One of the most severe and common diseases of the gastrointestinal tract is a stomach ulcer - a chronic pathology characterized by the formation of erosions in the duodenum and stomach. Complete remission never occurs - moreover, the disease is prone to progression.
What causes pathology? What reasons indicate its presence? How is the diagnosis carried out? And what is the treatment regimen? This and many other things will be discussed now.
Reasons
Chronic gastric ulcer (ICD-10 code - K25) occurs as a result of the harmful effects on the body of a bacterium such as Helicobacter pylori. Approximately 80% of people have it, and every person in that majority is potentially at risk.
However, the pathogen begins to exert its destructive effect in tandem with provokingfactors. They disrupt the work of the stomach, and therefore a favorable environment is formed for the development of bacteria. Provoking factors include:
- Diseases such as cholecystitis, gastritis, etc.
- Heredity.
- Unhe althy eating.
- Alcohol abuse.
- Depression and frequent stress.
- Drug abuse.
Chronic gastric ulcer (ICD-10 code - K25) is a chronic pathology, the course of which is irreversible. After all, a scar forms on the mucous membrane, and this area ceases to secrete gastric juice.
This disease occurs in about 10-12% of adults (mostly men). As a rule, the ulcer affects the urban population. Doctors suggest that this is due to nutrition and psycho-emotional factors.
Signs of disease
Chronic gastric ulcer (ICD-10 - K25) is not asymptomatic. But the clinic of this disease largely depends on the individual characteristics inherent in the patient's body.
However, almost all people have an alarming signal of pain, concentrating in the epigastrium. They increase after eating and physical activity (even light), often give to the left shoulder.
Also, many experience burning, aching discomfort and a feeling of excessive pressure. It is even worse when the pain appears at night. This means that the ulcer also affected the duodenum.
In addition, the following symptoms may occur:
- Nausea.
- Metallic taste in mouth.
- Burp. It is normal, but some have fragments of undigested food.
- Problems with bowel movements.
- Insomnia.
- Increased irritability and excitability.
- Heartburn. Happens both day and night.
- Loss of body weight.
- Appetite problems.
- Thirst.
Many people, noticing several of the symptoms listed above, suspect gastritis. The symptoms are really similar. That is why you need to immediately, at the first manifestations of the disease, contact a gastroenterologist.
Diagnosis
To determine a person has a chronic stomach ulcer (ICD-10 - K25), the doctor must conduct a survey and palpation of the abdominal cavity. This will help to identify if the patient has pain in the left hypochondrium and epigastric zone.
After that, events are assigned, the passage of which is aimed at concretizing the diagnosis. Only on the basis of their results it will be possible to find out what a person suffers from - a chronic ulcer of the antrum of the stomach, the bulbar region of the duodenum, or even gastritis.
Here are the required lab tests:
- Blood test for glucose, albumin, total iron, cholesterol and protein.
- Examination of feces and urine.
- Complete blood count.
- Fractional study of gastric secretion.
In addition to the above, instrumentalresearch. As a rule, EGD and ultrasound are prescribed.
If the doctor, even after these examinations, have questions and doubts about the diagnosis, the patient is referred to determine the level of serum gastrin and undergo an endoscopic urease test.
If indicated, CT scan, stomach X-ray and intragastric pH-metry may be ordered.
Antibiotics
These drugs are mandatory prescribed for chronic stomach ulcers. Their action is aimed at destroying the cell walls of bacteria, and they also get inside their cells, after which they destabilize metabolic processes. As a result, the pathogenic microflora dies.
Often doctors prescribe Clarithromycin. This drug is resistant to hydrochloric acid. It is quickly absorbed, and the effect on the body for a long time. If the patient has no contraindications, then he is prescribed as the main remedy for the treatment of chronic stomach ulcers.
They also prescribe Amoxicillin. This remedy is also resistant to the damaging effects of gastric enzymes. It is absorbed by 90%. This fact determines its effectiveness and frequency of use - the drug should not be used more than 2 times a day.
Metronidazole is also a good remedy, which is a reliable, effective, long-used drug. Its components act directly on the DNA of the parasitic bacterium.
Some patients take Tetracycline. Active ingredientsof this drug disrupt the protein synthesis of bacterial cells, as a result of which they die.
Antacids
The use of this group of drugs helps to alleviate the symptoms of chronic stomach ulcers. The most popular remedies include:
- "Almagel". Provides a long-lasting effect, but does not disturb the metabolism. The agent is not absorbed, does not accumulate in the epithelium. This drug well envelops the walls of the digestive organ and neutralizes hydrochloric acid.
- Enterosgel. An excellent sorbent that absorbs harmful substances and promotes their removal from the body. Aggressive components do not have time to damage the mucous epithelium.
- Maalox. The composition of this drug includes magnesium hydroxide and aluminum. These substances work in tandem to neutralize bile acids. The agent has cytoprotective, adsorbing and enveloping effects. A single dose for more than 3 hours relieves a person of pain, belching and other unpleasant symptoms.
- "Phosphalugel". It also has an antacid, adsorbing and enveloping effect. Another tool absorbs pathogenic bacteria and toxic substances within the digestive tract, and then removes them from the body.
- "Gastal". Combined remedy that reduces the level of acidity in the stomach, and also enhances the regenerative and protective processes in the mucous membrane.
- Gaviscon. The drug is characterized by the ability to quickly interact with the acidic contents of the stomach. The gel protects it from the effects of aggressive substances, actsup to 4 hours.
In addition to the above, other antacids may be prescribed. As a rule, the doctor prescribes non-absorbable medications - bismuth preparations, Topalkan, Vakair, Vikalin, etc.
Antisecretory drugs
Their use in chronic stomach ulcers is necessary to minimize the production of hydrochloric acid. Your doctor may prescribe one of the following:
- "Omeprazole". Not only reduces acid secretion. This drug also has a bactericidal effect on the ulcerative pathogen.
- "Gastrosidin". The drug enhances the protection of the mucous membranes of the gastrointestinal tract, and also promotes the healing of lesions that were caused by exposure to hydrochloric acid.
- "Ranitidine". It has a similar effect, also reduces the amount of gastric juice and increases the pH of its contents.
- "Letsedil". Suppresses stimulated and basal production of hydrochloric acid. Known for long-lasting action - from 12 to 24 hours.
- "Thorsid". A diuretic drug that enhances the effect of other antihypertensive drugs. Because of this peculiarity, it must be taken with caution.
- "Rabeprazole". An effective antiulcer drug metabolized in the liver. It is a real salvation for many patients, but has a number of serious contraindications.
Micropreparations "Famotidine", "Ultop", "Pirenzepin", etc. are also used for chronic stomach ulcers
Other medicines
As you can already understand, for the treatment of chronic ulcersstomach complex therapy is used. In addition to the previously listed drugs, the patient may be prescribed:
- Cytoprotectors. They help to increase the protective functions of the mucous membrane. You can drink "Sucralphate" or licorice preparations - "Andapsin" and "Carbenoxalone".
- Antiulcer. This effect is produced by lithium preparations and calcium channel blockers. Well-known medicines of this group are Isoptin, Verapamil, Kordafen and Nifedipine.
- Probiotics. They help reduce reflux. The means of this group include Propulse, Domperidone, Cerucal, Motilium, as well as chaga preparations.
- Sedatives. Individually selected neuroleptics, as well as motherwort and valerian, have a calming effect.
- Antioxidants and vitamins. Needed to strengthen immunity.
As a rule, intensive treatment does not last more than 7 days. But everything is decided on an individual basis, depending on the general he alth of the patient and the stage at which the disease is located. In any case, he will have to be registered with the dispensary for at least 5 years.
And if it turns out that conservative therapy was ineffective, the patient will be recommended surgical treatment.
Operation
If there is an exacerbation of a chronic stomach ulcer or the patient's condition is steadily deteriorating, then he is offered to solve the problem through surgical intervention. The indications for surgery are:
- Rise ingastric or intestinal wall through defect.
- Unstoppable ulcer bleeding.
- Cicatricial narrowing of the outlet section of the stomach, due to which the passage of food is difficult.
- Suspicion of the transition of the ulcer into a malignant form.
- Frequent relapses.
- The presence of diffuse polyposis in the stomach.
- Ulcers that do not heal for a long time.
As a rule, a stomach resection is performed, or a perforated hole is sutured. In rare cases, one has to resort to such operations as pyloroplasty, vagotomy, local excision, gastroenteroanastomosis.
Any intervention is prohibited if a person is diagnosed with an acute infectious or chronic disease in the stage of decompensation or has a malignant ulcer with distant metastases. They also do not perform surgery in case of a serious condition of the patient.
Consequences
Like gastritis, chronic stomach ulcers can lead to serious complications if a person ignores them. Here are some possible consequences:
- Persistent pain that nothing can fix.
- Severe ulceration of the stomach wall, which leads to internal bleeding. This can result in anemia.
- Perforated ulcer. It is characterized by the appearance of a through hole in the wall of the stomach. Because of this, the contents of the stomach spill into the abdominal cavity. As a result, peritonitis may develop.
- Persistent spasms. Because of them, food will stop passing through the stomach and moving through the digestive tract.
- Penetration. Ulcerpenetrates into nearby organs. The pancreas is the most commonly affected. As a result, acute pancreatitis develops.
- Stenosis of the pyloric part of the stomach. This complication can only be eliminated by surgery. Otherwise, the patency of food into the duodenum cannot be restored.
- Perigastritis. This phenomenon is fraught with the formation of adhesions connecting the serous membrane of the stomach with the liver or pancreas. As a result, the gastrointestinal tract is deformed.
- Malignancy. The rarest complication. But also the most life-threatening. After all, it implies the transformation of an ulcer into a malignant tumor.
You also need to be aware of the complications that may arise after surgery. These are suture failure, wound suppuration, peritonitis, bleeding, thrombophlebitis, paralytic ileus, and pulmonary embolism. Fortunately, these effects are extremely rare.
Proper nutrition
Of course, with a chronic stomach ulcer, a diet must be followed. Here are her rules:
- Eat 6 small meals a day.
- Cook food in liquid, jelly-like and mushy form.
- Difficult-to-digest foods, as well as any stimulants of secretion and mucosal irritants, are prohibited.
- No bread of any kind.
- Soups can only be water or milk with cereals (rice, semolina and oatmeal). Definitely a slimy consistency. You can make them with baby food flour.
- Calcined cottage cheese, cream (asadded to soups), as well as whole milk (up to 4 glasses per day).
- Steam omelet and soft-boiled eggs become the main source of proteins.
- It is forbidden to eat too cold or hot food. Comfortable temperature - 15-20 °С and 50-55 °С respectively.
Depending on the patient's condition, diets No. 1A, No. 1B and No. 1 are prescribed. If the patient's he alth improves, then the time for proper nutrition is reduced to 2-3 months. All recommendations regarding the diet are voiced by the doctor, taking into account the condition of his patient.
