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Causes, signs and symptoms, how to treat a stomach ulcer?

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What is a stomach ulcer?

Gastric ulcer is a chronic disease in which the mucous membrane of the stomach arise trophic disorders. Most often, the ulcer occurs in men aged 20 to 50 years. The disease is characterized by frequent relapses in the spring and autumn period. The cause of stomach ulcers, as a rule, are often the stresses that strain the human nervous system, which in turn causes spasms of muscles and blood vessels of the gastrointestinal tract. The result is a circulation disorder of the stomach, and the gastric juice begins to have a detrimental effect on the mucous membrane, which leads to the formation of ulcers.

But still the main cause of stomach ulcers is the bacterium Helicobacter pylori and disturbance of the balance between the protective mechanisms of the stomach and the aggressive factors, i.e., the mucus that secretes stomach can't cope with pepsin (the enzyme responsible for the digestion of proteins) and hydrochloric acid.

Statistics indicates that everything in the world from this disease affecting up to 14% of the population. In Russia this figure is slightly lower at 10%, while the share of children accounted for 1%, and youth 8%.

Most often, peptic ulcer disease diagnosed in men between the ages of 20 and 40 years – approximately 70% of cases. More rarely the disease is detected in older age – 20% of cases. In recent years there has been a tendency to increase the frequency of occurrence of the disease among women.

Depends on the frequency of occurrence of the disease is not only age and gender, but also from professional activities. So, often affects those people whose work is associated with risk of injury to the abdomen, for example, shoemakers, and those who do not have regular opportunities to eat liquid food, for example, the rail workers. Besides, stomach ulcer in different regions of the same country is found with varying frequency due to supply local residents.


Signs and symptoms stomach ulcer

Knowledge of the basic symptoms of a developing pathologicalprocess allows faster to go to the doctor for help and to diagnose the disease, which guarantees the success of therapeutic effects without surgery. However, sometimes a stomach ulcer does not manifest itself, suggesting the need for routine examinations. Usually asymptomatic ulcerative process is observed in 25 – 28% of cases, and detects the presence of ulcers after the death of the patient.

Suspected ulcerative lesions of the stomach can by the following features:

  • Painlocalized in the upper abdomen. This symptom is manifested in 75% of cases. Half of the patients complain of feeling weak intensity, the remaining 50%, they are more pronounced and intensify during exercise and after ingestion of alcohol or spicy foods, prolonged intervals between meals;

  • Heartburn. It is expressed in the burning sensation in the epigastrium. Arises from the fact that the acid stomach contents having a corrosive environment, enters the lumen of the esophagus, irritating its walls. This symptom is commonly observed and found 80% of patients. A heartburn usually after 1-2 hours after eating;

  • The feeling of nauseasometimes accompanied by vomiting. This symptom is caused by disorders of gastric motility. Ulcer vomiting is observed after 1.5-2 hours after eating and as the release of stomach brings a sense of relief. So often sick cause vomiting independently;

  • Loss of appetite peptic ulcer disease may be associated with apprehension of a person to experience pain or impaired motility of the gastrointestinal tract;
  • Regurgitation, which is characterized by the uncontrolled reflux of gastric juice into the oral cavity. Thus the patient feels the bitterness or sour taste in the mouth;
  • Increased gas formation;

  • The emergence of a feeling of heaviness in the stomach, observed after eating;

  • Fast coming the feeling of fullness;

  • Violations of the chair. Most often, patients complain of constipation, and diarrhea atypical for peptic ulcer disease. Difficulty with bowel movements experiencing to 50% of patients, especially in acute ulcers of the stomach.

Among the external signs of stomach ulcers should also note the presence of gray patches on the tongue that almost always indicates problems with the gastrointestinal tract. The patient may suffer from excessive sweating of the palms and experience painwith pressure on the epigastric region.

Pain gastric ulcer

The nature of the pain depends on where the lesion is localized.

Depending on the complaints presented by the patients, the doctor is able to suspect an ulcer or other stomach Department:

  • With the defeat of subcatalog and cardia the pain starts to bother you before, about 20 minutes after eating. While localized discomfort highly enough – from the ensiform process of the epigastric region. Often such pain can give in the heart and it is wrong to differentiate. They traced a clear connection with food intake, but there are no Parallels with physical exertion. Relief brings the adoption of milk or antacids. As for intensity, the pain is weak. Often accompanied by vomiting, belching, heartburn.

  • With the defeat of the lesser curvature of the stomach pain occurs in the epigastric region, which is located to the left of the median line of the abdomen. They start after eating on average 1 hour. After the stomach is doing its job, the pain go away. Often patients complain about the appearance of discomfort after long breaks in the meal and in the evening and night hours. The intensity of pain is moderate, nature – aching. When the process is acute, the pain become very pronounced. The patient is often sick, but vomiting is rare;
  • With the defeat of the greater curvature of the stomach pain have low intensity, making it difficult to diagnose this type of ulcerative lesions. This is such a ulcer is often malignant in nature, although rarely;

  • With the defeat of the antrum pain often occur in the evening and night hours, are accompanied by sour belching and heartburn. Localization epigastric region;

  • With the defeat of the pyloric canal the pain is quite intense, their character – paroxysmal. One attack may last up to 40 minutes. Meet night of pain and hunger, however in some patients a correlation between food intake and pain. Increased saliva production, there is often persistent and prolonged heartburn.

Sometimes physicians are faced with atypical manifestations of ulcerative process. Pain can occur in the right hypochondrium, right iliac region, lumbar region, in the region of the heart, or not appear at all. All this makes diagnosis of disease and often leads to complications.


Causes stomach ulcers

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At the moment it is proved that the ulcer occurs due to infection by the bacterium Helicobacter pylori (75% of cases). It is a spiral bacterium that adapts to the aggressive environment of the stomach and has the ability to neutralize hydrochloric acid. Under the influence of the products of that bacteria die off cells of the gastric mucosa, which leads to the development of ulcers.

Infected with this bacterium difficult, the source is the media, and it is transmitted through saliva (by kissing), through contaminated food and water, through medizintechnologie medical instruments, through the dirty dishes, from mother to fetus.

Among other reasons, leading to the development of stomach ulcers, can be identified:

  • The use of medicines. First and foremost, on the development of the disease have an effect of NSAIDs (aspirin, indomethacin, diclofenac, phenylbutazone, Ketoprofen, ibuprofen). The risk increases when the patient's age exceeds 65 years, and if there were cases of gastric bleeding if you want in large medicinal doses, if treatment involves the use of anticoagulants or corticosteroids. Other drugs that can trigger the development of ulcers include cytotoxic drugs, potassium supplements and antihypertensive drugs;

  • Ulcers can be a consequence of other diseases, among which tuberculosis, diabetes, Crohn's disease, hyperparathyroidism, lung cancer, hepatitis, cirrhosis, pancreatitis, syphilis , etc.;

  • Injury of stomach, infection blood, any shock, burns large body surface and frostbite;

  • Stress, poor diet, bad habits, unstable emotional state. In particular, the abuse of coffee can be attributed to the factors influencing the development of ulcers;

  • A hereditary factor, in particular, the presence of the same pathological process in close relatives. Besides, it is established that risk of ulceration is higher in people with first blood (average 40%).

Risk factors

Factors leading to the development of ulcers, a lot, but here are those that are considered to be the most common:

  • Smoking (not necessarily cigarettes, and this includescigars and hookah);
  • The abuse of alcohol;
  • Frequent and in large doses the consumption of soda and drinks containing caffeine;
  • Irregular meals;
  • Eating too cold or too hot food, which can damage the gastric mucosa;
  • Constant intake of anti-inflammatory drugs (e.g. ibuprofen);

  • Frequent depression or a stressful situation;

  • Frequent and excessive consumption of sweet products (such as biscuits and cakes).

Complications of stomach ulcers

Stomach ulcer dangerous serious complications, many of which can lead to death.

Among the most dangerous effects of ulcers decided to allocate the following pathology:

  • Penetration. When this happens the destruction of the gastric wall, and the bottom of the ulcer becomes organ located directly under this wall. Most often, suffers from the pancreas, but sometimes the process involves a small gland, gall bladder, intestines, or liver. Secreted by the stomach, hydrochloric acid destroys the pancreas and leads to the development of acute destructive pancreatitis. That the patient has manifested penetration, according to acute pain zoster nature, the increase in body temperature to critical values and an increase in blood levels of alpha-amylase. There are all signs of inflammation, pain occurs regularly, regardless of meals or time of year. To determine the presence of penetration necessary to conduct x-ray examination of the stomach and FGS;

  • Perforation of the stomach, when the destruction of one of its walls there is a rupture of the contents into the abdominal cavity. The impetus for the perforation of the wall can be reinforced physical activity, intake of spicy food and alcohol. This patient complains of severe pain in the abdomen, feeling of General weakness, there are signs of poisoning the body. Perforation encountered suddenly, can cause painful shock 10 hours later the person develops peritonitis. In this case, the FPS is contraindicated, necessary x-rays of the stomach;

  • Gastric bleeding. This complication is often fatal and occurs in 20% of cases. Oftenaccompanied by penetration. In this case the patient vomits mass similar to coffee grounds, there are General signs of blood loss. The stool becomes black and tarry. Pressure falls, there is shortness of breath, tachycardia, sweating appears. It is crucial to stop the bleeding, otherwise it will lead to death.

  • Malignancyin which the ulcer turning into stomach cancer, although this is very rare and was observed only in 3% of patients. As for duodenal ulcers, they never actually go into cancer. Degeneration in most cases is exposed to callous ulcers, and those that are long-term scars. If there is a transformation of the ulcer, the patient rapidly loses weight, refuses to accept food, especially meat. Progression of tumor process, the person begins to suffer from feverand vomiting, often with blood. Without treatment, the body will be brought to a state of complete exhaustion, which threatens a fatal outcome. If you suspect a transformation of the ulcer is necessary to conduct FGS with the implementation of the three-point biopsy (sampling of the material from the walls of the ulcer, with its bottom and edges);

  • Stenosis of the pylorus is a dangerous complication of ulcers localized in the pyloric division of the organ, that is, in the most narrow part of the stomach. More frequently recurs ulcer, the higher the risk of this complication. Narrowing of the pyloric part leads to the fact that the food begins to stagnate in the body because of difficulties with the passage in the intestine.

It is customary to distinguish several degrees of stenosis, depending on its severity:

  1. Compensated stageduring which symptoms such as sour belching, feelings of heaviness and fullness. However, the patient feels well;

  2. At subcompensated stage, even when taking minor servings of food a person begins to feel the glut and heaviness in the stomach, this condition eases vomiting, which leads to its frequent occurrence. The person begins to experience a fear of eating and therefore refuses it, the fast and largely lose weight;

  3. About decompensated stage of stenosis can be judged by the following symptoms: profuse and frequent vomiting immediately after eating, dehydration and weight loss, the occurrence of muscle cramps. With all that goes into the stomach can no longer take place inthe gut as the gatekeeper finally narrowed.


Diagnosis of gastric ulcer

The reason for referral of the patient at diagnosis with the aim of establishing ulcers of the stomach are complaints of pain associated with the process of eating. No time to hesitate if the pain is accompanied by vomiting or nausea.

Diagnosis consists of several stages:

  • For a start, the patient will need to take a blood, urine, and feces for a General analysis, and also to pass stool for occult blood. If a General blood test will show the presence of anemia, decrease in the number of erythrocytes on the background of increase in ESR, it indicates the presence of inflammation;

  • Faggs, when the doctor, using a special tube with a camera on the end, thoroughly examines the gastric mucosa. At the same time possible the collection of material for biopsy;

  • Ultrasound of the digestive tract (stomach, gall bladder, liver and pancreas);

  • Roentgenography of the affected organ with the use of a contrast agent. Although currently this method is deprecated;

  • Monitoring the pH of gastric juice during the day and pH-metry. It is quite a painful method, as it refers to invasive. It allows us to estimate the aggressiveness of gastric juice in relation to its lining mucous membrane.

It is desirable that conducted special tests to determine the presence in the human body of the bacterium Helicobacter pylori.

To do this:

  • Detection of antibodies to them in blood (serological method);

  • Conducting a fecal test (detection of antibodies to Helicobacter pylori in the stool of the patient);

  • Radionuclide respiratory urease test (defined man exhaled urea, which secrete bacteria);

  • Rapid urease test (testing of the gastric mucosa following fegds).

If indicated, the patient is sent for x-ray examination of stomach on CT, endoscopic ultrasonography, etc.

Most importantly, as soon as possible to exclude the presence of complications, particularly bleeding.

How to cure a stomach ulcer?

To cure this disease, using only one specific drug, it is impossible. The approach should be comprehensive and, first and foremost, you shouldto neutralize the bacterium Helicobacter pylori. Then it is necessary to reduce the acidity of gastric juice, which will eliminate many unpleasant symptoms (in particular, belching, heartburn and nausea) and prevent the development of complications.

Upon detection of bacteria previously it was thought that it must be eliminated from the body completely, using antibacterial therapy.

Her disappearance from the body was tested using:

  • Sowing;
  • Urease test during EGD;
  • Serological method.

However, after it was determined that to completely withdraw Helicobacter pylori will fail because some types of this microbe have the ability to move down into the intestines, which causes the development of dysbiosis and inflammatory process. Moreover, a high risk of reinfestation, given the ease of transmission of the germ from one person to another.

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Antibiotic therapy

At the moment the patient with gastric ulcer appoint a maximum of two courses of antibiotic therapy.

They may include:

  • Penicillins, mainly Amoxicillin;
  • Tetracycline;
  • Macrolides, namely Clarithromycin;
  • Derivatives nitroimidazole.

Tools that increase the protection of the mucosa

Patients with an ulcer it is necessary to increase the protection of the mucous membrane lining the stomach.

To do this, doctors prescribe the following medications:

  • For forming a protective coating on the bottom of the ulceration prescribe Sucralfate;
  • To accelerate the process of regeneration of the gastric mucosa is used sodium carbenoxolone, in particular – Caved, Bigastro, Ventrical;
  • For the formation of a film on the wall of the stomach, as well as for the destruction of helicobacteria used colloidal subcitrate of bismuth, namely, a drug De-Nol;
  • For stimulation of regenerative processes of damaged cells, as well as to enhance the production of mucus is advisable to take Enprostil.

Antisecretory drugs

A full treatment of ulcers is impossible without the use of antisecretory drugs.

These include:

  • Antacids, enveloping the stomach and contribute to neutralization of corrosive properties of hydrochloric acid combined withanti-inflammatory action. The antacids include Maalox, Almagel, a's keala and Sucralfate;

  • Patient requires taking proton pump inhibitors (Omez, Omeprazole, Rabeloc, Rabeprazol, Nexium, etc.). They prevent an increased formation of hydrochloric acid in the stomach and inhibit the proton pump;
  • Blockers n2gistaminovyh receptor – (Quamatel, Famotidine, Erinit, Ranitidine). These drugs eliminate the merging of histamine and increase the production of gastric juice. It should be noted that blockers of H2-histamine receptors in recent years, almost not appointed. This is due to the fact that after their withdrawal the symptoms of peptic ulcer disease returned in full;

  • Blockers M-cholinergic receptors, in particular, Pirenzepin and Gastrozepin. These funds are aimed at decreased production of hydrochloric acid, in addition, they help to eliminate pain and dryness in the mouth;

  • Synthetic analogs of prostaglandin E1, namely Misoprostol and Cytotec. These drugs increase the production of mucus and bicarbonate, as well as reduce the formation of hydrochloric acid.

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Other drugs

A patient with a gastric ulcer may need additional medicines, we are talking about:

  • The antispasmodics (no-Spa, Drotaverine, Mebeverine) which contribute to pain relief and the removal of spasm of the gastric walls;
  • Prokineticin (Motilium, itopride does, Domperidone, etc.) that improve the motor function of the digestive tract and do not give products stay too long in the stomach;

  • Probiotics (Bifiform, Linex, etc.) in that case, if you use antibacterial agents;

  • Sedative drugs, such as TenTen and Valerian.
  • Antidepressants – Amitriptyline and tranquilizers, among which Tazepam and Elenium.

The ulcer treated from 2 weeks to 1.5 months, depending on the severity of the pathological process and the size of the existing defect.

To understand what tools are used for the treatment of stomach ulcers, it is important to focus on two main schemes. The second is used when the first doesn't help. In the first scheme consists of proton pump inhibitors + drugs penicillin + clarithromycin. If after a week of receiving not observed any visible effect, doctors apply a second therapeutic scheme, which includes proton pump inhibitors +metronidazole + De-Nol + tetracycline.

However, it should not be assumed that improvements in methods of treatment of ulcers of the stomach occurs. At the moment, scientists developed and already tested a new vaccine that helps protect people from infection with Helicobacter pylori.

Indications for surgery

Sometimes ulcers cannot be resolved using only conservative treatment. In this case, the patient shows an operation. Surgeon can be carried out only in the presence of specific indications. In particular, if medication does not give desired results, or if high risk of complications with the medication.

Among absolute indications are:

  • Ulcer perforation;
  • The development of bleeding;

  • The third degree of stenosis;

  • The transformation of the ulcerative process in cancer.

Relative to the testimony of doctors include:

  • The process of penetration;

  • Deformation of the stomach resulting scars;

  • The increasing incidence of recurrence of the disease;
  • The second degree of stenosis;
  • Callous ulcer;
  • Nasazhivanii ulcers over a long period of time.

If there are indications for surgical intervention, it is not necessary to avoid it and delay. Please note that any elective surgery carries fewer risks than an emergency. Moreover, emergency intervention is not always effective, and complications definitely are a threat to the life and health of the patient. Therefore, if the doctor speaks of the necessity of surgical intervention, it is not necessary to continue the treatment by conservative means.

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The nutrition of the patient with gastric ulcer

What you can eat with a stomach ulcer?

Patients with stomach ulcer are in need of a specific power scheme. First and foremost, to the diet presented two basic requirements: products must not be irritating to the gastric mucosa, but at the same time needs to provide the full needs of the body. Should have at least five times per night, but the portions must be strictly dosed, not to stretch the diseased organ.

It is important that cooked food was not too cold or hot,you should not fry dishes. The main way of brewing for a couple.

The patient is allowed to eat:

  • Mucous soups from cereals, semolina, rice and oats;
  • Lean meat varieties (chicken, Turkey or veal);
  • Liquid pureed cereals;
  • Eggs in the form of an omelette or boiled;
  • Jellies, compotes;
  • For dessert, you can use honey;
  • Of dairy products need to give preference to the cream cheese and cream, but with a small amount of fat.

You need to eliminate from the diet?

  • Alcohol;
  • All fried, smoked and fatty;
  • Flour (bread and bakery products);

  • Fall under the ban of fruits and vegetables, but not all, and irritating the stomach. It's tomatoes, beans, cabbage, radish, figs, gooseberries, citrus fruits;

  • Should abandon sauce, canned food, spicy seasonings;
  • Not recommended coffee, cocoa, strong meat broths.

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Prevention of gastric ulcers

Preventive measures aimed to prevent the development of disease, are as follows:

  • Protection from infection by the bacterium Helicobacter pylori. This requires the observance of rules of personal hygiene, and use separate equipment and utensils and the restriction of close bodily contact. This is especially true if the immediate environment of the person with peptic ulcer disease;
  • It is important to monitor their health and time to eliminate the disease, which can lead to the development of gastric ulcers;

  • Should give up bad habits and eliminate all the factors causing the decline in immunity;

  • A proper diet is an important preventive measure. You need to eat thermally processed foods, food take small frequent meals, minimize spicy and fried meals;

  • Reception of all medicines, especially those that provoke development of peptic ulcer disease, should be under medical supervision and with strict observance of dosage;

  • Should be possible to protect yourself from getting into a stressful situation. If this is not possible, after consultation with the doctor to take sedatives;

  • Notforget about minimal physical exertion. It is important not to overload the body, to fully relax and to do as much work;

  • The adherence of the day with full rest and sleep at least 8 hours – that is the basis of prevention of most diseases, including stomach ulcers.

There are secondary preventive measures that must be followed in the case if the disease has already been diagnosed. They are intended to prevent cases of relapse of the disease and avoid its complications. For this it is important to regularly be seen by a doctor and comply with their recommendations. In the case of aggravation of the disease, especially in the spring and autumn period, it is necessary to pass therapeutic courses.

To the patient it is important to stick to a diet and not eat foods that are banned. Will benefit for a long period of time on the fresh air and Spa treatment. On the recommendation of doctor may be assigned to the long-term antisecretory medications.

About a complete remission of peptic ulcer can be the case that for three years or more, the person is not observed exacerbations.

With regard to the Outlook for recovery is favorable in that case, if the disease was detected. Also a necessary condition remains adequate complex therapy, and, if necessary, the consent of the patient for surgery. Poor prognosis when the disease gives complications.