helicobacter pylori, scarring of the ulcer. With severe pain, ineffectiveness of outpatient therapy, the 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
cereals: oatmeal, buckwheat, rice, semolina; boiled vegetables: zucchini, potatoes, cauliflower, carrots; mucous soups; bananas, baked apples, pears; lean fish and meat in the form of meatballs, steam cutlets, soufflé; milk and dairy products; steam omelette, soft-boiled eggs; pasta, noodles; dry biscuit, biscuit cookies; kissels, compotes from sweet berries and fruits, weak tea.	strong meat, bone, fish broths; raw vegetables and fruits; acidic 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; baking products; black bread; carbonated drinks; chips, crackers; mayonnaise, ketchup; alcohol.

Medications

In case of peptic ulcer, anti-Helicobacter therapy is always prescribed: a combination of several drugs that suppress the activity of the Helicobacter pylori microbe and promote healing of the ulcer. The scheme and duration of medication is determined individually.

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

In the treatment of peptic ulcer, other drugs are also used:

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

Folk remedies

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

potato juice

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

cabbage juice

Rinse the cabbage leaves well, chop with a combine or meat grinder, squeeze 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

An operation for peptic ulcer is done in a planned manner or urgently (according to vital indications).

Indications for surgery

Emergency surgery is performed with the development of life-threatening complications.

Planned surgery - in such situations:

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

Operation types

The suturing of the ulcer defect is carried out with perforation of the ulcer, if the patient's condition or the surgeon's qualifications do not allow performing a radical operation.
Resection of the stomach - the lower 2/3 of the stomach is removed, the remaining part is connected to the duodenum 12 end to end (according to Billroth 1) or to the jejunum end to side (according to Billroth 2).
Stem vagotomy - cross the trunk of the vagus nerve, make the pylorus plastic.
Selective proximal vagotomy - cross the branches of the vagus nerve.

Recovery period

To prevent postoperative complications, patients are recommended early activation:

The duration of treatment in the 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 ulcers in people with a hereditary predisposition.

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

Secondary Activities

Secondary measures reduce the risk of exacerbations and complications in an already established diagnosis. Patients with peptic ulcer are registered with 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 - the choice of the optimal drug therapy regimen, laboratory and FGDS - control; unreasonably low doses of drugs and a short duration of treatment contribute to the exacerbation of the disease.
individual characteristics of the organism - in elderly patients with concomitant chronic diseases, ulcers heal longer;
adherence to treatment - diet, elimination of risk factors, medication accelerates the healing of the ulcer.

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

A disease of its mucous membrane, accompanied by an inflammatory process and the formation of lesions 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 when damaged;
neutralization of hydrochloric acid with an alkaline reaction;
protection of cells from bacteria (mucus secretion).

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

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

If the above factors of aggression will be much more 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 from hydrochloric acid. But not always the presence of Helicobacter pylori can cause the development of an ulcer. Sometimes pathology is also formed as a result of other factors. For example:

genetic predisposition;
long fasting time;
sharp overeating, overloading the duodenum;
violation of the motor function of the stomach;
stresses leading to the appearance of spasms of the blood vessels of the DVK;
the use of fatty, peppered and smoked foods;
irregular meals;
alcohol intake;
smoking (especially on an empty stomach);
complications of diseases of the digestive tract;
the presence of gastrinoma (tumors of DVC).

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

How is it manifested?

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 localization. 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;
periodic nausea;
vomiting, bringing significant relief;
distension of the abdomen;
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.

Disease classification

According to the clinical form, duodenal ulcer 12 can be:

identified for the first time;
chronic.

By the nature of pain and the number of relapses:

latent - no symptoms;
mild - relapses less than 1 time per year;
moderate - 1-2 times a year;
severe - from 3 or more exacerbations per year.

According to concomitant dysfunctions of the gastroduodenal system:

secretory;
evacuation;
motor.

Diagnostics

Diagnosis of duodenal ulcer 12 is performed by several methods. But first, a patient is interviewed, during which the nature of pain sensations, the time of their appearance (after eating or before), the seasonality of relapses and other symptoms are clarified.

The main method for detecting peptic ulcer is gastroscopy - a procedure that allows you to examine the mucous membranes of the intestine 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 biopsy tissues 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.

X-ray of the duodenum with the use of a contrast agent allows you to see the so-called wall defect - the penetration of the bar mixture into the ulcer. Also, the results of the study can show penetration and perforation of the ulcer, intestinal stenosis.

Duodenal sounding - a study of 12 duodenal ulcers 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 deal with pathology?

Treatment of duodenal ulcer 12 depends on the cause of the disease and is performed strictly according to the prescription of a gastroenterologist.

When detecting hylacobacteria, treatment consists in 2-week antibiotic therapy. For this, the following drugs are used:

amoxicillin;
clarithromycin;
metronidazole.

For treatment aimed at lowering the acidity of gastric juice, apply:

rennie;
maalox;
phosphalugel;
gastal;
almagel.

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

de-nol;
misoprostol;
venter.

For treatment in order to reduce the secretory activity of the stomach, appoint:

omeprazole;
rabeprozole;
lansoprazole;
esomeprazole.

If, after the prescribed time of taking the drugs, the patient does not feel improvement, the main method of treating the pathology is surgical intervention. It consists in excision of the 12th duodenum or its suturing.

Nutrition

When a duodenal ulcer is detected, a strict diet must be included in the treatment. 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 1 to 12 days consists of the following principles of nutrition:

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

With this diet, you can use:

jelly;
steamed omelets;
milk;
soft-boiled eggs;
mucous soups (rice, oatmeal, semolina);
liquid cereals (except wheat).

From the 13th day from the start of the diet, it is allowed to add to the diet:

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

Diet from 24 days after the exacerbation of the disease:

the amount of proteins - 100 g, carbohydrates - up to 400 g, fats - 90 g;
fractional nutrition;
salt - up to 10 g;
water - about 1.5 l;
the mass of food eaten is not more than 3 kg.

Dishes allowed to be included in the diet:

vegetable puree;
non-acidic berries and fruits;
stale wheat bread;
strained vegetable soups;
boiled vermicelli;
boiled meat, fish, poultry, cooked in a piece without seasonings;
beetroot juice;
cottage cheese;
cracker;
greenery.

While following a diet for a duodenal ulcer, it is necessary to exclude from the diet:

smoked;
rich meat, fish broth;
pickled;
acute;
strong tea;
fatty;
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 the remission is stable and the disease does not return for quite a long time, the patient is allowed to "move away" from the diet and eat like a healthy person.

Complications

With untimely treatment of duodenal ulcer 12, the disease can cause: bleeding, perforation and penetration of the intestine, 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 pain of a stabbing nature, which increases with a change in body position or during pressure on the abdominal wall. When these symptoms appear, the patient needs urgent hospitalization, and in most cases, surgical intervention.

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

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

Violations of the normal functioning of the digestive organs are characterized by signs:

The appearance of flatulence, bloating.
The appearance of belching sour.
Nausea and profuse vomiting, after which the patient becomes better. In some cases, patients, trying to get rid of painful sensations, cause vomiting on their own.
Chronic constipation, the duration of which reaches several weeks.
The appearance in the feces of impurities of blood or occult blood.

General deterioration

Since the exacerbation of peptic ulcer is severe, affects the general condition, patients become irritable and tired, complain of insomnia, depression. With the foregoing, the appetite of patients rarely suffers. The decrease in the amount of food taken is due to the fear of pain after eating. The signs of growing asthenic syndrome are described.

Principles of treatment

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

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

If drug therapy has been ineffective for a long time, or the patient has developed serious complications, doctors decide to perform surgery on the small intestine. Often, operations are performed with gross cicatricial deformities.

If the patient is in a state of stable remission, he leads a normal life. At the same time, it is advisable to protect yourself from stress and overload, avoid alcohol, smoking. Under the conditions met, if the duodenal ulcer becomes aggravated, the treatment proceeds much faster, the healing is more intense.

Diet for peptic ulcer

If a person has 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, worsen the condition.

Alcoholic, highly carbonated, sugary drinks.
Spicy spices, seasonings, spicy sauces.
Any fried foods, including vegetables, fish dishes.
Coffee and caffeinated drinks.
Rich mushroom or meat broths.
Wholemeal black bread, fresh muffin.

The listed 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 preferred for ulcers.
Vegetable and milk soups.
Boiled meat of low-fat varieties, fish in boiled or baked form.
Bread should be eaten yesterday.
Cereal dishes.

Principles of therapeutic nutrition

The nutrition of patients suffering from peptic ulcer is built according to the rules.

The number of meals during the day is at least five.
The amount of food in a serving should not exceed the volume of a saucer.
Food temperature 30-35 degrees. You can 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 texture of food - the dishes must be ground.
Fruits and berries are allowed in small quantities, completely ripe, with soft skin or peeled.
Concentrated sweet juices are diluted with water.

Medical treatment

With an exacerbation of the disease, doctors prescribe a group of drugs:

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

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. With severe pain syndrome, myotropic antispasmodic drugs, analgesics are prescribed. With prolonged constipation, laxatives are prescribed. It is necessary to treat an exacerbation of an ulcer with medication only under the supervision of a physician. Self-activity 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 reduce the time of scarring of the ulcer, reduce pain and discomfort in the abdomen.

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

A number of medicinal plants bring benefits - calendula, plantain decoction, yarrow. You can prepare special medicinal preparations from dried herbs for treatment.

Most often, an exacerbation of a duodenal ulcer occurs as a result of gross neglect of the diet, alcohol abuse 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 - in 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 depends on the form of the disease.

The disease is classified according to the following features:

According to the frequency of relapses:

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 region of the bulb or in the post-bulb area.

By the number of foci of mucosal lesions:

single hearth;
multiple foci.

Acute peptic ulcer of the duodenum gives a very pronounced clinical picture with vivid symptoms, due to which it is difficult to confuse it with any other disease. The chronic form of a duodenal ulcer without exacerbation may not give symptoms at all and proceed hidden.

Causes of duodenal ulcer

The causes of the onset of the disease may be due to aggravated heredity, 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, an ulcer can undergo malignant transformation.

The following are recognized as the most likely factors for the onset of the disease:

abuse of alcohol and tobacco products, which leads to impaired blood circulation in the organs, as well as irritation of the mucous organs of the gastrointestinal tract;
irregular meals with long intervals between meals, as well as the predominance in the diet of foods that are fried in fat, too sour, fatty and pickled. Meals, 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.

At the first stages, the disease does not always give tangible symptoms, so often the patient goes to the doctor with an advanced form of the disease. The trigger mechanism of the disease can also be existing pathologies of the endocrine system, liver and kidneys, infectious diseases.

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

Symptoms of disease recurrence

Clinical symptoms of duodenal pathology do not appear immediately, often at the very beginning the disease is hidden. A neglected form of peptic ulcer can manifest itself sharply as life-threatening signs. 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 a duodenal ulcer:

epigastric pain;
symptoms of gastrointestinal dysfunction;
neurological symptoms.

The main symptom of the disease is soreness "under the spoon" 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 the place of localization 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 pain in the abdomen subsides. But if the patient overeats or consumes foods prohibited by the nutritionist, then the pain may intensify.

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

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

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

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

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

Diet for exacerbation of duodenal ulcer

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

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

In the second week, meat dishes are added to the treatment menu, which should be steamed, these can be meatballs from poultry or fish. 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 exacerbation of duodenal ulcer:

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

To neutralize the aggressive effect of hydrochloric acid, you should eat little and often. It is better to treat a duodenal ulcer in stationary conditions, while dietary table No. 1-a or 1-b is indicated, such nutrition should last 4 months. After discharge, you can stick to diet number 5.

Pathology therapy

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

The method of influence includes the following set of measures:

medical nutrition;
pharmacological agents (antibiotics, antacids and antisecretory drugs);
herbal decoctions;
surgical treatment is indicated only if conventional methods have failed. Most often, the patient needs prompt assistance after constant exacerbations of the disease, in violation of the healing of the ulcer and gross scarring.

When Helicobacter pylori is detected, treatment should include a complex of several antibiotics that have an antiprotozoal and bactericidal effect:

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;
Lansoprazole.

When, after prolonged use of drugs under the supervision of a doctor, the patient does not feel improvement, it is advisable to agree to a surgical intervention, which will consist in removing the affected area or suturing the duodenum.

Complications of duodenal ulcer

With improper therapy of duodenal ulcers, the pathology can periodically worsen and eventually cause serious complications.

When blood vessels are involved in the process, the disease can be complicated by hemorrhage. Occult bleeding can be identified by such a characteristic feature as anemia. If hemorrhage is abundant, then it can be determined by the type of feces (they become 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.
The narrowing of the lumen of the duodenum occurs as a result of edema or scarring. It is determined by bloating, indomitable vomiting, 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 a diet or stress. The main symptom is pain in the navel. To avoid this, one must remember about preventive measures, compliance with all conditions prescribed by a specialist, including strengthening immunity and dieting.