Peptic ulcer disease – Stomach ulcer or duodenal ulcer

Description of peptic ulcer

Язвенная болезнь – боль в слизистой оболочке желудка или начальной части тонкого кишечника, duodenum. Peptic ulcer disease is characterized by its location:

• Ulcer желудка – в желудке;
• Язва двенадцатиперстной кишки – в двенадцатиперстной кишке.

Causes of peptic ulcer

Disturbances in the balance of gastric acid and digestive juices can lead to ulcers. It can cause:

• Helicobacter pylori bacterium (H.pylori);
• The use of non-steroidal anti-inflammatory drugs (NSAIDs) – блокируют способность организма защитить слизистую оболочку желудка;
• Disease, which cause an increase in the amount of acid, such as Zollinger-Ellison.

Not all people, who take NSAIDs or infected with Helicobacter Pylori risk of occurrence of ulcer.

Rare causes of ulcers include:

• Radiation therapy;
• Bacterial or viral infections;
• Alcohol abuse;
• Trauma;
• Severe stress (eg, operation, trauma, traumatic brain injury, shock, or burns).

Risk factors for peptic ulcer

Risk factors for ulcer from H. pylori infection:

• Age: 60 and older;
• Paul: male;
• The lower socio-economic groups;
• Unsanitary living conditions;
• Cigarette smoking;
• Family history of peptic ulcer disease;
• First blood.

Risk factors for ulcer from taking anti-inflammatory drugs:

• Age: 60 and older;
• Paul: male;
• History of stomach disorders from NSAIDs;
• Previous peptic ulcer;
• Cigarette smoking;
• Alcohol abuse.

The symptoms of ulcer disease

Peptic ulcer disease does not always cause symptoms. Symptoms may come and go. Stomach pain after eating, in ulcer, may increase. Also, the food often relieves the pain in the duodenum.

Symptoms include:

• Gnawing pain:
  • Sometimes the pain is impossible to sleep;
  • May change during the meal;
  • It may last from a few minutes to a few hours;
  • Feeling unusually strong hunger;
• Nausea;
• Vomiting;
• Loss of appetite;
• Swelling;
• Belching.

Ulcers can cause serious problems and severe pain in the abdomen. Problems include:

• Кровотечение – симптомы могут включать:
  • Black, tarry stools;
  • Vomiting, that looks like coffee grounds;
  • Weakness;
  • Dizziness;
  • Anemia;
• Перфорированные язвы – прорыв стенки желудка или двенадцатиперстной кишки, and then may receive:
  • Sudden and severe pain;
• Scar tissue, which restricts and eventually closes the exit from the stomach into the intestine and can cause:
  • Vomiting;
  • Weight Loss;
  • Severe pain.

Diagnosis of gastric ulcer or duodenal ulcer

The doctor asks about the symptoms and medical history, and perform a physical examination. Tell your doctor about all the medicines, that you take.

Tests may include:

• Ректальный осмотр и тест для обнаружения скрытой крови;
• Анализ крови или дыхательный тест – для проверки на наличие инфекции Helicobacter Pylori;
  • A blood test may also show the presence of Zollinger-Ellison syndrome;
• Рентген верхней части желудочно-кишечного тракта – выполняется после употребления раствора сульфата бария;
• Эндоскопия– ​​в горло будет вставлена тонкая трубка, allowing to examine the gastrointestinal tract. The procedure used for the next:
  • Preparation of tissue samples, to test them for infection of Helicobacter Pylori or cancer;
  • To rule out other causes of gastrointestinal symptoms.

The treatment of ulcers of the stomach or duodenum

The goal is, to eliminate the source of the problem and heal the ulcer. The healing of gastric ulcers can take a long time.

Treatment includes:

Medication

Some medications block or reduce acid production. Some create a skin ulcer on, to close it. If ulcers caused by h. pylori, you need to take a combination of drugs to kill bacteria. It usually consists of antibiotics and proton pump inhibitors. It is important to take these drugs on prescription. Your doctor may order additional tests through 6-12 months after treatment. This is done, To make sure, bacteria that disappeared.

Medications may include:

• Антациды – могут обеспечить некоторое облегчение от изжоги, not heal ulcers;
• Antibiotics (eg, amoksiцillin, tetracycline and clarithromycin);
• Bismuth-containing drugs;
• Ингибиторы протонной помпы – уменьшают выработку желудочной кислоты (eg, omeprazole, lansoprazole);
• N₂-блокаторы – для уменьшения выработки желудочной кислоты (eg, famotidin, ranitidine, cimetidine, nizatidin);
• Medications to cover the ulcer (eg, sucralfate);
• Medications to protect stomach against NSAID damage (eg, Misoprostol).

Lifestyle changes

• If you smoke, you need to quit smoking. Smoking interferes with ulcer healing;
• Do not drink alcoholic beverages;
• NSAIDs should be avoided, Taki how aspirin and ibuprofen;
• Spicy or fatty foods may worsen symptoms of ulcers. Keep in mind, that these products do not cause ulcers, and do not affect its healing.
• If stress increases ulcer pain, to learn and practice stress management techniques.

Surgery and Endoscopy

If there is bleeding, perforation or neprohodimosty, perhaps, need surgery. Surgical options include:

• Selektivnaя (Election) ваготомия – это техника отсечения части блуждающего нерва. This operation does not require additional drainage;
• Vagotomy combined with antrumectomy (antrektomiey) – операция предполагает отсечение блуждающего нерва в сочетании с удалением нижней части желудка (pylorus). Gatekeeper generates chemical, which promotes the development of acid. Without this chemical acid level falls.

Endoscopy

It can be used, krovotechenie.Tonkuyu to stop tube is inserted through the throat into the stomach or intestines. Then, using heat, electricity, adrenaline, or a substance, которое называется “фибриновый клей” рана, causing bleeding closes.

Vagotomy and drainage

Ваготомия – отсечение части блуждающего нерва. This procedure can greatly reduce acid production. Stripping all the nerve can lead to problems with stomach. In this case it should be created drainage. Drainage can be done one of two ways:

• Пилоропластика – увеличение зазора между желудком и двенадцатиперстной кишкой, allowing stomach contents easy to get into the intestine;
• Гастродуоденостомия – создание нового соединения (anastomosis) between the stomach and duodenum;
• Гастроэнтероанастомоз – создание нового соединения между желудком и тощей кишкой (part of the small intestine).

Two other forms of vagotomy include:

• Избирательная ваготомия – отсекается только часть блуждающего нерва; It requires no additional drainage;
• Ваготомия с антрэктомией – отсекается блуждающий нерв и удаляется нижняя часть желудка (privratnik). Gatekeeper generates chemical, which stimulates the production of acid.

Prevention of ulcers of the stomach or duodenum

To reduce the risk of ulcers from H.pylori infection:

• Wash your hands after using the toilet, before eating or preparing food;
• Drink clean water;
• Do not smoke. Cigarette smoking increases the likelihood of ulcers.

To reduce the risk of ulcers from NSAIDs:

• Use other medications, where possible;
• Take the lowest possible dose of medication;
• Do not take the drug longer, than necessary;
• Do not drink alcohol while taking medicines;
• Ask your doctor about switching to a new NSAIDs. Ask your doctor about taking other drugs to protect the stomach and intestines;
• Do not smoke. Smoking increases the likelihood of ulcers.