How to treat duodenal bulb. Effective treatment of duodenal bulb ulcer. Diagnostics and therapy

When we feel pain in the stomach, we most often attribute this symptom to it. Coming up with various reasons(stale or indigestible food, drug poisoning or chemicals, beginning gastritis or even a stomach ulcer), we do not think that the cause of pain and discomfort in the abdomen may not be associated with the stomach at all. The nature of the pain, as well as the results of a gastrological examination, which clearly shows erosions on the mucous membrane of the initial part of the intestine adjacent to the stomach, allow the doctor to accurately diagnose “bulb ulcer” duodenum”, and this completely confuses us.

Let's figure it out, what kind of organ is this in the digestive system, what are its functions and why ulcers form on its mucosa, causing such unpleasant sensations, reminiscent of the symptoms of gastritis with high acidity. We’ll also try to understand how to identify and effectively fight peptic ulcers that affect the stomach or duodenum, and often both organs at once.

Something from anatomy

The digestive system is one of the most multifunctional and longest systems in the human body. It includes many organs that perform the functions of grinding, moving, digesting and absorbing food. Some organs, such as the intestines, have such a complex structure that different parts of it perform various functions related to the functioning of the gastrointestinal tract. The initial section of the intestine is called the duodenum (duodenum), which received its name due to its length (about 12 fingers folded together).

The upper (initial) section of the duodenum is a kind of continuation of the pylorus of the stomach, which performs the function of further transporting food through the gastrointestinal tract. Because of unusual shape, resembling an onion head, and about 5 cm in size, it is called the duodenal bulb. Its function is to regulate the acidity of the stomach contents for its safe movement to the lower intestines, i.e. protecting the intestines from irritation.

An ulcer of the duodenal bulb can not only bring some discomfort into the life of a patient with this diagnosis, but also prevent the initial part of the intestine from performing its function, as a result of which the rest of the digestive system will suffer.

ICD-10 code

K26 Duodenal ulcer

Epidemiology

Epidemiological studies show that most often an ulcer of the duodenal bulb develops against the background of a gastric ulcer, which is understandable due to the proximity of these organs and the functions they perform. Therefore, the diagnosis in most cases sounds like “stomach and duodenal ulcer.”

Ulcerative lesions of the gastrointestinal tract are a fairly common disease, affecting about 3-5% of the adult population worldwide. Moreover, this pathology occurs almost 4 times more often in men than in women. In addition, the course of the disease in young women is characterized by a mild pain syndrome, although all other symptoms are fully present.

An ulcer of the duodenal bulb can be considered a disease of the young, in contrast to a stomach ulcer, which often develops in old age.

By the way, city residents suffer from peptic ulcers 2 times more often than residents of villages and towns. Perhaps the reason lies precisely in the food preferences of city residents and the increased stressful environment associated with labor activity and the difficulties of everyday life, especially in big cities.

Causes of duodenal bulb ulcer

Like a stomach ulcer, ulcerative lesions of the duodenum are caused precisely by increased level hydrochloric acid, which seems to corrode the mucous membranes of organs. Most susceptible negative impact acids in the gastric juice are the stomach itself and the bulbous region of the initial section of the small intestine, which is designed to combat high acidity, providing an alkaline environment for the chyme (semi-digested food) at the exit from the stomach.

This means that it is the increase in acidity level, for a number of reasons, that causes the appearance of erosions on the duodenal mucosa. Based on this, the reasons for the development of duodenal bulb ulcers can be considered the same reasons that contribute to an increase in the level of acidity of gastric juice, in particular:

• increased secretion of a special hormone (gastrin), which regulates the digestive function of the stomach,
• poor nutrition with big amount bitter, salty, sour foods, uncontrolled consumption of fatty and fried foods, pickles, marinades, preservatives,
• tendency to have dry snacks at the expense of a full breakfast and lunch, evening overeating,
• long-term use some medicines, especially when administered orally. Most often this applies to hormonal and anti-inflammatory drugs (corticosteroids and some NSAIDs),
• psychological trauma (both isolated stressful situations and regular nervous overstrain),
• bad habits, such as smoking and alcoholism, which affect the normal functioning of the gastrointestinal tract due to their irritating effect on receptors.

Even a slight increase in the acidity of gastric juice creates best conditions to reproduce and increase the activity of the bacterium Helicobacter Pylori, which causes the development of inflammatory processes in the stomach and duodenum. Therefore, a stomach disease such as gastritis often becomes the main cause of development and ulcers of the duodenal bulb. However, like duodenitis, which is an inflammation of the duodenal mucosa.

As for severe stress, it is one of the main reasons for the development of this pathology, although many patients still tend to deny the influence of nervous reactions on the development of gastrointestinal diseases, not recognizing the internationally recognized truth that all diseases are caused by nerves.

Sometimes doctors diagnose ulcerations on the mucous membrane of the duodenum, which appear as a result of the development of pathologies such as increased calcium levels in the body (hypercalcemia), insufficient functionality of the kidneys and liver, in particular with cirrhosis of the liver, COPD with difficulty breathing, chronic inflammation Gastrointestinal tract (Crohn's disease). The presence of HIV infection in the body and some other diseases can also become real, although infrequent, risk factors for the development of ulcers of the duodenal bulb. Doctors also do not rule out a hereditary factor in the development of this pathology, which significantly increases the risk of its development among the patient’s relatives.

Pathogenesis

Duodenal bulb ulcer is a chronic disease characterized by alternating periods of exacerbation and remission. I distinguish 3 main stages of the disease:

• exacerbation stage (acute course of the disease) with pronounced clinical symptoms, the presence of ulcerations and an inflammatory process on the mucous membrane of the duodenum,
• the stage of a fading (or subsiding) exacerbation, when there are no clinical manifestations, but the inflammation still persists, and fresh scars form in place of the ulcers,
• the stage of remission, when the inflammatory process is sluggish, but scarring changes on the mucous membrane remain.

In the pathogenesis of ulcerative lesions of the duodenal bulb, scientists assign the main role to an imbalance between agents of aggressive influence and protection of the duodenal mucosa in the direction of increasing the former and reducing the activity of the latter. U healthy person such balance is maintained by the coordinated work of various parts of the neuroendocrine system (this is the answer to the question of why nervous reactions affect the functioning of the gastrointestinal tract).

The discrepancy between the factors of aggression and defense within the body leads to the formation of erosions and ulcers on the gastrointestinal mucosa. Moreover, in the case of an ulcer of the duodenal bulb, the decisive role is played by the increased activity of aggressive factors, among which we can highlight an increase in the acidity of gastric juice due to increased production of gastrin, the activity of the harmful gastric bacterium Helicobacter Pylori and other factors mentioned above.

Thus, an ulcer of the duodenal bulb is characterized by an increase in the tone of the muscles of the stomach and increased peristalsis, an increase in the number of parietal cells of the stomach that produce hydrochloric acid (HCl) and a violation of the inhibitory function, limiting the activity of the gastric glands in the production of pepsin and HCl. This state of affairs is the reason for increased secretion of gastric juice even outside meals and a sharp increase in the level of acidity of the stomach, leading to the destruction of cells of the duodenal bulb mucosa.

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Symptoms of duodenal bulb ulcer

Cases where an ulcer of the duodenal bulb occurs without symptoms corresponding to the disease are so rare that it is not worth dwelling on them. Typically, this gastrointestinal pathology is characterized by symptoms of noticeable intensity. In general, the manifestations of an ulcer of the duodenal bulb (duodenal ulcer) are similar to the main signs of a gastric ulcer (in particular, its pyloric section).

The first signs of a duodenal ulcer are severe pain localized in the navel area. They can be easily treated with antacids that reduce stomach acidity. Depending on the physiological characteristics of the patient’s body and the nature of the food consumed, the pain can be either acute or dull aching. Pain (usually in the area of ​​the right epigastric region, radiating to the lower back) can occur at night or 1-2 hours after eating (late pain).

There are frequent cases of pain when the stomach is completely empty of food debris. Eating eliminates symptoms of ulcers such as “hunger” pain, as well as accompanying symptoms such as belching, nausea and even vomiting.

Belching and nausea can also be observed after eating in combination with heartburn, a sour taste in the mouth and a feeling of heaviness in the stomach and throat.

A feeling of hunger that often arises out of nowhere, a short period of time after eating, can also be a symptom of a duodenal bulb ulcer. As well as the appearance of constipation, cases of bloating and flatulence, characteristic of this particular type of ulcerative lesion of the gastrointestinal tract.

The symptoms of duodenal ulcers are characterized by periodic manifestations. Symptoms worsen in the spring and autumn, as well as under the influence of stressful situations. During periods of remission, the ulcer may not manifest itself in any way, even if the patient does not adhere to a special diet.

Specular duodenal ulcer

Among ulcerative lesions of the duodenum, one can distinguish such varieties as ulcers of the lower (descending) section, bulbous and mirror ulcers, when deep ulcerations are observed not only on the mucous membrane of the bulb, but also on the opposite end of the duodenum.

Bulbous forms of pathology are considered the most common, but ulcers of the descending section are much less common.

Mirror duodenal ulcer is of particular interest. It is not a rare phenomenon, but its course is complicated by the presence of not one, but several ulcers, resulting in delayed scarring of ulcers and frequent exacerbations. Along with the number of ulcerations on the duodenal mucosa, the likelihood of developing various complications also increases.

This type of pathology is characterized by the same symptoms as with an ulcer of the duodenal bulb, but the localization of pain may be slightly different. Most often, patients with a mirror ulcer complain of severe pain in the epigastric area on the left side. And sometimes the pain is localized in the area of ​​the left hypochondrium.

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Complications and consequences

Duodenal bulb ulcer is a rather dangerous disease that cannot be ignored. The consequences of an irresponsible attitude towards one’s health against the background of the appearance of symptoms peptic ulcer Various complications may arise, both chronic, developing over a long time (penetration, stenosis, periduodenitis), and occurring suddenly and posing a threat to the patient’s life (bleeding and perforation).

Penetration of an ulcer is its spread to the area of ​​nearby organs. In the case of a bulbous ulcer, there is a high probability of its expansion into the pancreas area. Pain sensations change, girdling pains appear, which taking antacids cannot relieve.

Stenosis is a narrowing of the lumen in the initial part of the small intestine, where the duodenal bulb is located, which negatively affects the entire digestion process, making it difficult for food to move from the stomach to the intestines. Now the symptoms of an ulcer, depending on the stage of stenosis, are complicated by a constant feeling of heaviness in the stomach, pallor of the skin, constant weakness, dry skin and mucous membranes, and general exhaustion. The belching changes its smell from sour to rotten, and the vomit contains an admixture of undigested food.

Further prognosis depends on the stage of development of the pathology. Compensated stenosis, if caused by functional disorders (swelling or spasm during an exacerbation of peptic ulcer disease), responds well to treatment. Subcompensated and decompensated forms of stenosis are already pathologies that are difficult to treat and life-threatening.

Periduodenitis is characterized by an inflammatory process in the serous membrane of the duodenum, which is a fairly common complication of ulcers and is often accompanied by the formation of adhesions and deformation of the duodenal bulb. In the future, the pathological process can spread to other organs (stomach, gall bladder, etc.), causing partial obstruction of the duodenum and other serious diseases that can cause limited ability to work.

I don’t think it’s worth talking about the danger of bleeding again. But they are the most common complications of duodenal bulb ulcers. With almost every exacerbation, hidden bleeding is observed, which does not pose any particular danger, which cannot be said about obvious bleeding with large loss of blood. They are characterized by bloody vomiting, loose stools resembling tar in color, pale skin, weakness and other symptoms of acute blood loss.

Perforation is also one of the most common complications of duodenal ulcer, and in the male population this complication develops a couple of dozen times more often than in the fair sex.

Perforation, or perforation, of an ulcer of the duodenal bulb is a through violation of the integrity of the duodenal wall, in which partially digested food can enter outside the intestine, causing inflammatory processes in the duodenum. abdominal cavity(peritonitis). Accompanied by sharp severe pain in the epigastric area, increased tone abdominal wall muscles, fever and other symptoms of pneumoperitoneum, and subsequently peritonitis.

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Diagnosis of duodenal bulb ulcer

When we feel pain in the lower part of the stomach, we rarely think that the painful condition may be associated with its extension, which is the duodenum or with the pancreas, located in the same area. It is almost impossible to diagnose an ulcer of the duodenal bulb or the development of the same pancreatitis on your own due to the symptoms and localization of discomfort similar to other gastrointestinal pathologies. Therefore, a gastroenterologist should make a diagnosis.

Symptoms various types peptic ulcer of the stomach and duodenum is so similar to each other that it is difficult even for a specialist to distinguish one pathology from another. Nevertheless, an important point in differential diagnosis is the study of subjective symptoms from the patient’s words: frequency and localization of pain, reaction to acid-lowering drugs, the presence of other dyspeptic disorders (nausea, vomiting, heartburn, etc.).

The study of the anamnesis should be accompanied by palpation, which is likely to help determine the development of the ulcerative process. But it is possible to determine its localization only with the help of a set of studies, which include instrumental diagnostics, laboratory tests (complete blood count, biochemical blood test, stool tests: general and Gregersen’s reaction, tests to determine gastrin levels and tests for the presence of Helicobacter Pylori ), histological studies and other diagnostic methods.

The most popular and accurate methods of instrumental diagnostics, allowing to determine the location of the ulcer and make a final diagnosis, are esophagogastroduodenoscopy and radiography of the peritoneal organs. The first method is not only more accurate, but also the most informative, because it allows not only to assess the condition of the gastrointestinal mucosa and determine the location of ulcers and large ulcerations, but also the degree of development of peptic ulcer disease, as well as conduct an analysis to identify the presence of pathogenic bacteria, in particular Helicobacter pylori.

The use of the radiographic method is advisable if there are dystrophic changes in the duodenal bulb, reducing its patency and the ability to visually examine it from the inside. X-rays can also give useful information if there are various neoplasms in the gastrointestinal tract. Often, in parallel with an x-ray examination, an ultrasound of the abdominal organs is prescribed.

Additional, fairly informative methods that allow assessing dysfunction of the gastrointestinal tract organs are electrogastrography, phono- and balloonography. Using these methods, the doctor monitors changes in the motor function of the intestines and other organs involved in the digestive process.

Such A complex approach allows you to make a diagnosis with great accuracy, avoiding errors and confusion in the need to distinguish between an ulcer of the duodenal bulb and other pathologies of the initial part of the small intestine.

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Treatment of duodenal bulb ulcer

Treatment of duodenal ulcers is a long and multi-stage process. It includes drug therapy, traditional treatment, physical procedures, diet. All these methods are not used simultaneously; their purpose depends on the stage of development of the pathology.

Since an ulcer of the duodenal bulb can be caused by many reasons of different nature, the approaches to treatment in this regard should be different. After all, you first need to calculate and remove the pathogenic factor, and then deal with its consequences. Drug therapy for duodenal bulb ulcers is used precisely for this purpose.

The formation of ulcers on the mucous membrane of the duodenum occurs against the background of increased acidity, which means that first of all it is necessary to fight it. Drugs called antacids help reduce the acidity of gastric juice and slightly reduce the production of hydrochloric acid and pepsin.

Now there are many medicines belonging to the group of antacids. But the most popular of them are Omez or its analogue Omeprazole. The drugs “Gastrozol”, “Zerotsid”, “Omitox”, “Pepticum”, “Ultop” and some others are also analogues of the above drugs, since they are based on the same active ingredient - omeprazole.

Same proon pump inhibitors(H + -K + -AFTases), but with another active ingredient - esomeprazole, are also applicable for the treatment of ulcerative lesions of the duodenum. These are the drugs “Nexium”, “Neo-Zext”, “Esomeprazole”.

Well proven in terms of inhibition of hydrochloric acid secretion and such budget drugs, like Ranitidine and Famotidine. And the drugs “Almagel” and “De-Nol” will be indispensable at the acute stage of the development of the process to protect the mucous membrane from the aggressive effects of hydrochloric acid.

If the cause of the increase in acidity and the development of the ulcerative process was a stressful situation, and its effect has not been stopped to this day, it makes sense to prescribe sedatives that normalize the mental state and sleep, and prevent the subsequent negative impact of nervous tension on the functioning of the gastrointestinal tract. In order not to once again injure the stomach and intestines, such drugs should be chosen from a series of herbal remedies (tincture of motherwort, “Barboval”, sedatives herbal teas). Doctors rarely resort to more serious medications such as antidepressants or antipsychotics in connection with diseases of the duodenum.

Pathogenic bacteria, especially Helicobacter Pylori, are also very common cause development of gastritis, gastric and duodenal ulcers. And, as you know, fighting a bacterial infection without the use of antibiotics is simply unthinkable. A good effect in the treatment of duodenal bulb ulcers caused by Helicobacter Pylori is given by combined use of 2 drugs: Clatrimycin and Amoxicillin. Sometimes, in addition to them or as the main medicine, antimicrobial agents such as Metronidazole, Erythromycin, Ampiox, etc. can be prescribed.

Antibiotic therapy carried out as part of complex therapy, including the mandatory use of antisecretory drugs (antacids). Moreover, antacids are indicated for patients with ulcerative lesions of the stomach and duodenum throughout life in certain courses or once to relieve heartburn and other symptoms of high acidity.

To improve nutrition of the intestinal mucosa and activate regenerative processes, Solcoseryl, Actovegin, vitamins and vitamin-mineral complexes containing vitamin A can be prescribed.

Taking antacids usually relieves pain, but if this is not enough, you can try taking antispasmodics, such as No-shpa, Spazgan, etc.

You can fight nausea and vomiting with Metoclopramide, Motilium, Cerucal and similar drugs.

Concerning physiotherapeutic treatment, then it is applicable at the stage of remission or subsiding exacerbation. Effective procedures: mud therapy, mineral and pine baths with a temperature close to body temperature, novocaine electrophoresis, UHF procedures.

More about medications

"Omeprazole" is a cheaper, but no less effective analogue of the popular "Omez". It is used to treat the acute phase of the ulcerative process in the duodenum, and also as an anti-relapse agent. It is available in capsule form, which allows it to begin to act exactly where its action (neutralization of acid) is needed.

If an exacerbation of a duodenal ulcer was caused by stress or negative influence Omeprazole medications are taken in a dosage of 1 capsule (20 mg) per day for a course of 2 to 4 weeks.

If the development of peptic ulcer disease was not without the influence of Helicobacter Pylori, then Omeprazole is taken as part of complex therapy together with antibiotics (double and triple therapy).

With double therapy using Omeprazole and 1 antibiotic, the course of treatment is 2 weeks. Treatment regimens:

• "Omeprazole" - 1-2 capsules plus "Amoxicillin" - 750 mg = 2 times a day.
• "Omeprazole" - 2 capsules (1 time per day) plus "Clarithromycin" - 500 mg (3 times per day).
• "Omeprazole" - 2 capsules (1 time per day) plus "Amoxicillin" - from 750 to 1500 mg (2 times per day).

With triple therapy (Omeprazole plus 2 antibiotics), the course of treatment is reduced to 1 week. Treatment regimens.

When leading an unhealthy lifestyle with frequent stress and problems, as well as with a bad genetic predisposition, people develop problems digestive tract. The main cause remains the Helicobacter bacterium, but without a number additional factors the disease develops more slowly. Chronic ulcer of the duodenal bulb occurs 3 times more often in men than in women.

Duodenal bulb ulcer is more often diagnosed in men

If the disease is in remission, then a sign of the past pathology is the presence of a scar. According to the protocol, young people of military age should be exempt from military service. At the military registration and enlistment office, such people are enlisted in the reserves and are subsequently issued with a military ID.

Irritating factors

Previously, doctors considered the culprit of this condition to be a stressful lifestyle, which really has a great impact on human health. The relationship between gastrointestinal infection with specific microorganisms and the formation of various inflammatory lesions in the mucous membrane of the stomach and duodenum. And only a little later, experts found that in 95% of cases of bulb ulcers, the cause was Helicobacter pylori infection.

This section of the duodenum is most susceptible to frequent lesions. Chronic disease worsens in spring and autumn. Helicobacter is transmitted through shared plates, spoons, forks, cups, and towels. In addition, if you know that a person has an ulcer, you should not kiss him, since the disease can be transmitted this way.

Anxiety increases the risk of developing ulcers

Auxiliary conditions aggravate a person’s condition:

• genetic predisposition;
• anxiety;
• alcoholism, which increases the aggressiveness of gastric juice, while reducing the protective barrier of the mucous membrane;
• stressful situations;
• smoking, because nicotine leads to excessive production of stomach acid, preventing the organ from normally performing its functions of digesting food;
• untimely and unbalanced nutrition, when the menu is dominated by dishes with sharp tastes and rough texture, which injures the mucous membrane;
• uncontrolled use of certain medications.

Smoking stimulates increased production of gastric juice

All these problems aggravate the state of human health, which leads to pathologies of vegetative nervous system and development of the vagus nerve symptom. As a result, the patient experiences spasms of blood vessels and muscles, and this causes the walls of the organ to be digested by their own juice. Painful lesions of varying depth and size form on the mucous membrane.

Main groups

Because of large quantity varieties of duodenal bulb ulcer, the symptoms and treatment of which will differ accordingly, it is necessary to carefully undergo the diagnostic procedure. If we analyze the main groups according to the nature of the flow, there are 4 types:

• pathology that doctors discovered for the first time;
• rare occurrences of exacerbation, if they recur after 3 or more years;
• frequent relapses (up to 3 years);
• problems with constant deterioration of the condition after treatment, if the period of remission lasts no more than 1 year.

Duodenal ulcer can occur in acute form

The ulcer proceeds into different forms: light, medium and heavy.

Separately, doctors distinguish a classification based on endoscopic characteristics. So, there may be a fresh ulcer and illness when epithelization has just begun. In addition, the moment of healing with or without scarring is distinguished, and the stage of remission is also separately mentioned.

When considering complications, doctors may write down the following diagnoses:

• presence of bleeding;
• penetration, when the pathology spreads beyond the organ;
• with the development of through holes (perforation);

Duodenal ulcers often perforate

• the formation of adhesions and inflammatory processes in the area of ​​serous integument (perivisceritis);
• pathology with the development of persistent narrowing of the lumen of an organ or intestine (stenosis);
• mirror type of problem (lesions are also diagnosed on the opposite part of the stomach);
• the process of deformation of the duodenum with the formation of scars.

Code of this disease in the international classification ICD-10.

Clinical picture

An ulcer of the duodenal bulb, the symptoms and treatment of which depend on various factors, has the following first signs: hunger pain in the upper part of the stomach and discomfort at night. The patient struggles with the desire to eat, and only after eating does he not feel pain for a while.

The patient loses his appetite

Pathology of the duodenum is characterized by the following features:

• lack of appetite;
• feeling of bitterness and heartburn;
• gag reflexes;
• The act of defecation is difficult due to constipation.

Doctors note that pathology almost always occurs during exacerbation seasons with enviable frequency. Typically, pain occurs before eating, and after eating, the discomfort decreases.

Diagnostic measures

Gastroscopy allows you to identify an ulcer of the duodenal bulb. The procedure is carried out in a medical center, but the person should not eat beforehand. A flexible tube with a narrow end and a device that allows you to take a small layer of mucous membrane for analysis is inserted into his stomach.

Gastroscopy is performed to identify mucosal lesions.

Another type of research is CT scan. To do this, the patient is injected intravenously with a contrast agent.

Danger of condition

Complications can be very unpleasant. The consequence of an ulcer is bleeding from gastrointestinal tract. Then sharp vomiting occurs (dry), which in color resembles diluted coffee. These symptoms include weakness, loss of balance, fainting and heavy sweating. In this case, urgent treatment in a hospital is necessary.

Ulcer rupture - perforation. Occurs when the bulbous wall breaks down, causing stomach contents to leak into the abdominal cavity. The pathology can be limited or open (more often found in duodenal bulb ulcers).

With peritonitis, body temperature rises

In the second case, it often degenerates into peritonitis. Then the patient suddenly feels a sharp, very severe pain in the right lower abdomen, which quickly spreads throughout the entire abdominal cavity. Every movement and breath can strengthen it. Body temperature rises quickly. In such cases, you need to call ambulance, as this is a life-threatening condition.

Chronic duodenal ulcer is less serious, but it often causes severe vomiting at the end of the day or 6 hours after eating, and the patient also exhibits the following symptoms:

• flatulence;
• loss of appetite;
• lack of feeling of satiety.

If symptoms do not disappear within a week after taking the drugs, the help of a surgeon is necessary.

Chronic duodenal ulcer is accompanied by severe vomiting

Untreated ulcers can transform into cancerous lesions, so a section is taken during gastroscopy for histopathological examination. In 60% of cases, stomach cancer is directly related to Helicobacter pylori. When cancer develops, it is necessary to remove part or all of the stomach. After this operation, you can live normally, but you need to follow certain recommendations that will slightly limit the person’s activity.

Proper nutrition

The principles of the diet for peptic ulcer of the duodenal bulb are eating at certain times 5-6 times a day. It is necessary to eliminate foods that stimulate the production of gastric juice. For example, coffee, tea, fatty broths, fried and smoked meat and fish, salted, pickled and spicy dishes.

The body should be provided with the required amount of nutrients, so the menu is planned based on a combined daily diet. Food should not be too cold or hot. An important condition diet is getting rid of bad habits, such as smoking.

Treatment should be supplemented with proper nutrition

Course of therapy

The results of the study showed that there is a strong correlation between bulb deformation and the degree of gastric metaplasia of the regenerating duodenal mucosa. The rate of ulcer recurrence had a significant difference between patients with and without Helicobacter pylori colonization in the stomach (P<0,001).

The higher the degree of gastric mucosal metaplasia, the higher the likelihood of increased incidence of pathology (P = 0.021). The more deformed a part of the organ is, the more often a relapse of a duodenal ulcer is diagnosed (P = 0.03).

There is a correlation between bulb deformation, gastric mucosal metaplasia and recurrence of the disease. A high degree of lesions is closely associated with gastric metaplasia. Both factors contribute to relapse of the disease. Studies have shown that long-term treatment with ranitidine significantly reduced the incidence of symptom recurrence.

Ranitidine promotes wound healing on the mucous membrane

A set of factors that might confound this outcome (gender, age, alcohol consumption, history of ulcerative relatives, disease duration, previous complications, smoking, and duodenal bulb morphology) were assessed in multivariate analyzes using a Cox regression model. In the untreated group, relapses of the ulcer and recurrence of the disease occurred earlier (2 months), and in patients with a normal or slightly deformed bulb after 8 months.

Treatment with ranitidine slowed relapse in these patients (more than 1 year) and almost eliminated it in people with normal morphology. The study confirms the primary importance of anti-H2 therapy and suggests that the anatomical characteristics of the compartment also influence the course of treatment.

After several years of experimentation, an effective remedy for Helicobacter was found. For example, Omeprazole, Nexium and Lansoprazole tablets. They reduce the release of hydrochloric acid to almost zero. At the same time, patients take antibiotics: Clarithromycin and Amoxicillin or Metronidazole. Thanks to these drugs, the ulcer of the duodenal bulb is practically not removed surgically.

Medicines reduce the production of hydrochloric acid and alleviate the patient’s condition

Traditional medicine methods

You should seek treatment from a doctor. If you coordinate the entire course with it, you can use additional folk remedies. Before switching to antibiotic therapy, you should try to fight alone and use a course of treatment with water.

According to Irish doctor Batmanghelidj Fereydon, drinking liquid provides the body with the necessary level of hydration and can become a cure for many people suffering from back and head pain, osteoarthritis, heartburn and even depression. He wrote several books related to this topic.

Dr. Batmanghelidj's method: drink 2 glasses of water with a pinch of salt half an hour before each meal. After eating, wait at least 2.5 hours, and then drink 1-2 glasses again.

The cause of pathologies is dehydration of the body. If you properly moisturize your body, many diseases will go away. A person needs a large amount of water during the digestive process in order to separate the required volume of gastric juices.

Fresh homemade cabbage juice speeds up the healing of lesions. One liter of juice per day should be drunk for 2-6 weeks. There are tablets in pharmacies with the same effect. Cabbage contains gefarnate, which is an ingredient in many anti-ulcer medications.

Green tea works in the same way. The polyphenols contained in it stop the development of the disease, the ulcer heals. Tea has an antibacterial effect and neutralizes the effect of pepsin, which stops the secretion of gastric juice. The best drink for a healthy stomach and duodenum is chamomile.

Green tea promotes scarring of duodenal ulcers

Preventive actions

Constipation should not be allowed to occur. Most foods take 12 to 24 hours to digest. The same time is needed to get rid of toxic waste. When this doesn't work properly, rotting debris builds up on the intestinal walls and can damage them.

You need to eat less, but more often and, above all, do not leave home without breakfast. A cup of coffee is not a complete meal. Patients should avoid very hot drinks and foods, limit fat intake, replacing it with butter or vegetable oils. Instead of ready-made spices, herbs are used, increasing the taste of dishes and preventing problems with the digestive tract (wild rose, dill, ginger, lobelia, licorice, marjoram, lemon balm, mint, flaxseed, chamomile, thyme, comfrey).

You should avoid beer, especially light beer, because the malt it contains increases the secretion of gastric juice. You should not abuse alcohol because it irritates the mucous membrane. You should take care of the oral cavity, for which you regularly remove tartar from your teeth and put fillings.

Relaxation is necessary not only for the psyche, but also for the body. The patient must learn to unload emotions and not give in to anger. To improve your condition, you can talk about your problems to your loved ones and friends. You should not abuse anti-inflammatory drugs and painkillers, because they contribute to the development of ulcers (especially acetylsalicylic acid).

For symptoms of duodenal ulcers, see below:

Article prepared by:

The pace of life of modern people does not allow them to postpone their affairs until later due to abdominal discomfort. Therefore, in most cases, pain is suppressed with the help of drugs, citing poor quality food or diet, but very often the problem lies much deeper. Ulcer of the duodenal bulb (DU) is a disease that occurs in most cases of causeless abdominal pain. An ulcer of the duodenal bulb brings the patient to the hospital in advanced stages of development, when it is no longer possible to dull the pain with medications. Only a doctor can identify the symptoms and treatment of a duodenal bulb ulcer; self-medication will lead to adverse consequences.

Peptic ulcer disease is often detected with severe pain

In this article you will learn:

Concept of disease

The disease can only occur in a chronic form, with the formation of deep defects in the mucous membrane of the organ. A mirror duodenal ulcer is the formation of defects at the end or at the beginning. Treatment of this disease follows the same principles as any other. Peptic ulcer of the duodenal bulb is characterized by a long course. Periods of exacerbation and remission alternate. Damage to the duodenum occurs in the layer under the mucous membrane, which complicates the healing process.

The frequency of the disease may depend on the region of residence; in addition, men are more susceptible to acquiring the pathology. According to statistics, from 5 to 15 percent of people living in Russia are carriers of the disease. Also, the prevalence of this disease is four times higher than that of a stomach ulcer.

Diagnostics

Even at the stage of determining the diagnosis, invasive diagnostics plays an important role. Determining the degree of organ damage, identifying a predisposition to malignant tumors or their presence, and the presence of bulb deformation is possible only with the help of penetrating diagnostics.

Gastroscopy is one of the mandatory studies

Required collection of biological materials:

• general blood test;
• biochemical blood test;
• stool analysis to detect latent blood.

Drug treatments

Taking medications during the development of this type of disease is possible only as prescribed by a doctor. Self-treatment is often limited to taking painkillers, which can only aggravate the patient’s condition and lead to the development of complications. Any manifestation of peptic ulcer disease leads to scar-ulcerative deformation of the duodenal bulb after recovery.

After healing, the affected areas of the intestine heal, and scars or cicatrices form in their place. Thus, the bulb is also deformed.

Treatment should not consist of painkillers only

Prescribing medications to a patient will primarily be aimed at the pathogens. At the same time, therapy will be carried out to reduce the acidity of gastric juices, which will lead to healing of the affected areas.

Medicines used in treatment:

1. Broad-spectrum antibacterial drugs with the main active ingredients – Clarithromycin, Metronidazole or Amoxicillin – are used at the eradication stage. Therapy is carried out over ten days - a week.
2. Gastric secretion is reduced using omeprazole-based inhibitors (Omez, Omeprazole, Rabeprazole).
3. Antihistamines – Ranitidine, Famotidine.
4. Reducing the acidity of gastric juices is done with the help of antacids. They envelop the intestinal walls, covering the lesions and reducing pain. Common drugs among them are Gastal, Almagel, Phosphalugel, Maalox.
5. Gastroprotective agents that increase intestinal immunity and its ability to resist diseases - Sucralfate, Misoprostol, bismuth preparations.

Clarithromycin helps to defeat Helicobacter pylori, which is often the cause of the disease

The peculiarity of this therapy lies in its variability. If a course of treatment using drugs from one group is not suitable, then another is used. Surgical intervention is used as a last resort for patients who are not amenable to conservative treatment.

Among the types of lesions, “kissing” ulcers of the duodenal bulb may occur. This type of lesion of the duodenum occurs if the ulcers are located on the anterior and posterior walls of the organ at the same time. This form of the disease does not cause any negative manifestations; treatment is carried out in a standard manner.

The video shows how to identify and treat the disease:

When is surgery scheduled?

Chronic duodenal ulcer is a disease that responds well to medication. Advanced stages of the disease and severe course may be a reason for surgery. Most often, endoscopic equipment is used, after which there are practically no scars left on the abdominal cavity. Complex surgical interventions with a wide incision of the abdominal wall can be used in emergency situations or when surgeons cannot intervene using endoscopy. Recovery from puncture procedures takes several days. And strip operations will require a long regeneration process.

Surgery is prescribed in rare cases

Symptoms of a duodenal ulcer can be complicated by severe internal bleeding or large amounts of blood leaking through the colon. Such manifestations require immediate initiation of surgery.

Importance of Nutrition

The diet for duodenal bulb ulcer includes not only recommendations for the foods consumed, but also rules for their intake.

1. Meals should be taken in small portions, periodically, with an interval of three to four hours.
2. Food should be chewed thoroughly or eaten as a puree.
3. The food temperature should not be higher than 40°.

Acceptable and prohibited products are shown in the table.

An acute ulcer of the duodenal bulb is most often accompanied by a lack of appetite. Drinking large amounts of liquid can cause increased levels of gastric acid production.

Traditional treatment recipes

Treatment of duodenal bulb ulcers can also be carried out in combination with traditional medicine. Doctors advise combining the use of medications with recommendations verified by people. It will also be effective to use these methods during periods of remission to reduce the possibility of exacerbation of the disease.

1. Treatment of duodenal bulb ulcers is effective using potato juice. Before meals, a quarter of an hour, you need to drink a third of a glass of freshly squeezed potato juice. Efficiency is achieved after two weeks from the start of use.
2. In the morning, before you start drinking liquids and food, you need to drink one egg (preferably not a factory-made one), then a spoonful of honey.
3. Pour propolis into 70% ethyl alcohol in a 1:1 ratio. Infuse the mixture for three days, after which drink 1 tablespoon of infusion on an empty stomach.

Potato juice has the ability to relieve inflammation

Prevention of disease

Preventive measures for ulcers of the duodenal bulb do not require special efforts and in most cases are limited to maintaining a healthy lifestyle, periodic examinations by a therapist and testing.

The frantic pace of modern life gives rise to various diseases. One of them is an ulcer of the anterior wall of the duodenal bulb.

Severe abdominal pain above the fart, nausea, vomiting after eating fatty foods - all these symptoms indicate that it is time for a person to see a doctor. It is necessary to undergo esophagogastroduodenoscopy. FGDS can determine the cause of pain, since the above symptoms characterize not only peptic ulcer of the LDPC.

What causes ulcers? Stressful situations, poor diet and lifestyle, heredity, etc.

Ulcers, as a rule, cannot be treated at home. The patient is admitted to the hospital for a full examination and treatment in an inpatient setting. In some patients, the ulcer heals in three weeks, in others it takes a couple of months. As written in the article http://ledy-life.ru/yazva-12-perstnoj-kishki-lechenie, the effectiveness of treatment largely depends on the person himself. As the doctors themselves say, healing an ulcer depends 15% on proper nutrition, 20% on taking pills, and 65% on the emotional state of the patient. Stress, a nervous environment, negative emotional moods do not help the scarring of the ulcer, but, on the contrary, slow it down. Antibiotics kill bacteria that provoke ulcers of the LDPC, tablets are curative, but if a person does not follow a diet and is constantly nervous, then the treatment will not be effective and the course of the disease will be prolonged.

Drug treatment, based on the examination, is prescribed by a gastroenterologist. In some cases, duodenal intubation is also required. These procedures are not the most pleasant, but health is more expensive and important.

A gentle diet excludes fatty, salty foods, fresh fruits, vegetables, and smoked foods. It is necessary to include porridge, jelly, and soups in the diet. You need to eat little and often, never go hungry, but also don’t overeat. All food consumed should fit into a 200 ml glass.

After recovery, many people forget that stress and dry snacks, fasting during the day and overeating in the evening, after a working day, are harmful to health and often lead to relapse of the ulcer. To avoid this, you need to monitor your health and avoid developing a peptic ulcer. Try to adhere to the specified diet, and do not abuse foods that provoke peptic ulcers.

Complete recovery - scarring of the ulcer - can only be confirmed by a repeat FGDS procedure.

Prevention: at the first discomfort in the abdomen, take tablets that help digestion, or be treated with folk remedies. Sea buckthorn oil helps wound healing; it should be drunk in the morning or evening on an empty stomach.

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At first, a person does not feel discomfort, so he does not rush to see a doctor. Subsequently, the situation only worsens, which leads to pain. However, everything can still be corrected; the main thing is to contact a specialist who, based on the tests obtained, will prescribe the optimal therapy.

Treatment of duodenal bulb ulcers with medications

This disease has the following symptoms:

• lack of appetite;
• sudden weight loss;
• feeling of fullness or emptiness in the stomach;
• pain;
• belching;
• nausea;
• heartburn turning into burning pain.

An ulcer can appear not only due to bacteria; it often occurs after long-term use of medications, poor diet, frequent stress and anxiety. If you do not consult a doctor if pain and spasms occur, then there is a risk of the disease degenerating into a malignant tumor and bleeding may occur. One of the following drugs is prescribed as treatment:

They will help relieve inflammation and reduce stomach acidity. If the cause of the disease is the activity of Helicobacter, then an antibiotic is prescribed. Most often this is:

To protect the affected bulb, Almagel is prescribed. This drug will form a special film that will help speed up the healing of the ulcer.

Diet is of great importance in treating the disease. The patient should eat finely ground food, which should be cooked only in a water bath. The following should be excluded from the diet:

Fried, salty, fatty and spicy foods are prohibited. You should not eat bran either, as it damages the mucous membrane. Meals should be fractional. Eating chunky food is not allowed. Fruits, meats and vegetables need to be chopped. It is recommended to eat dairy, vegetable soups, and liquid porridges. All this will help normalize digestion and speed up recovery. The diet must be followed throughout the year.

Treatment of duodenal bulb ulcers with folk remedies

Treatment of duodenal bulb ulcers can be carried out using folk remedies. However, such therapy must be agreed with a doctor and combined with medications.

Honey and butter will help get rid of the disease. To prepare the medicine, you will need to mix 250 g of ingredients and place the container on low heat. The mixture should be cooked until it turns brown. Then the product is cooled and taken 10 g in the morning before meals. It is recommended to store the medicine in the refrigerator. The duration of therapy is 21 days. During this time, the ulcer should heal.

Potato juice is a sure cure for this disease. To prepare it, you will need to grate several tubers, put the mass in cheesecloth and squeeze out the juice. It is recommended to take it 50 ml before meals three times a day. The duration of therapy is 3 weeks. During this time, all symptoms of the disease should cease to bother you.

Treatment with honey and raw eggs also gives good results. Every morning you should eat a raw egg on an empty stomach, and then 10 ml of honey. After this, you should not drink or eat anything for 2 hours. The duration of treatment is 14 days.

Propolis gives a good effect. The tincture can be purchased at any pharmacy or made yourself. To do this, you will need to pour propolis with alcohol in a 1:1 ratio. After 3 days the product is ready for use. For ulcers, it is recommended to drink 10 ml before meals three times a day.

You can prepare a medicine based on propolis. To do this, 50 g of crushed product is poured into 500 ml of olive oil. Then the container is placed in a water bath for 20 minutes. It is recommended to take the resulting medicine 10 g in the morning, warmed up.

Celery and cabbage will help you forget about the disease. To do this, you will need to squeeze juice out of 4 kg of vegetables, add 30 ml of lemon juice to it and mix thoroughly. It is recommended to take the resulting medicine 200 ml in the morning before breakfast. The course of treatment is 3 weeks.

A plant called blue cyanosis will help get rid of ulcers. A decoction is prepared from it. To do this, 10 g of raw material is poured into 500 ml of water and boiled in a water bath after boiling for 15 minutes. The product must infuse for 24 hours. Take the product 10 ml after meals 5 times a day. The duration of treatment is 14 days.

Calendula helps with many diseases; you can also get rid of ulcers with its help. A decoction should be prepared from the flowers. To do this, 20 g of raw material is poured into 500 ml of cold water and boiled over low heat for 6 minutes after boiling. After which the product is infused for 3 hours. After this time, it is filtered and consumed before meals, 100 ml. The course of treatment is 2 weeks. As a preventive measure, folk healers recommend drinking it in spring and autumn, then the disease will not make itself felt.

Honey medicine helps with all types of ulcers. To prepare it, 35 g of honey is diluted in 200 ml of warm water. You need to use the product 1.5 hours before meals if the acidity is high. If you have low acidity, you should drink it 10 minutes before meals. Treatment should be continued for a month. If heartburn occurs, you can take the medicine with 50 ml of milk.

The course of treatment is 10 days. Subsequently, therapy should be repeated twice a year.

Collections for duodenal bulb ulcer

Herbs will help with this ailment. Decoctions and infusions give a good effect and have a beneficial effect on the entire gastrointestinal tract.

You can try a collection that includes the following herbs:

You will need to mix the ingredients in a ratio of 2:2:4. 20 g of the resulting mixture should be poured into 200 ml of boiling water and left for 20 minutes. Then the infusion is filtered and taken 50 ml three times a day. This remedy helps well with cramps and flatulence.

A collection that includes the following components helps well with ulcers:

The ingredients should be mixed in a container. Then take 10 g of the mixture, pour in 200 ml of boiling water and leave for 30 minutes. After which the product is filtered and taken 10 ml three times a day. The infusion copes well with pain and heaviness in the stomach.

For duodenal bulb ulcers, a collection of the following herbs helps:

You will need to mix the herbs, then take 20 g of the mixture, pour in 500 ml of boiling water and leave in a thermos for 2 hours. It is recommended to take the product before meals, 100 ml 5 times a day. Thanks to it you can get rid of diarrhea, flatulence and cramps.

If discomfort occurs when using a folk remedy, you should immediately stop taking it. You should definitely tell your doctor about your feelings. He will have to choose another therapy that will be as comfortable as possible.

One of the most common types of erosive formations of the gastrointestinal tract is an ulcer of the duodenal bulb. The disease is common. According to official data, up to 10% of the planet's population is sick. Deformation develops due to a failure in the chemical processing of food. The anatomy of erosive formations is different, but most often they form on a bulb shaped like a ball. The duodenal bulb is located at the very beginning of the intestine, at the exit from the stomach. Treatment is long and complex.

It can be deformed on the front and back walls (kissing ulcers). The ulcer of the duodenal bulb also has a special location - at the end or at the beginning (mirror). Specular erosions are treated like other forms. Negative factors affecting the functioning of the stomach and intestines provoke the appearance of ulcers of various forms. The risk group includes middle-aged people and those who are forced to work night shifts.

If the stomach fails to process food, an ulcer of the duodenal bulb may occur.

Causes of duodenal bulb ulcer

Most often, inflammation of the duodenum occurs due to the aggressive action of acid. In the absence of therapy, the development of a perforated ulcer and bleeding is possible. There could be a number of reasons:

• disordered diet (a lot of fatty foods, spicy foods, diet abuse, carbonated drinks);
• The Helicobacter bacterium is the cause of ulcerative formations in most cases;
• smoking, alcohol;
• severe stress or systematic stay in a state of emotional tension;
• hereditary predisposition;
• long-term use of certain anti-inflammatory drugs;
• incorrectly prescribed treatment at the initial stage of the disease.

Kissing ulcers in the intestines can appear due to concomitant causes: HIV infection, liver cancer, hypercalcemia, renal failure, Crohn's disease, etc.

Symptoms

Symptoms of duodenal bulb ulcers are also characteristic of other types of gastrointestinal ulcers, and they appear depending on the stage of the disease:

• heartburn;
• nausea in the morning or after eating;
• pain in the epigastric region;
• pain in the stomach at night;
• flatulence;
• the appearance of a feeling of hunger a short period of time after eating;
• if the disease is in an advanced form, bleeding may occur;
• vomit;
• pain localized in the lumbar region or chest area.

The inflammatory lymphofollicular form of the duodenum has a different type of pain: stabbing pain, sharp or aching. Sometimes it goes away after a person has eaten. Hunger pains usually occur at night, and to eliminate the discomfort it is recommended to drink a glass of milk or eat a little. Night pain is caused by a sharp increase in acidity levels.

Stages

The intestinal healing process is divided into 4 main stages:

• Stage 1 - initial healing, characterized by creeping layers of epithelium;
• Stage 2 - proliferative healing, in which protrusions in the form of papillomas appear on the surface; these formations are covered with regenerating epithelium;
• Stage 3 - the appearance of a polysadic scar - the ulcer on the mucous membrane is no longer visible; upon closer examination, many new capillaries are visible;
• Stage 4 - scar formation - the bottom of the ulcer is completely covered with new epithelium.

Erosive kissing formations on the duodenum heal after therapy. Multiple ulcers in a small area of ​​the intestine result in multiple scars. The result of such healing is cicatricial and ulcerative deformation of the duodenal bulb. The appearance of fresh scars leads to a narrowing of the lumen of the bulbous sector. Inflammatory scar deformation of the duodenal bulb has negative consequences, for example, stagnation of food and malfunctions of the entire gastrointestinal tract.

There is also a distribution by stage: exacerbation, scarring, remission.

One form of intestinal ulcer is lymphoid hyperplasia of the duodenal bulb, which is characterized by inflammation due to a disturbance in the outflow of lymph. The causes are exactly the same as for duodenal ulcers. There are also similar symptoms. Lymphofollicular dysplasia is a pathology in the mucous membrane of the intestines or stomach. It is characterized by the appearance of round-shaped formations on a wide base. Lymphofollicular dysplasia is deformed and has a dense consistency and point size. Lymphofollicular mucosa is infiltrated. Stages of development:

Diagnosis of the disease

The FGDS method (fibrogastroduodenoscopy) will help to accurately diagnose the presence of a duodenal ulcer. Using a special probe with a camera, the intestinal surface is examined. It is this diagnostic method that will allow us to determine the location of the ulcer, its size and stage of the disease. Inflammation is usually observed, or the surface is hyperemic, covered with point erosions of a dark red color. The intestinal area is inflamed at the mouth, and the mucous membrane is hyperemic.

Tests are required to determine the Helicobacter bacteria. Not only blood and feces are used as testing material, but also vomit and material after a biopsy. Ancillary diagnostic methods include x-rays, palpation in the stomach area, and a general blood test.

Treatment

After a diagnosis of “inflammation of the duodenal bulb” is made, treatment must begin immediately, as serious complications may develop. Kissing ulcers are treated mainly with medications. During an exacerbation, hospitalization is necessary.

The doctor selects medications and physical procedures individually for each patient, taking into account the characteristics of the body and stage. For example, the chronic or lymphofollicular stage is treated differently than during an exacerbation. This regimen usually includes the following medications:

• bismuth-based medications, if Helicobacter bacteria are detected; such drugs have a depressing effect on pathogenic microflora;
• drugs that reduce the amount of gastric juice produced: blockers, inhibitors, anticholinergics;
• prokinetics - improve intestinal motility;
• unpleasant pain is eliminated with the help of antacids;
• To combat the bacterial cause of lymphofollicular ulcers, antibiotics are prescribed;
• Gastroprotectors will help prevent the negative effects of hydrochloric acid on the affected area;
• inflammation is relieved by analgesics and antispasmodics.

The combination of medication and physiotherapy promotes faster recovery of the body. These techniques include: electrophoresis, ultrasound, the use of microwaves, modulated current therapy for pain relief. Special physical therapy will help normalize gastric motility. Gymnastics is a good preventative against stagnation in the intestines and stomach.

In addition to generally accepted methods of healing intestinal ulcers, traditional medicine has long proven its effectiveness. The first place for ulcerative lesions is freshly squeezed potato juice. It must be drunk three times a day, and only freshly squeezed. First, the potatoes are peeled, grated, and squeezed through cheesecloth. The first few days the dosage is one tablespoon. Gradually it can be increased to half a glass. You need to drink before eating.

Other equally effective remedies include honey, medicinal herbs (calendula, St. John's wort, plantain), olive and sea buckthorn oils.

During the acute period, bed rest is mandatory. After the exacerbation passes, you can take short walks. Heavy physical activity and exercise are prohibited. The army is contraindicated for those who have ulcers. In order not to provoke new attacks, it is important to avoid stress and take care of the nervous system.

Diet is one of the important factors on the path to recovery and reduction of inflammatory processes. General dietary recommendations are as follows:

• small portions;
• chew each piece thoroughly;
• temporarily exclude foods that provoke active production of gastric juice (vegetable soups, fish and meat broths);
• in order not to further irritate the mucous membrane, food should be ground;
• fruit juices should be diluted with water;
• drink milk more often;
• do not use spices in dishes;
• prepare ground porridge;
• eat food at the optimal temperature, not too hot and not too cold;
• meals are fractional, up to 5 times a day.

Food should be prepared by steaming or in the oven. The diet must include non-acidic fruits, kefir, milk, cottage cheese, boiled or steamed vegetables. It is necessary to stop drinking alcohol and smoking, as this can lead to the development of serious complications.

Forecast

A favorable prognosis for recovery can be achieved if treatment is carried out on time and the correct diet is followed. If you do not consult a doctor in a timely manner or if medications are prescribed incorrectly, serious complications can develop: lymphofollicular ulcer, bleeding (vomiting blood), ulcer perforation (acute pain under the sternum) and penetration (due to adhesions, intestinal contents enter neighboring organs). In each of these cases, the only option is surgery.

Duodenal stenosis is a complication. After healing, there are scar changes, which can subsequently cause swelling and spasm. Stenosis usually manifests itself during the acute form or after therapy. Stenosis occurs in those patients whose ulcer does not heal for a long time. Stenosis is accompanied by impaired intestinal and gastric motility.

Prevention

The main methods for preventing duodenal ulcers are regular and proper nutrition, a healthy lifestyle (complete abstinence from alcohol and nicotine). After taking medications or in the postoperative period, sanatorium-resort rehabilitation is recommended. To prevent ulcers, you should regularly undergo examination by a gastroenterologist and take tests. The emotional state plays an important role in the prevention of erosive manifestations of the gastrointestinal tract, so it is better to avoid stressful situations.

Acute ulcer of the stomach and duodenum

Chronic gastrointestinal diseases cause discomfort and last for a long time without significant symptoms.

An acute stomach ulcer is accompanied by severe pain and can become perforated, causing bleeding or peritonitis - the release of gastric juice into the abdominal cavity. The outcome of the attack can be fatal. It is necessary to recognize the symptoms of gastritis and ulcers and treat them at the initial stage, excluding relapse.

Exacerbation of stomach ulcers

Externally, the ulcer usually has a round shape, inflamed red tissue around the wound and a gray bottom on which bacteria and traces of their vital activity accumulate. A chronic ulcer damages the superficial mucous layer and may partially affect the mucous membrane. In the acute form, the wound deepens to the muscle tissue of the stomach, affecting them with acid. The patient experiences severe pain. Destroyed small capillaries begin to bleed. Damage to the walls of large vessels leads to large blood losses.

Experts distinguish three forms of acute gastric and duodenal ulcers:

In all cases, conditions are created for the sharp activation of Helicobacter Pylori - bacteria that can live in the aggressive environment of gastric juice and even increase its acidity due to their effect on the glands. They are the ones who damage the protective layer of the mucous membrane and open the way for acid to the walls of the stomach.

Uncontrolled intake of tablets, especially non-steroidal drugs, aspirin, hormonal drugs, leads to changes in the normal functioning of the mucous layer and corrodes it. The glands produce less mucous secretion and more acid. Cushing's ulcer is a form of exacerbation that occurs when the central nervous system is injured by a stroke, traumatic brain injury, or neurosurgery.

Causes of exacerbation of stomach ulcers and its symptoms

Doctors call an acute ulcer a stress ulcer. In most cases, it develops from a chronic form of the disease when a person receives stress. It can be:

• Injuries in accidents.
• Operations on internal organs and blood vessels.
• Extensive sepsis.

Redness from inflammation forms around the ulcer. The cylindrical shape gives way to a conical shape, the size of the bottom is smaller than the top of the wound. Instead of a gray coating there is bleeding tissue. Symptoms of an acute ulcer are pronounced and begin early:

• Severe headaches.
• Nausea.
• Dark to black stool.
• Vomiting blood.
• The temperature rises to 37.5 degrees.

Irradiation of pain may occur when it radiates away from the affected area, for example, to the shoulder, side and back. The exacerbation occurs with bleeding. First, the small vessels of the stomach wall are destroyed, then the depth of the ulcer reaches the fatty layer of the peritoneum and destroys the walls of large vessels. Up to half of a person's blood can leak out in an hour. The maximum acceptable norm for life is the loss of a third part.

Depending on the location of the bleeding ulcer, pain appears in different places. Epigastric inflammation is signaled by sharp pain, mainly in the center, or radiates to the heart area, as in a heart attack. An ulcer of the antrum of the stomach is most often felt by pain and heaviness in the umbilical area. Pyloric below the navel and in the pelvic area.

Symptoms of exacerbation of a gastric ulcer

An exacerbation may be accompanied by symptoms similar to other diseases, for example, aching pain in the heart, liver, pancreas, and appendages. You can tell by the color of the stool. Since the exacerbation occurs with bleeding of varying intensity, the feces become black.

For perforation of the gastric wall, the symptoms of the disease are characteristic:

• A sharp pain that appears in one place and quickly spreads to the entire abdomen.
• The abdominal muscles become very tense.
• Chills, fever.
• My mouth is dry.
• Condition on the verge of fainting, weakness, dizziness, ringing in the ears.
• Nausea without vomiting.

If several of these symptoms appear, the patient should be hospitalized immediately. In most cases, urgent surgery is needed.

Duodenal bulb ulcer

The duodenum is located behind the stomach and serves as the beginning of the small intestine. Food, along with gastric juice, enters it for final processing and completion of alkalization. Therefore, a violation of the integrity of the protective shell occurs in it simultaneously with the mucous membrane inside the stomach. In most cases, the patient is diagnosed with a stomach and duodenal ulcer. When the functioning of the glands is disrupted and the concentration of hydrochloric acid in the antrum and epigastrium is increased, the duodenal bulb, located near the valve, suffers the most.

Disruption of the stomach leads to the release of food debris, hydrochloric acid, and with them Helicobacter Pylori into the intestines. As a result, tissue damage is formed in the duodenum by caustic enzymes, and wounds deepen where bacteria accumulate. Signs of the disease:

• Pain around the navel and in the right epigastric region.
• Belching and nausea after eating.
• Heartburn, sour taste in the mouth.

In some cases, soon after eating, a feeling of hunger suddenly arises. Depending on the characteristics of the body, sometimes constipation is accompanied by bloating and severe flatulence. Most often, an acute ulcer of the duodenal bulb develops, since this section, resembling the shape and size of an onion, is located immediately behind the pyloric section of the stomach and takes the blow, protecting the small intestine.

Chronic disease of the duodenal bulb is often asymptomatic and severe pain during relapse occurs unexpectedly. The patient does not associate it with gastrointestinal diseases.

Complications of acute gastric ulcer

In case of exacerbation of chronic gastritis and stomach ulcers, Helicobacter Pylori deepens the wound to smooth muscles and the acid corrodes the walls of the organ. Through the resulting perforated - through wound, gastric juice begins to flow out. Once in the abdominal cavity, it causes peritonitis and infection. If the wall rests on a neighboring organ, then hydrochloric acid and bacteria corrode it. Most often they suffer:

An exacerbation is accompanied by bleeding, anemia or complete loss of blood and death. Damage to the walls of blood vessels allows food debris, gastric juice and bacteria to enter the circulatory system. This leads to extensive sepsis - blood poisoning. With a perforated ulcer, neighboring organs are affected. Acute pain can cause convulsive contraction of muscles, including the heart and respiratory organs.

Surgical and medicinal treatment

Acute ulcers are treated surgically. A course of medication is possible for mild forms of relapse. The main goal of this treatment:

• Reduce the number and destroy Helicobacter Pylori.
• Reduce the acidity of gastric juice.
• Create an enveloping protective layer.

The measures are aimed at relieving inflammation, eliminating irritants and accelerating wound healing. 3–4 medications are used simultaneously. Additionally, you can take traditional medicine, having previously agreed on the dosage and duration of the course with your doctor.

A perforated ulcer requires immediate surgery. The affected areas of the stomach and duodenum are cut out, healthy tissue is pulled together or resection is performed. If the ulcer is large or there are several wounds, the volume of the stomach decreases. After recovery, the patient is forced to eat small portions.

Diet for acute stomach ulcers

A necessary condition for treatment is a diet for acute gastric ulcers. Products harmful to the gastrointestinal tract are excluded from the patient’s menu:

For the first 2 days after surgery, nutrition is administered through the blood, then you can drink mineral and table water. After 5–7 days, the patient switches to a diet followed during an exacerbation:

• Liquid porridges: oatmeal, buckwheat, rice.
• Puree soups.
• Kiseli.
• Herbal teas made from chamomile with the addition of other herbs.

After about 10 days, you can add steamed white meat cutlets, stewed vegetables, jellies, porridge with milk, and fermented milk products. Bad habits have a detrimental effect on the stomach and can cause aggravation:

• Drinking alcohol, especially on an empty stomach, when overeating and in large quantities.
• Smoking.

Alkaloids and resins with nicotinic acid create conditions for the development of Helicobacter Pylori and wash away the mucus of the protective lining of the stomach walls. As a result, the risk of exacerbation of the disease increases.

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All about the disease of ulcers and gastritis!

Perforated and bulbous duodenal ulcer

There are many different classifications of duodenal ulcers. They are based on the etiology of the disease, pathogenesis or localization. These classifications are used for convenience in making a diagnosis and prescribing treatment.

Types and types of ulcers

An ulcer can be classified according to the stage of development, the phase of its progression (acute phase and remission), the nature of scarring, and the number of formations (single, double, multiple). According to localization they distinguish:

• ulcer of the duodenal bulb (its anterior section);
• postbulbar part (extrabulb ulcers);
• front and back walls;
• major and minor curvature.

Most often, it is the bulb that is affected by peptic ulcers, as it is connected to the stomach. This is the place of maximum contact and exchange of media between two important sections of the gastrointestinal tract.

By size they are distinguished:

According to the nature of complications, they are usually divided into:

• ulcer without complications;
• with bleeding of varying severity;
• with perforation (perforated, dangerous for the development of peritonitis);
• with penetration (spread beyond the duodenum);
• with stenosis (narrowing of the lumen preventing the normal passage of food mass);
• with malignancy (degeneration of an ulcer into a malignant tumor).

Almost all ulcers with complications are treated not only with medication but also with surgery.

Duodenal bulb ulcer

A bulbar or bulbous ulcer is a lesion of the bulbous part of the duodenum. The symptoms are very similar to those of a gastric ulcer. These are hungry night pains, seasonality of exacerbations and remissions, sometimes asymptomatic.

Bulb ulcer may be accompanied by obstruction and stenosis. Then, due to the deterioration of food passage through the gastrointestinal tract, frequent vomiting and intense pain in the epigastrium are observed. Dyspeptic syndrome can manifest itself more painfully.

For diagnosis, duodenal gastroendoscopy is performed. Treatment is the same as for stomach ulcers. Antibacterial drugs are used to eliminate the main causative agent of the disease - Helicobacter. In addition, treatment is aimed at reducing the secretion of gastric juice and eliminating the symptoms of dyspepsia. Rest and diet are prescribed.

Perforated duodenal ulcer

The phenomenon of perforation of an ulcer into the abdominal cavity is more common in young men during the off-season (spring, autumn). Perforation of the intestinal wall causes its contents to enter the abdominal cavity. It acts as a mechanical and chemical irritant and becomes a source of bacterial infection.

The body’s primary reaction to a burn of the insides by gastric juice is called shock, due to the similarity of symptoms. Further, depending on the level of acidity of the juice produced by the stomach, peritonitis develops. The lower the acidity, the higher the speed of this process. It can take from 6 to 12 hours.

The main symptom is pain comparable in strength to a dagger in the stomach. At first it is localized in the upper abdomen, but gradually spreads to all its parts. If a perforated ulcer is detected, urgent hospitalization of the patient in the surgical department is necessary.

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Duodenal bulb ulcer

Duodenal ulcer develops together with the stomach or in isolation. Characteristically, there is damage to the mucous membrane of the initial section of the intestine. In anatomy, the “bulb” is the part of the duodenum closest to the stomach. It has a round shape. Functionally, this part is most closely connected with gastric juice and takes the first blow when secretory function is disrupted. Therefore, among all cases of ulcers in the duodenum, the bulb accounts for 94% of all cases. The remaining 6% are localized in other departments.

In this case, pronounced gastritis is found on the gastric mucosa, and duodenitis (inflammation) is found lower in the duodenum. They require treatment. The diameter of a typical ulcer is no more than 1.5 cm.

Causes of the disease

The following causes leading to the disease are identified:

• infectious pathogen - Helicobacter is present in 70% of patients;
• poor nutrition (frequent consumption of fatty and fried foods, fast food, use of starvation diets for weight loss, alcohol, carbonated drinks);
• disruption of the nervous regulation of the secretory function of the duodenum is caused by prolonged stressful situations;
• family hereditary predisposition;
• nicotine poisoning, which disrupts secretion production.

Symptoms of the disease

An ulcer located in the duodenal bulb is associated with typical manifestations of the disease:

• “hungry” pain in the epigastric region - occurs on an empty stomach or one and a half to three hours after eating, radiating to the right hypochondrium, right shoulder blade, lower back;
• vomiting of eaten food, which brings relief;
• heartburn - can turn into burning pain.

Seasonality of exacerbations is characteristic (spring and autumn).

Diagnostics

An ulcer on the duodenal bulb is visible on fluoroscopy of the stomach and intestines. Even greater opportunities are provided by the method of fibroesophagogastroduodenoscopy. Endoscopic technology allows you to determine the exact location, size, and condition of the edges of the ulcer.

Treatment

Treatment is based on the basic principles adopted for peptic ulcer disease.

Compliance with the regime

Staying in bed is necessary during the first 10 days of an exacerbation, after which the patient can gradually walk. But vigorous physical exercise is not recommended.

The patient needs a calm environment. For treatment, you need to learn to avoid stress and conflicts. Protect your nervous system.

You will have to give up smoking forever.

Diet

During an exacerbation, the doctor prescribes a gradual, restrictive diet. Basic requirements for treating an ulcer with nutrition:

• chew food well, organize meals often, but little by little;
• exclude from food foods that can stimulate juice production (rich meat, fish, vegetable soups);
• in the first days, use only pureed dishes that do not cause mechanical irritation to the mucous membrane of the stomach and duodenum;
• Cold and hot foods are prohibited.

Conservative treatment

Medicines are selected based on their ability to relieve pain, stop the production of excess acid, protect the affected areas and promote the healing process of the bulb ulcer.

Medicines should be used only as prescribed by a doctor. They may cause side effects. The course of treatment is applied individually.

Physiotherapy is prescribed in combination with medications: galvanization, electrophoresis with novocaine, microwave therapy, sinusoidal currents, ultrasound, ozokerite, mud applications.

Surgical treatment for duodenal ulcers in the area of ​​the bulb is carried out as an emergency in case of bleeding, a perforated ulcer or an ulcer penetrating into a neighboring organ. Planned surgical treatment is necessary for cicatricial deformation of the bulb that prevents the normal passage of food. The scope and nature of the operation is determined by the surgeon based on a complete examination.

Typical complications caused by a bulb ulcer are bleeding in 1/5 of patients, perforation in every tenth patient, cicatricial narrowing in 7 to 11% of cases. According to statistical data, cancerous degeneration occurs rarely (0.3%).

The prognosis of the disease depends on complete treatment and the patient’s compliance with all the requirements of the regimen.

Duodenal Bulb Ulcer - Symptoms and Treatment

Any peptic ulcer, including duodenal ulcer, is a chronic disease with periods of exacerbation. An ulcer occurs due to a violation of the motor-evacuation and excretory functions of the stomach and, accordingly, the duodenum. As a result of the pathological process, erosion forms on the walls of the intestinal mucosa. However, ulceration can appear not only on the mucous membrane, but also on the so-called duodenal bulb. It is located at the exit from the upper part of the pylorus of the stomach, at the very beginning of the duodenum and has the shape of a ball. Therefore, doctors call this part of the intestine the bulb.

Causes

Duodenal bulb ulcer is a fairly common disease of this organ. According to medical statistics, extra-bulb ulcers are much less common. The main reason for the occurrence of such a pathological manifestation is a sharp increase in the level of acidity, which creates a favorable environment for the proliferation of Helicobacter pylori bacteria. It is these pathogenic microorganisms that cause the development of the inflammatory process in the duodenal bulb.

One of the main reasons for the appearance of a bulbous ulcer is a strong single stress that occurs against the background of a severe injury. However, often peptic ulcer disease, especially in young people, can develop due to a systematically unstable neuro-emotional state. Also predisposing factors for the occurrence of ulcers are exacerbation of gastritis, alcohol abuse, and long-term use of medications, such as corticosteroids. In addition, concomitant diseases can provoke the appearance of a bulbous duodenal ulcer: hypercalcemia, renal failure, liver cirrhosis, chronic obstructive pulmonary disease, HIV infection, Crohn's disease and other pathologies.

Symptoms

The most characteristic symptom of a bulbous ulcer is acute burning or aching pain in the upper part of the stomach, which occurs during periods of exacerbation. Most often, pain occurs at night or after eating. Often, when the stomach is empty, so-called “hunger pains” develop, which are accompanied by belching, nausea, and vomiting. The aggravation is felt especially strongly when a stressful situation arises. Compared to erosion of the duodenal mucosa, a bulb ulcer is much deeper and more sensitive.

Treatment

A bulbous ulcer should never be ignored. Failure to see a doctor in a timely manner can cause complications such as chronic bleeding, perforation of the disease into the abdominal cavity and other organs, and even the formation of a malignant tumor. You should also remember that self-medication is unacceptable, because you can significantly worsen your condition. If the patient seeks help in time, then modern medicine has many effective means to maintain the function of the duodenum. Treatment of bulb ulcer requires an integrated approach, which is carried out under the supervision of a gastroenterologist. In addition to taking appropriate medications, the patient will be prescribed a special diet.

The treatment process for this disease is aimed at relieving inflammation, destroying (eradicating) the Helicobacter pylori bacterium and protecting the duodenal bulb from the aggressive effects of hydrochloric acid. Medications that reduce the secretion of hydrochloric acid help stop the inflammatory process. These include proton pump inhibitors (for example, Omeprazole), bismuth preparations (De-Nol), and H2-histamine receptor inhibitors, in particular Ranitidine. To eliminate Helicobacter pylori infection, the antibacterial drug Metronidazole, antibiotics from the macrolide group (Clarithromycin, Erythromycin), and penicillin antibiotics, for example, Ampiox, are used. To form a protective film on the duodenal bulb, use antacids Maalox and Almagel.

When diagnosing a duodenal bulb ulcer, you will need to change your diet. The patient will be prescribed a special diet that excludes spicy, fatty, salty, and hot foods. Food should be boiled, finely chopped, or steamed. You will need to eat in small portions, at least 5 times a day.

Treatment of a bulbous ulcer takes a long time. To prevent the development of the disease, it is necessary to give up fast food, alcohol, smoking, and learn to control stressful situations. Take care of yourself!