Causes and symptoms of duodenal ulcer. Signs of a stomach and duodenal ulcer Duodenal ulcer symptoms and manifestations

And the intestines are diverse in nature and do not appear immediately or at the same time. The first characteristic signs of the manifestation of such diseases begin at an early stage and are mistaken by many people for non-serious functional disorders of the digestive organs. At an early stage, the symptoms are vague, many signs are similar, but a quick cure is still possible if the disease is diagnosed in time. The long process of disease development initially manifests itself occasionally, episodically, approximately 1-2 times a year. The future patient of the gastroenterologist, without paying special attention to this, does not seek medical help, although the general deterioration of the condition is progressing constantly and steadily, and this is associated with the defeat of more and more new areas.

An irresponsible attitude towards one’s health leads to the fact that the signs of an ulcer or stomach become more pronounced, and a stage of the disease begins at which it is no longer possible not to react. Inflammation of the mucous membrane leads to permanent and acute pain in the epigastric region, indigestion, discomfort, and deterioration of the general condition. In order to prevent serious damage to organs, you need to see a doctor at an early stage in order to undergo a diagnosis and determine what is still possible for successful treatment. The longer the moment of making a decision is delayed, the more irreversible the consequences of delay will be.

1 Early manifestations

At an early stage, when the external signs resemble gastritis, which occurs in approximately 35% of adults, the pathology manifests itself as follows:

pain after eating in the epigastric region with radiation to the back, lower back, chest;
pain at night;
pain from hunger several hours after eating (“hunger” pain);
negative sensations 1 and 2 hours after eating (“early” and “late” pain).

Continuous signaling of the receptors is also reinforced by accompanying, extremely negative sensations in the form of nausea, which occurs for no apparent reason, often not related to food intake, and spontaneous, often in the morning when the stomach is empty. Gagging and vomiting occur a short time after eating. A direct relationship with the process of eating food causes loss of appetite, lack of desire to eat previously favorite foods, concomitant loss of body weight, and deterioration in appearance. All this is accompanied by impaired peristalsis, increased gas production, bloating, constipation or diarrhea, and a violation of the frequency of natural bowel movements. A reasonable person with such symptoms already understands the need to see a doctor.

The presence of constant pain causes character changes: a person withdraws into himself, constantly listens to internal sensations, becomes hot-tempered and irritable. The disease becomes chronic, but its diagnosis is sometimes complicated by the absence of pain or its uncharacteristic manifestation, which is mistaken for symptoms of another lesion. They begin to treat it, often on their own, and the use of medications in such cases only aggravates the overall clinical picture.

2 Initial stage of the disease

At the early stage of a duodenal ulcer, the symptoms are superficially similar to the same stomach disease. A specialist can determine the location of the lesion based on the differences that appear in the symptoms:

pain is observed only on an empty stomach, which leads to night meals to relieve the symptom;
when pressing on the stomach, a person experiences pain;
characterized by frequent sour belching, accompanied by heartburn;
vomiting is observed with blood, and later blood clots appear in the stool.

The intensity of pain can vary depending on the degree, location, and pain threshold of the patient. Seasonal exacerbations are characteristic, which become habitual and expected, which causes personal changes. A person becomes a hypochondriac, begins to treat himself with increased attention, demands the same from others, constantly listens to his feelings, and often falls into depression. This is due to indigestion, accompanied by heartburn, belching, nausea, and vomiting.

Intestinal ulcers are characterized by constant heartburn, sometimes simply unbearable, causing burning pain and smelling like a rotten egg or recently eaten food. All this leads to high fatigue, sensitivity to the weather, sometimes hysteria and self-obsession. There is no loss of appetite, as with a stomach ulcer; on the contrary, it is increased, because the feeling of hunger causes pain, which food can soothe.

The similarity of external manifestations of stomach and intestinal ulcers at an early stage sometimes causes difficulty in localizing the lesion. In the absence of appropriate treatment, which includes diet, the symptoms change somewhat and progress, indicating an exacerbation stage.

3 Symptoms of exacerbation

Failure to provide timely assistance and an irresponsible attitude towards the health of the digestive system cause exacerbation of stomach ulcers, and symptoms usually force one to seek medical advice. During this period, the pain intensifies, becomes unbearable, and is accompanied by negative manifestations. It can hurt between the shoulder blades and in the lower back.

Atypical pain manifestations are accompanied by belching, nausea, vomiting, heaviness in the abdomen, general weakness, and increased sweating. The clinical picture may be individual, with the absence of some symptoms, but the main signs, including stool disorders, indicate a pathology of the digestive organs. When trying to survive an exacerbation, which usually occurs in the fall or spring, you can wait until life-threatening complications arise:

destruction of the stomach wall (penetration);
holes in the wall of the stomach (perforation);
development of cancer (malignancy);
bleeding;
pyloric stenosis (narrowing of the narrow part of the stomach, up to complete refusal to eat food that causes discomfort).

Treatment of exacerbation of the disease, depending on the degree of its severity, can be inpatient, surgical, medicinal and dietary, strictly under the supervision of a doctor.

4 Duodenal ulcer

With an exacerbation of a duodenal ulcer, pain symptoms are characterized by the same intolerance and intensity as with a stomach ulcer. There is a sharp change in the sensations of taste buds, heartburn, nausea, vomiting, constipation, a grayish coating on the tongue, and a fairly frequent increase in temperature. A nagging pain may occur under the right rib.

A characteristic symptom is an aversion to dairy products and fruits, with increased appetite caused by the desire to get rid of pain by eating, weight loss is observed, constipation can be replaced by loose, foul-smelling stools. Lesion of the duodenum, which is not treated, can lead to:

digestive system disorders;
inflammation of the pancreas;
stagnation of bile;
gallstones;
liver dysfunction;

1Causes of the disease
2 Signs of pathology
3Diagnostic methods
4Therapeutic procedures
5Diet therapy
6Surgical treatment
7Physiotherapy
8Therapeutic exercise

1Causes of the disease

Now scientists claim that there are two main reasons for the development of duodenal ulcers (DU):

Infection with the bacterium Helicobacter pylori, which over time and under certain factors provokes inflammation and erosion of the walls of the stomach and duodenum. Helicobacter pylori infection occurs from person to person through kissing, sharing dishes, cutlery and personal hygiene items. After entering the stomach, the bacterium begins to actively multiply, producing urease and proteases. These enzymes destroy the protective layer of the walls of the stomach and duodenum, as a result, defects appear in the mucous membrane and peptic ulcer disease begins. Metabolic disorders develop in damaged tissues, mucosal cells do not work properly and produce less mucus.
A stomach ulcer develops due to a decrease in the protective properties of the mucous membrane, which is no longer able to withstand the corrosive effect of gastric juice. Increased aggressiveness of pepsin and hydrochloric acid against the background of pathological structural changes in tissues leads to the appearance of defects in the mucous membrane and duodenal ulcers.

Predisposing factors worth considering:

Heredity. At the genetic level, parents pass on to their children an excessive number of cells that produce hydrochloric acid or a reduced secretion of protective mucus components.
Easily excitable nervous system. Peptic ulcers often occur in people who are easily excitable and tend to keep the effects of stress and problems to themselves.
Poor nutrition. It is very harmful to eat dry food and on the run, especially when consuming semi-finished products and fast food. Abuse of spicy, smoked, fried, salty foods and seasonings leads to irritation of the gastrointestinal mucosa and disruption of the production of gastric juice.
Taking analgesics and non-steroidal anti-inflammatory drugs. Ibuprofen, Acetylsalicylic acid, Ortofen have a strong irritating effect on the gastric mucosa and duodenum.
Bad habits. Heavy smokers and those who like to drink a glass of vodka are also at risk for stomach and duodenal ulcers.

Rare causes of duodenal ulcer are considered to be: amyloidosis, celiac disease, Crohn's disease, liver cirrhosis, chronic obstructive bronchitis, diseases of the nervous system, HIV infection and germination of pancreatic cancer.

2 Signs of pathology

The first symptoms of a duodenal ulcer are pain that systematically appears in the upper abdomen. A characteristic symptom is pain at night and so-called “hunger” pains, when the patient needs to eat at least crackers for them to subside. With a duodenal ulcer, the symptoms have their own rhythm - pain occurs 1.5-3 hours after eating, when the patient feels hungry, and disappears after eating and antacids (Maalox, Almagel).

Painful sensations are localized above the navel or in the epigastric region. They can radiate to the back, under the shoulder blade and to the heart area. Eating food that does not fit into the diet, excess food, carbonated drinks and alcohol can cause a clear increase in pain.

It is noteworthy that 2-3 hours after eating, patients with gastric and duodenal ulcers experience heartburn. Not all patients experience nausea, vomiting, belching with a sour taste, and constipation.

People suffering from peptic ulcers have a normal or even increased appetite, but they still experience weight loss. Against the background of night hunger and pain, nervousness, poor sleep and unstable mood develop.

In an advanced stage, duodenal ulcer without appropriate treatment can manifest itself by vomiting blood. Blood in the stool is noticed by a change in the color of the stool, it becomes black. The listed signs are a reason for urgent hospitalization, since the patient has internal bleeding, which can be fatal. Please note that the symptoms of an intestinal ulcer do not always appear; without treatment, the mucosal defect will become deeper, and this is dangerous due to perforation, bleeding and blood poisoning.

3Diagnostic methods

Endoscopy is the most informative way to examine the internal conditions of the stomach and duodenum. Using endoscopic equipment during esogastroduodenoscopy, the doctor not only sees data on the mucous membrane in an enlarged form on the screen, but can also take a sample of ulcer tissue and a sample of gastric contents for the subsequent detection of Helicobacter Pylori microbes and study of the acidity of gastric juice.
The search for Helicobacter Pylori bacteria is carried out in all available biomaterials - blood, feces, vomit and a sample obtained from an endoscopy biopsy.
X-ray examination of the duodenum. Currently, the technique is rarely used.
Palpation. This method is used by talented diagnosticians to make a preliminary diagnosis.

4Therapeutic procedures

You need to prepare for the fact that the treatment of a duodenal ulcer will be long and complex. This includes medication, diet, physiotherapy, exercise therapy and systematic spa treatment.

How to treat a duodenal ulcer in the acute stage? The answer is clear - in a hospital setting.

To relieve pain and speed up scarring of the ulcer, the patient requires bed rest, complete emotional peace and a strict diet.

The treatment regimen is drawn up in accordance with the identified pathologies and test results. If Helicobacter bacteria are found on the mucous membrane of the stomach and duodenum, emphasis will be placed on the use of antibiotics to destroy microorganisms.

In general, treatment of duodenal ulcers includes the following groups of drugs:

Antibiotics and antiprotozoal agents aimed at inhibiting the vital activity of Helicobacter pylori. These drugs include Metronidazole, Tetracycline, Amoxicillin, Clarithromycin.
Complex preparations containing bismuth subnitrate or bismuth subcitrate - De-nol, Vikair, Vikalin. They have a bactericidal effect on Helicobacter pylori and promote the formation of a protective film on the walls of the stomach and duodenum. In addition, these drugs contain magnesium salts, which reduce the acidity of gastric juice and reduce the activity of pepsin.
Antisecretory drugs designed to reduce the production and reduce the aggressiveness of gastric juice. This group included proton pump inhibitors (Pariet, Omeprazole, Pantoprazole, Rabeprazole, Esomeprazole), H2-histamine receptor blockers (Roxatidine, Ranitidine, Nizatidine, Famotidine, Kvamatel), drugs blocking M-cholinergic receptors (Gastrocepin, Buscopan, Pirenzepine).
Prokinetics are drugs that improve the motility of the stomach and intestines; treatment with Trimedat simultaneously relieves the tone of the esophagus and affects the receptors of the large intestine, which leads to rapid emptying. Cerucal and Motilium help get rid of nausea and vomiting, epigastric pain, heartburn, belching, early feeling of fullness in the abdomen, etc.
Antacids (Maalox, Almagel, Phosphalugel, Keal) reduce stomach acidity, adsorb excess acid and gases, coat the walls of the stomach and intestines, thereby reducing pain in the upper abdomen for several hours.
Gastroprotectors (Sucralfate, Venter) accelerate the healing of peptic ulcers of the intestines and stomach, protect the gastric mucosa and duodenum from the effects of hydrochloric acid and pepsin. Venter reduces the activity of pepsin by almost 1/3, but does not affect the acidity of gastric juice. The active ingredient of both drugs, Sucralfate, binds to proteins at the site of the ulcer, resulting in the formation of a protective film. Thus, the medicine speeds up the restoration of damaged tissue, accelerating the scarring process, and prevents the development of relapses of peptic ulcer disease.
Auxiliary medications - antispasmodics and analgesics: Baralgin relieves spasms of the stomach and intestines and reduces pain. Drotaverine eliminates spasm of smooth muscles and relieves spastic pain by expanding the lumen of blood vessels and improving the supply of oxygen to tissues.
Means for improving the nutrition of the intestinal mucosa. The most commonly prescribed are B vitamins and Actovegin. The latter remedy has a stimulating effect on metabolism and the process of absorption of nutrients, and also increases blood supply.

5Diet therapy

How to treat a duodenal ulcer is now clear. There are a lot of medications, so the prescription should only be made by a doctor. Please note that diet plays an important role in the treatment of peptic ulcers. It should exclude chemical, mechanical and thermal irritation of the stomach and duodenum. During an exacerbation, special diet No. 1 is indicated, which involves split meals in small portions, that is, 5-6 times a day. It includes lean boiled meat and fish, unleavened dairy products, pureed boiled vegetables (not containing insoluble plant fiber), boiled, baked or mashed fruits and berries, liquid cereal porridge, day-old white bread, rose hip decoction, as well as cocoa. milk, weak tea and coffee.

The ban applies to pickled, salted, smoked and fried foods, canned food, sour berries and fruits, fermented milk products, bran, legumes, cabbage, beets, radishes, fatty meat and fish, strong coffee, sour fruit juices and carbonated drinks. . Food should be warm; hot and cold foods are contraindicated for patients.

6Surgical treatment

If an intestinal or gastric ulcer is perforated, bleeding appears, or stenosis of the duodenal pylorus develops, urgent surgical intervention is required. Surgical treatment of ulcers is recommended for patients whose benign ulcer has not healed after 4 months of conservative therapy.

7Physiotherapy

At the acute stage, physiotherapy increases the effectiveness of medications. Thus, ultrasound and microwave therapy, electrophoresis with papaverine and novocaine relieve pain and reduce the production of gastric juice.

Modulated sinusoidal currents are used to relieve pain and reduce inflammation. All of these procedures improve blood circulation in the digestive system.

8Therapeutic exercise

Simple physical therapy exercises help normalize the secretory function of the duodenum, as well as improve motility and overall blood supply to the intestines. Exercise therapy is useful for people after hospital treatment and prolonged bed rest.

Patients with peptic ulcer disease can undergo specialized treatment in resort-type sanatoriums Morshyn, Kvitka Polonyny (in Transcarpathia), Truskavets, Borjomi, Essentuki, Zheleznovodsk. In normal times, people with stomach and duodenal ulcers are recommended to drink mineral water from Jermuk, Borjomi, Essentuki No. 4. Duodenal ulcer is treated with a whole range of measures; trust the prescription of medications to an experienced doctor, but remember that diet is very important for recovery.

Peptic ulcer of the duodenum- a disease of the duodenum of a chronic relapsing nature, accompanied by the formation of a defect in its mucous membrane and the tissues located underneath it. It manifests itself as severe pain in the left epigastric region, occurring 3-4 hours after eating, attacks of “hungry” and “night” pain, heartburn, acid belching, and often vomiting. The most serious complications are bleeding, perforation of the ulcer and its malignant degeneration.

General information

Duodenal ulcer is a chronic disease characterized by the occurrence of ulcerative defects in the duodenal mucosa. It lasts a long time, alternating periods of remission with exacerbations. Unlike erosive damage to the mucosa, ulcers are deeper defects that penetrate into the submucosal layer of the intestinal wall. Duodenal ulcer occurs in 5-15 percent of citizens (statistics vary depending on the region of residence), and is more common in men. Duodenal ulcers are 4 times more common than gastric ulcers.

Reasons for development

The modern theory of the development of peptic ulcer considers the key factor in its occurrence to be infection of the stomach and duodenum by the bacteria Helicobacter Pylori. This bacterial culture is sown during bacteriological examination of gastric contents in 95% of patients with duodenal ulcers and in 87% of patients suffering from gastric ulcers.

However, infection with Helicobacter does not always lead to the development of the disease; in most cases, asymptomatic carriage occurs.

Factors contributing to the development of duodenal ulcer:

nutritional disorders - improper, irregular nutrition;
frequent stress;
increased secretion of gastric juice and decreased activity of gastroprotective factors (gastric mucoproteins and bicarbonates);
smoking, especially on an empty stomach;
long-term use of medications that have an ulcerogenic (ulcer-generating) effect (most often these are drugs from the group of non-steroidal anti-inflammatory drugs - analgin, aspirin, diclofenac, etc.);
gastrin-producing tumor (gastrinoma).

Duodenal ulcers that occur as a result of taking medications or accompanying gastrinoma are symptomatic and are not included in the concept of peptic ulcer.

Classification of peptic ulcer

Peptic ulcer disease varies by location:

Peptic ulcer of the stomach (cardia, subcardial region, body of the stomach);
peptic post-resection ulcer of the pyloric canal (anterior, posterior wall, lesser or greater curvature);
duodenal ulcer (bulbous and postbulbar);
ulcer of unspecified localization.

According to the clinical form, acute (newly diagnosed) and chronic peptic ulcer disease are distinguished. The phase is divided into periods of remission, exacerbation (relapse) and incomplete remission or fading exacerbation. Peptic ulcer disease can occur latently (without pronounced clinical symptoms), mildly (with rare relapses), moderately severe (1-2 exacerbations per year) and severely (with regular exacerbations up to 3 or more times a year).

The duodenal ulcer itself varies in morphological picture: acute or chronic ulcer, small (up to half a centimeter), medium (up to a centimeter), large (from one to three centimeters) and gigantic (more than three centimeters) in size. Stages of ulcer development: active, scarring, “red” scar and “white” scar. With concomitant functional disorders of the gastroduodenal system, their nature is also noted: violations of motor, evacuation or secretory function.

Symptoms of duodenal ulcer

In children and the elderly, the course of peptic ulcer disease is sometimes practically asymptomatic or with minor manifestations. This course is fraught with the development of severe complications, such as perforation of the duodenal wall followed by peritonitis, hidden bleeding and anemia. The typical clinical picture of duodenal ulcer is a characteristic pain syndrome.

The pain is most often moderate and dull. The severity of pain depends on the severity of the disease. Localization is usually in the epigastrium, under the sternum. Sometimes the pain can be diffuse in the upper abdomen. It often occurs at night (at 1-2 hours) and after long periods without eating, when the stomach is empty. After eating, milk, and antacids, relief occurs. But most often the pain returns after the stomach contents are evacuated.

The pain can occur several times a day for several days (weeks), after which it goes away on its own. However, over time, without proper therapy, relapses become more frequent and the intensity of the pain increases. Seasonality of relapses is characteristic: exacerbations occur more often in spring and autumn.

Complications of duodenal ulcer

The main complications of a duodenal ulcer are penetration, perforation, bleeding and narrowing of the intestinal lumen. Ulcerative bleeding occurs when the pathological process affects the vessels of the gastric wall. Bleeding can be hidden and manifested only by increasing anemia, or it can be pronounced, blood can be found in vomit and appear during bowel movements (black or bloody stool). In some cases, bleeding can be stopped during an endoscopic examination, when the source of bleeding can sometimes be cauterized. If the ulcer is deep and the bleeding is profuse, surgical treatment is prescribed; in other cases, it is treated conservatively, correcting iron deficiency. For ulcer bleeding, patients are prescribed strict fasting and parenteral nutrition.

Perforation of a duodenal ulcer (usually the anterior wall) leads to penetration of its contents into the abdominal cavity and inflammation of the peritoneum - peritonitis. When the intestinal wall is perforated, a sharp cutting-stabbing pain in the epigastrium usually occurs, which quickly becomes diffuse and intensifies with a change in body position and deep breathing. Symptoms of peritoneal irritation (Shchetkin-Blumberg) are determined - when pressing on the abdominal wall and then suddenly releasing it, the pain intensifies. Peritonitis is accompanied by hyperthermia.

This is an emergency condition that, without proper medical care, leads to shock and death. Perforation of an ulcer is an indication for urgent surgical intervention.

Prevention and prognosis of duodenal ulcer

Measures to prevent the development of duodenal ulcer:

timely detection and treatment of Helicobacter pylori infection;
normalization of diet and nutrition;
quitting smoking and alcohol abuse;
control over medications taken;
harmonious psychological environment, avoidance of stressful situations.

Uncomplicated peptic ulcer disease, with proper treatment and compliance with dietary and lifestyle recommendations, has a favorable prognosis; with high-quality eradication, ulcer healing and cure. The development of complications during peptic ulcer disease worsens the course and can lead to life-threatening conditions.

The main symptoms of a stomach ulcer (peptic ulcer) are pain and dyspeptic syndromes (a syndrome is a stable set of symptoms characteristic of a given disease).

Pain is the most typical symptom of gastric and duodenal ulcers. It is necessary to find out the nature, frequency, time of onset and disappearance of pain, and the connection with food intake.

Up to 75% of patients complain of pain in the upper abdomen (usually in the epigastric region). Approximately 50% of patients experience pain of minor intensity, and about a third of patients experience severe pain. Pain may appear or intensify with physical activity, eating spicy foods, a long break in eating, or drinking alcohol. In the typical course of a peptic ulcer, pain has a clear connection with food intake; it occurs during exacerbation of the disease and is characterized by seasonality - most often occurring in spring and autumn. In addition, it is quite common to see a decrease or even disappearance of pain after taking soda, food, antisecretory (omez, famotidine, etc.) and antacid (almagel, gastal, etc.) drugs.

Early pain occurs 0.5-1 hour after eating, gradually increases in intensity, persists for 1.5-2 hours, decreases and disappears as the gastric contents move into the duodenum; characteristic of ulcers of the body of the stomach. When the cardiac, subcardial and fundic regions are affected, pain occurs immediately after eating.

Late pain occurs 1.5-2 hours after eating, gradually intensifying as the contents are evacuated from the stomach; characteristic of ulcers of the pyloric stomach and duodenal bulb.

“Hungry” (night) pains occur 2.5-4 hours after eating, disappear after the next meal; characteristic of ulcers of the duodenum and pyloric stomach. A combination of early and late pain is observed with combined or multiple ulcers.

The intensity of pain may depend on age (more pronounced in young people) and the presence of complications.

The most typical projection of pain, depending on the location of the ulcerative process, is considered to be the following:

for ulcers of the cardial and subcardial parts of the stomach - the area of the xiphoid process;
for ulcers of the body of the stomach - the epigastric region to the left of the midline;
for ulcers of the pylorus and duodenum - the epigastric region to the right of the midline.

Palpation of the epigastric region may be painful.

The absence of a typical pattern of pain does not contradict the diagnosis of peptic ulcer.

Dyspeptic syndrome is characterized by heartburn, belching, nausea, vomiting, stool disturbances, as well as changes in appetite, a feeling of fullness or bloating in the stomach, and a feeling of discomfort in the epigastric region. Heartburn is observed in 30-80% of patients; it can be persistent and usually appears 1.5-3 hours after eating. At least 50% of patients complain of belching. Nausea and vomiting are not uncommon with peptic ulcer disease; most often, vomiting develops at the height of pain and brings relief to the patient, so patients can induce vomiting artificially. Almost 50% of patients suffer from constipation, which is more often observed during exacerbation of the process. Diarrhea is not typical. As a rule, there are no pronounced disturbances in appetite during peptic ulcer disease. The patient may limit himself in nutrition during severe pain, which happens during an exacerbation.

It is imperative to check with the patient for episodes of vomiting blood or black stools (melena). Additionally, a physical examination should specifically attempt to identify signs of a possible malignant nature of the ulceration or the presence of complications of a peptic ulcer.

With a favorable course, the disease proceeds without complications, with alternating periods of exacerbation, lasting from 3 to 8 weeks, and periods of remission, the duration of which can range from several months to several years. An asymptomatic course of the disease is also possible: the diagnosis of peptic ulcer during life is not established in 24.9-28.8% of cases.

Symptoms of peptic ulcer depending on the location of the ulcer

Symptoms of ulcers of the cardial and subcardial part of the stomach

These ulcers are localized either directly at the esophagogastric junction or distal to it, but no more than 5-6 cm.

The following features are characteristic of cardiac and subcardial ulcers:

Men over 45 years of age are more often affected;
pain occurs early, 15-20 minutes after eating and is localized high in the epigastrium near the xiphoid process;
pain quite often radiates to the heart area and can be mistakenly regarded as angina pectoris. In differential diagnosis, it should be taken into account that pain due to coronary heart disease appears when walking, at the height of physical activity and disappears at rest. Pain in cardiac and subcardial ulcers is clearly associated with food intake and does not depend on physical exertion, walking, and calms down not after taking nitroglycerin under the tongue, as with angina, but after taking antacids, milk;
characterized by mild pain syndrome;
pain is quite often accompanied by heartburn, belching, vomiting due to insufficiency of the cardiac sphincter and the development of gastroesophageal reflux;
often ulcers of the cardial and subcardial part of the stomach are combined with a hiatal hernia, reflux esophagitis;
the most common complication is bleeding; perforation of the ulcer is very rare.

Symptoms of an ulcer of the lesser curvature of the stomach

The lesser curvature is the most common location of gastric ulcers. The characteristic features are the following:

the age of patients usually exceeds 40 years, often these ulcers occur in the elderly and elderly;
pain is localized in the epigastric region (slightly to the left of the midline), occurs 1-1.5 hours after eating and stops after food is evacuated from the stomach; sometimes there are late, “night” and “hunger” pains;
pain is usually aching in nature, its intensity is moderate; however, in the acute phase, very intense pain may appear;
heartburn, nausea, and less often vomiting are often observed;
gastric secretion is most often normal, but in some cases it is also possible to increase or decrease the acidity of gastric juice;
in 14% of cases they are complicated by bleeding, rarely by perforation;
in 8-10% of cases, malignancy of the ulcer is possible, and it is generally accepted that malignancy is most typical for ulcers located at the bend of the lesser curvature. Ulcers localized in the upper part of the lesser curvature are mostly benign.

Symptoms of an ulcer of the greater curvature of the stomach

Ulcers of the greater curvature of the stomach have the following clinical features:

are rare;
Among the patients, older men predominate;
the symptoms differ little from the typical clinical picture of a stomach ulcer;
in 50% of cases, ulcers of the greater curvature of the stomach turn out to be malignant, so the doctor should always consider an ulcer of such a localization as potentially malignant and repeat multiple biopsies from the edges and bottom of the ulcer.

Symptoms of an ulcer of the antrum of the stomach

Ulcers of the gastric antrum (“prepyloric”) account for 10-16% of all cases of peptic ulcer and have the following clinical features:

found predominantly in young people;
the symptoms are similar to those of a duodenal ulcer, characterized by late, “night”, “hungry” pain in the epigastrium; heartburn; vomiting of sour contents; high acidity of gastric juice; positive Mendelian sign on the right in the epigastrium;
It is always necessary to carry out differential diagnosis with the primary ulcerative form of cancer, especially in older people, since the antrum is the favorite localization of stomach cancer;
in 15-20% of cases they are complicated by gastric bleeding.

Symptoms of a pyloric ulcer

Pyloric ulcers account for about 3-8% of all gastroduodenal ulcers and are characterized by the following features:

persistent course of the disease;
a pronounced pain syndrome is characteristic, the pain is paroxysmal in nature, lasting about 30-40 minutes, in 1/3 of patients the pain is late, at night, “hungry”, but in many patients it is not associated with food intake;
pain is often accompanied by vomiting of sour contents;
characterized by persistent heartburn, paroxysmal excessive secretion of saliva, a feeling of fullness and fullness in the epigastrium after eating;
with long-term recurrence, ulcers of the pyloric canal are complicated by pyloric stenosis; other common complications are bleeding (the pyloric canal is heavily vascularized), perforation, penetration into the pancreas; 3-8% have malignancy.

Symptoms of duodenal ulcer

Ulcers of the duodenal bulb are most often localized on the anterior wall. The clinical picture of the disease has the following features:

the age of patients is usually younger than 40 years;
Men get sick more often;
epigastric pain (more on the right) appears 1.5-2 hours after eating, often at night, early morning, as well as “hungry” pain;
vomiting is rare;
seasonality of exacerbations is characteristic (mainly in spring and autumn);
a positive Mendelian sign is determined in the epigastrium on the right;
the most common complication is ulcer perforation.

When the ulcer is located on the posterior wall of the duodenal bulb, the clinical picture is most characterized by the following manifestations:

the main symptoms are similar to the symptoms described above, characteristic of the localization of an ulcer on the anterior wall of the duodenal bulb;
often observed spasm of the sphincter of Oddi, dyskinesia of the gallbladder of the hypotonic type (feeling of heaviness and dull pain in the right hypochondrium with irradiation to the right subscapular region);
the disease is often complicated by penetration of the ulcer into the pancreas and hepatoduodenal ligament, and the development of reactive pancreatitis.

Duodenal ulcers, unlike gastric ulcers, do not become malignant.

Symptoms of extrabulb (postbulbar) ulcers

Extrabulb (postbulbar) ulcers are ulcers located distal to the duodenal bulb. They make up 5-7% of all gastroduodenal ulcers and have the following characteristic features:

most common in men aged 40-60 years, the disease begins 5-10 years later compared to duodenal ulcer;
in the acute phase, intense pain in the right upper quadrant of the abdomen, radiating to the right subscapular region and back, is very characteristic. Often the pain is paroxysmal in nature and may resemble an attack of urolithiasis or cholelithiasis;
pain appears 3-4 hours after eating, and eating food, in particular milk, relieves pain not immediately, but after 15-20 minutes;
the disease is often complicated by intestinal bleeding , development of perivisceritis, perigastritis, penetration and stenosis of the duodenum;
perforation of the ulcer, in contrast to localization on the anterior wall of the duodenal bulb, is observed much less frequently;
In some patients, mechanical (subhepatic) jaundice may develop, which is caused by compression of the common bile duct by an inflammatory periulcerous infiltrate or connective tissue.

Symptoms of combined and multiple gastroduodenal ulcers

Combined ulcers occur in 5-10% of patients with peptic ulcer disease. In this case, a duodenal ulcer initially develops, and after a few years a gastric ulcer develops. The putative mechanism for this sequence of development of ulcers is as follows.

With a duodenal ulcer, swelling of the mucous membrane, intestinal spasm, and often cicatricial stenosis of the initial part of the duodenum develop. All this complicates the evacuation of gastric contents, stretching of the ashral region (antral stasis) occurs, which stimulates hyperproduction of gastrin and, accordingly, causes gastric hypersecretion. As a result, prerequisites are created for the development of a secondary gastric ulcer, which is often localized in the area of the angle of the stomach. The development of an ulcer initially in the stomach and then in the duodenum is extremely rare and is considered an exception. Their simultaneous development is also possible.

Combined gastroduodenal ulcer has the following characteristic clinical features:

the addition of a gastric ulcer rarely worsens the course of the disease;
epigastric pain becomes intense, along with late, night, “hungry” pain, early pain appears (occurring soon after eating);
the area of localization of pain in the epigastrium becomes more widespread;
after eating, there is a painful feeling of fullness in the stomach (even after eating a small amount of food), severe heartburn, and vomiting is common;
when studying the secretory function of the stomach, pronounced hypersecretion is observed, while the production of hydrochloric acid can become even higher compared to the values that were present with an isolated duodenal ulcer;
the development of complications such as cicatricial pyloric stenosis, pylorospasm, gastrointestinal bleeding, perforation of an ulcer (usually duodenal);
in 30-40% of cases, the addition of a gastric ulcer to a duodenal ulcer does not significantly change the clinical picture of the disease and a gastric ulcer can only be detected during gastroscopy.

Multiple ulcers are 2 or more ulcers simultaneously localized in the stomach or duodenum. The following features are characteristic of multiple ulcers:

tendency to slow scarring, frequent recurrence, and development of complications;
In some patients, the clinical course may not differ from the course of a single gastric or duodenal ulcer.

Ulcer symptoms of giant gastric and duodenal ulcers

According to E. S. Ryss and Yu. I. Fishzon-Ryss (1995), ulcers with a diameter of more than 2 cm are called giant. A. S. Loginov (1992) classifies ulcers with a diameter of more than 3 cm as giant.

Giant ulcers are characterized by the following features:

located predominantly on the lesser curvature of the stomach, less often - in the subcardial region, on the greater curvature and very rarely - in the duodenum;
the pain is significantly pronounced, its frequency often disappears, it can become almost constant, which requires differential diagnosis with stomach cancer; in rare cases, the pain syndrome may be mild;
characterized by rapidly occurring exhaustion;
very often complications develop - massive gastric bleeding, penetration into the pancreas, less often - perforation of the ulcer;
careful differential diagnosis of a giant ulcer with a primary ulcerative form of gastric cancer is required; malignancy of giant gastric ulcers is possible.

Symptoms of long-term non-healing ulcers

According to A. S. Loginov (1984), V. M. Mayorov (1989), long-term non-healing ulcers are those that do not scar within 2 months. The main reasons for the sharp prolongation of ulcer healing time are:

hereditary burden;
age over 50 years;
smoking;
alcohol abuse;
the presence of pronounced gastroduodenitis;
cicatricial deformation of the stomach and duodenum;
persistence of Helicobacter pylori infection.

Long-term non-healing ulcers are characterized by erased symptoms; with therapy, the severity of pain decreases. However, quite often such ulcers are complicated by perivisceritis, penetration, and then the pain becomes persistent, constant, and monotonous. There may be a progressive decline in the patient's body weight. These circumstances dictate the need for a careful differential diagnosis of a long-term non-healing ulcer with the primary ulcerative form of gastric cancer.

Peptic ulcer disease in old age and old age

Senile ulcers are defined as ulcers that first developed after the age of 60 years. Ulcers in the elderly or elderly are ulcers that first appear at a young age, but remain active until old age.

Features of peptic ulcer disease in these age groups are:

an increase in the number and severity of complications, primarily bleeding, compared to the age when the ulcer first formed;
a tendency to increase the diameter and depth of the ulcer;
poor healing of ulcers;
pain syndrome is mild or moderate;
acute development of “senile” ulcers, their predominant localization in the stomach, frequent complication of bleeding;
the need for careful differential diagnosis with gastric cancer.

Signs of a sucking in the pit of the stomach in the morning, nausea, and a feeling of hunger can be a signal of an impending disaster called an “ulcer.” There is no need to wait for persistent pain and serious complications, but it is better to immediately visit a therapist at the slightest suspicion of pathology. Let's look at what a duodenal ulcer is, its symptoms and treatment, diet, complications and consequences.

What is the duodenum

Duodenum (duodenum) is a section of the digestive canal located immediately behind the stomach. Its length is equal to the width of 12 fingers, which is 25-30 cm. It is shaped like a loop with a bend around the head of the pancreas. The wall consists of the same layers as the entire digestive canal:

External (from connective tissue) - performs protective functions.
Muscular – provides contractile activity, contains nerve nodes.
Submucosal (with many blood and lymphatic vessels) - forms semilunar and spiral folds. They do not smooth out even when the intestines are full of food gruel.
Mucous (with short and wide villi).

The duodenum is a part of the small intestine that performs a number of important functions:

The breakdown of carbohydrates, fats and proteins into molecules that can be absorbed into the blood.
A shift in the pH of food coming from the stomach towards an acidic reaction.
Regulation of the process of secretion of pancreatic juice and bile depending on the nutrients contained in the chyme.
Gatekeeper's job.

What causes ulcers?

Duodenal ulcer (ICD code 10 K26) occurs when the balance between the aggressive factors of the digestive canal and its protective capabilities is disturbed:

Creation of an alkaline environment.
Mucus secretion.
Blood supply and nutrition of cells.

The disease begins with inflammation of the mucous membrane duodenum, but ends with the formation of serious defects on it with the bottom in the muscle layer. They appear, as a rule, in the initial part of the duodenum, where acidic gastric juice is most often thrown.

The disease occurs in 10% of the population. These are mostly young and middle-aged men. They are not drafted into the army. In women, pathology is less common due to estrogens, which provide a trophic effect on tissues, improve their blood supply and nutrition, and increase vitality. There are frequent cases of complete recovery of women with ulcers during pregnancy.

Among the causes of the disease, not the least important is the spiral - a common inhabitant of the gastrointestinal tract. It coexists with the host for a long time, but under certain conditions it sharply increases the number of the colony and damages the cells that produce mucus.

Early theories of the development of ulcers include the idea of an imbalance between the protective properties of the mucosa and the destructive effects of enzymes and hydrochloric acid, which are observed with pyloric dysfunction. Today no one denies that there are more ulcers among people with blood group I.

In Soviet times, the prevailing opinion was that defects in the duodenum are more often formed in people exposed to chronic stress and overwork (this stimulates the release of gastrin as a mediator of inflammation). The hormone is released in greater volumes if a person spends a long time in the sun. Gastroenterologists are confident that an ulcer is a psychosomatic disease. Usually it affects people with constant mood swings, excessive suspiciousness, excitability, and anxiety. An important circumstance is the weakening of the immune system.

Provocateurs of ulceration include corticosteroids and non-hormonal anti-inflammatory drugs, as well as antibiotics. The mucous membrane suffers from the negative effects of nicotine and alcohol. Ethyl alcohol causes direct harm to her.

A repetition of the “family scenario” threatens those who have ulcers in their family. The reason is hereditary factors, namely the psychological status, as well as the number of cells that produce hydrochloric acid. In combination with poor nutrition and an erratic lifestyle, the likelihood of defects occurring on the walls of the duodenum reaches 100%.

Ulcer symptoms, how it hurts

The pathology is characterized by a chronic relapsing course. Periods of exacerbations are followed by remissions. Scars form in place of the damaged mucosa. A large number of them deform and narrow the lumen of the duodenum. Signs of an ulcer become more pronounced during exacerbation, including:

Pain above the navel radiating to the heart and scapula. Occurs in the dark, 2-3 hours after eating. It intensifies with alcohol abuse, non-compliance with diet, and taking a number of medications.
Mild belching and heartburn.
Feeling of fullness in the abdomen.
Nausea and vomiting.
Stool disorders with prolonged constipation, stool with mucus or blood.
Irritability, problems sleeping.
Losing weight even with a good appetite.

The disease worsens in the off-season. The most difficult, according to doctors, is a “silent” ulcer that occurs without pain. Occurs in 15% of cases. It makes itself felt only during exacerbation in the form of perforation or bleeding.

Accurate diagnosis

To identify a peptic ulcer, the doctor needs to find out:

How often do you worry about discomfort in the epigastric area, what is it associated with?
Have any blood relatives suffered from gastrointestinal problems?

The patient is asked to undergo tests:

Urine, blood, feces.
To determine the pH level of gastric juice.

Among the instrumental diagnostic methods:

and determining the condition of the mucous layer with a biopsy for histological examination of the nature of the defects. The doctor can visually assess the characteristics of the ulcerations. At the same time, it is possible to remove existing polyps.
to examine the outlines of the duodenum, its deformations, areas of narrowing, and neoplasms. An outdated method, which is used if the medical institution does not have the appropriate equipment or the patient has suffered a stroke, suffers from angina pectoris, recurrent attacks of bronchial asthma, or severe arrhythmias.

Ultrasound of the abdominal organs is a less informative method for diagnosing the disease in question, but it also clarifies the overall picture.

Treatment of duodenal ulcers

The disease is successfully cured using one of the specially developed regimens, including drips, injections, and tablets. Along with conservative therapy, the following are useful:

Health-improving gymnastics that eliminates congestion in the digestive canal.
Sanatorium-resort treatment.
Physiotherapy.
Compliance with a special diet.

Taken together, these measures help get rid of Helicobacter pylori and bulbitis, do not allow the development of negative consequences. In case of complications, the patient is hospitalized in order to observe and take timely measures in each case.

Medicines

Conservative therapy is based on proton pump inhibitors to reduce the secretion of hydrochloric acid:

Omez.
Losek.
Gastrozol.
Paries.

Gastrocepin and other drugs that block M-cholinergic receptors help reduce the synthesis of pepsin and chloride acid and resist pain. Taking them often leads to dry mouth and increased heart rate.

H2-histamine blockers are no longer used in treatment practice, since when they are discontinued, the signs of pathology quickly return.

To protect the bottom of the ulcer, Sucralfate is used, De-nol helps to create a film on intestinal defects. Prostaglandins are used to stimulate recovery processes and mucus formation.

Symptomatic treatment of duodenal ulcers is carried out using certain groups of medications:

Antispasmodics.
Drugs that improve nutrition of the mucous membrane.
Antidepressants to calm the central nervous system.
Cerucal, Metoclopramide and other prokinetics to normalize intestinal motility.

Antacids in liquid form: Almagel, Maalox, in tablet form (Becarbon, Bellalgin) help eliminate heartburn, neutralize hydrochloric acid, and have an adsorbing astringent effect. The action time is from 10 minutes to an hour, depending on the alkalizing properties of the medication. Dosage regimen: several times during the day with an additional portion at night.

If Helicobacter is present, antibacterial drugs are used:

Clarithromycin.
Amoxicillin.
Metronidazole.

If the microbes survive, therapy is carried out according to a different scheme. The process is controlled by a doctor. Self-medication can result in complications.

The duration of treatment is influenced by the general condition of the patient, as well as the size of the ulcerations. They usually last from 2 to 6 weeks. In case of exacerbation, bed rest and rest are indicated.

Baking soda, which has always been the #1 remedy for high stomach acidity, actually instantly neutralizes the cause of low pH. But it leads to the release of large volumes of carbon dioxide, which only enhances the secretory capabilities of the duodenum. Therefore, when used frequently, it does more harm than good.

Folk remedies

Among the most effective formulations:

Freshly squeezed potato juice(can be combined with cabbage). It’s easy to prepare: chop healthy tubers and squeeze out the liquid part from them. From 1 to 3 days – drink 1 tbsp. l. 3 times a day half an hour before meals. From 4 to 6 - 2 tbsp. l. With a gradual increase to 125 ml at a time. The course of treatment is 3-4 weeks. Take while on a diet. Repeat if necessary.
Natural honey is no less useful. Ayurveda uses it to transport a number of medicines that provide healing. It can be eaten pure or taken in combination with olive oil (1:1) 5-6 times a day, 1 tbsp. l. mixtures. The course lasting 2 weeks is repeated if necessary after 10 days.
Decoction of 10 g plantain seeds and 100 ml of boiling water. Let cool, drink 3 times 1 tbsp. l. an hour before meals.
A mixture of a kilogram of melted butter and 150 g of crushed propolis. For complete dissolution, keep in a water bath and store in the cold. Take 1 tsp. 3 times an hour before meals. The course of treatment is a month. After 3 weeks you can repeat.
Powerful wound healing antimicrobial St. John's wort has an anti-inflammatory effect. Drink 1 tsp of its decoction. on an empty stomach.
To reduce the duration of scarring of ulcerations To relieve pain and discomfort in the abdominal area, you can also use yarrow and calendula.

All folk remedies can be taken only after permission from a doctor.

Surgical treatment

Surgery is indicated for the following conditions:

The presence of polyposis, which increases the secretion of gastric juice.
Bleeding.
Degeneration of an ulcer into a cancerous tumor.
Ineffectiveness of drug therapy.

Local excision of the ulceration or resection of the duodenum is performed.

Diet

A gentle diet for ulcers should become part of the patient’s life. It can be zigzag, that is, during an exacerbation, it is as dietary as possible, and during periods of calm (within reasonable limits) even some harmful foods are allowed. Remissions will be longer if:

Take food at least 5 times a day in small portions.
Avoid cold and too hot foods; the optimal temperature for ulcers is 25-30 °C.
Minimum salt.
In case of exacerbation, only pureed food.
Soft ripe fruits and vegetables.
Dilute concentrated juices with water.

Permitted and prohibited products

The list of dangerous foods includes those foods that provoke an increase in the acidity of gastric juice:

Baking and rye bread.
Rich broths.
Fried foods.
Canned food.
Smoked meats.
Citrus.
Garlic and onion.
Alcohol, fortified and dry wines.
Sparkling water.

The diet should include more soups with milk and vegetable broths, cereals, boiled meat and low-fat fish.

Foods rich in fiber irritate the walls of the duodenum. Therefore, it is worth excluding or limiting the consumption of corn, peas, radishes, and white cabbage.

Exacerbation of ulcer

If a person violates the medical and protective regime, does not follow a diet, abuses alcohol, or is exposed to constant stress, then a chronic disease, which is characterized by an undulating course, inevitably worsens. In spring and autumn, the body's resistance decreases, so the manifestation of ulcers becomes brighter. Intensive therapy carried out in the department of surgery or gastroenterology for a period of 2 to 8 weeks saves.

Complications and consequences

With timely treatment of duodenal ulcers, it is possible to relieve pain, achieve healing of the mucous membrane, and long periods of satisfactory well-being. Without adequate medical care, quite serious conditions are possible:

Narrowing (stenosis) of the duodenal lumen as a result of scarring. In this case, food stagnation occurs, as well as repeated vomiting.
Internal bleeding, which can be identified by dark, tarry stool, loss of consciousness.
Development of a cancerous tumor at the site of mucosal defects.

Particularly dangerous is intestinal perforation, which takes the form of a sudden rupture of its membranes with characteristic signs:

"Board belly."
Nausea, vomiting.
Cold sweat.
Thirst.
Dagger pain.

After some time, the discomfort partially disappears. The imaginary improvement lasts no more than 24 hours, then peritonitis develops with chills, fever up to 38-39 °C, and confusion. In this condition, the patient must be urgently taken to the hospital.