Stomach ulcer and duodenal ulcer

Peptic ulcer of the stomach and duodenum is a chronic relapsing disease in which as a result of disorders of the nervous and humoral mechanisms regulating secretory-trophic processes in the gastroduodenal zone, an ulcer is formed in the stomach or duodenum (less often two ulcers and more).

Etiology, pathogenesis. The peptic ulcer is associated with a violation of the nervous and then humoral mechanisms regulating the secretory, motor function of the stomach and duodenum, circulation in them, trophism of the mucous membranes. The formation of an ulcer in the stomach or duodenum is only a consequence of the disorders of the above functions.

Negative emotions, prolonged mental overstrain, pathological impulses from the affected internal organs with chronic appendicitis, chronic cholecystitis, cholelithiasis, etc. are often the cause of ulcer disease.

Among the hormonal factors, the disturbances in the activity of the pituitary-adrenal system and the function of sex hormones, as well as the disruption of the production of digestive hormones (gastrin, secretin, enterrogastron, holicystokinin-pancreosimin, etc.), disruption of the exchange of histamine and serotonin, which sharply increases the activity of acid -peptic factor. A certain role is played by hereditary constitutional factors (hereditary predisposition is found among patients with peptic ulcer in 15-40% of cases).

Direct formation of the ulcer occurs as a result of a disturbance in the physiological balance between "aggressive" (proteolytically active gastric juice, bile reflux) and "protective" factors (gastric and duodenal mucus, cellular regeneration, the normal state of local blood flow, the protective effect of certain intestinal hormones, for example, secretin, Enterogastron, as well as alkaline reaction of saliva and pancreatic juice). In the formation of ulcers in the stomach, the reduction in the resistance of the mucous membrane, the weakening of its resistance to the damaging effect of acidic gastric juice is most important. In the mechanism of development of ulcers in the gastric outlet and especially in the duodenum, on the contrary, the decisive factor is the intensification of the aggressiveness of the acid-peptic factor. The formation of ulcers is preceded by ultrastructural changes and disturbances in the tissue metabolism of the gastric mucosa.

Once emerged, the ulcer becomes a pathological focus, supporting the afferent way the development and deepening of the disease as a whole and dystrophic changes in the mucous membrane of the gastroduodenal zone in particular, contributes to the chronic course of the disease, the involvement of other organs and body systems in the pathological process. Predisposing factors are violations of diet, abuse of acute, rough, irritating food, constantly fast, hasty food, the use of strong spirits and their surrogates, smoking.

Symptoms, course. Characterized by pain, heartburn, often vomiting with acidic gastric contents soon after eating at a height of pain. During the exacerbation of pain daily, occurs on an empty stomach, after eating temporarily decreases or disappears and appears again (with gastric ulcer after 0.5-1 h, duodenal ulcer - 1.5-2.5 h). There is often night pain. Pain is stopped by antacids, anticholinergics, thermal procedures on the epigastric region. Often peptic ulcer is accompanied by constipation. When palpation is determined pain in the epigastric region, sometimes some resistance of the abdominal muscles. Coprological examination determines latent bleeding. With the localization of ulcers in the stomach, the acidity of the gastric juice is normal or somewhat reduced, with duodenal ulcer - increased. Presence of resistant histamine-resistant achlorhydria excludes peptic ulcer (cancer, trophic, tubercular and other nature of ulceration is possible).

Radiographic examination in most cases (60-80%) reveals a limited leakage of barium suspension for the contour of the mucous membrane-the ulcer niche. In the stomach, ulcers are usually localized by a small curvature, in the duodenum - in a bulb. Rarely are found and difficult to diagnose pylorus ulcers, extra-ulcer duodenal ulcers.

The most reliable diagnostic method is gastroduodenoscopy, which allows to detect a ulcer, determine its nature, take a biopsy (with stomach ulcers).

Differential diagnosis is carried out with symptomatic gastric ulcers, ulcerated tumor (including primary-ulcer cancer), tuberculosis, syphilitic ulcer; Ulceration with collagenoses, amyloidosis. A characteristic of peptic ulcer disease is the nature of the pain (hungry, after eating after a certain period of time, nocturnal), a long history of the disease with periodic exacerbations in the spring and autumn periods, the presence of hydrochloric acid in the gastric juice during the study.

The course usually lasts with exacerbations in the spring-autumn period and under the influence of unfavorable factors (stressful situations, nutritional errors, reception of strong alcoholic drinks, etc.).

Complications: bleeding, perforation, penetration, deformities and stenoses, degeneration of the ulcer into cancer (see Surgical diseases), vegetative-vascular dystonia, spasmodic dyskinesia of the gallbladder, chronic cholecystitis, fatty hepatosis, reactive pancreatitis.

The prognosis is relatively favorable, except in cases when complications arise. The ability to work has been preserved, but all kinds of work related to irregular feeding, great emotional and physical overloads are not shown.

Treatment during an exacerbation is spent in a hospital. In the first 2-3 weeks, the regime is bed, then ward. Nutrition is fractional and frequent (4-6 times a day), the diet is full, balanced, chemically and mechanically sparing (No. 1a, 1 b, then No. 1). Assign antacid (Almagel, magnesium oxide, calcium carbonate, etc.), enveloping, astringent (bismuth basic nitrate, 0.06% solution of silver nitrate), and cholinolytic (atropine sulfate, etc.), spasmolytic (papaverine hydrochloride, Etc.) drugs or ganglion blockers. To relieve the emotional strain, use bromine preparations and other sedative drugs, tranquilizers.

Assign vitamins (U, A, group B), methandrostenolone (0.01 g), retabolil (0.025-0.05 g IM once a week), methyluracil (0.5-1 g), pentoxyl (0, 25 g), biogenic stimulants (FIBS, aloe extract, etc.), acting on metabolic and separative processes. Physiotherapy is widely used (diathermy, UHF therapy, mud therapy, paraffin and ozocerite applications).

Sanatorium treatment is recommended to be performed only in the stage of persistent remission (Zheleznovodsk, Borjomi, Essentuki, Pyatigorsk, Morshin, Staraya Russa, etc.).

Prevention: observance of hygienic norms of work, life and nutrition, abstention from smoking and alcohol consumption.

Patients should be under clinical supervision with active courses of anti-relapse treatment (in spring and autumn). Preventive treatment even without severe exacerbation of the disease should be carried out within 3-5 years.