Duodenal ulcer (DU): types, causes, symptoms and treatment. Stomach and duodenal ulcers - diagnosis How to recognize a duodenal ulcer

Update: October 2018

Duodenal ulcers often begin gradually with sucking pain in the pit of the stomach, an increased feeling of hunger in the morning, and mild nausea.

But just as often, these signals that the body gives are not taken seriously. The person simply does not realize the scale of the impending problem. After all, persistent pain syndrome, as well as dangerous complications of this disease, develop much later.

If there is the slightest doubt about the presence of the disease, you should immediately contact a therapist or gastroenterologist with complaints, so as not to end up with a surgeon or, God forbid, a pathologist.

To help you navigate the variety of manifestations of duodenal ulcer, this article collects and highlights the main issues related to this disease.

What is an ulcer?

The wall of the duodenum, which is called duodenum in Latin, consists of mucous, submucosal and muscular layers. An ulcer is a wall defect, the bottom of which is located in the muscle layer, that is, the mucosa and submucosa are destroyed.

In the duodenum, the ulcer is most often located in the initial section (bulb or bulb), since here are the most favorable conditions for the reflux of acidic gastric contents and a wonderful place for the proliferation of bacteria that provoke peptic ulcer disease. Sometimes not one ulcer of the duodenal bulb is formed, but several at once. More often these are paired, opposite each other, “kissing” ulcers.

Peptic ulcer disease is the repeated formation of ulcerative defects in the wall of the duodenum, occurring with periods of exacerbation (the presence of an ulcer) and remission (the absence of an open defect in the intestinal wall). Since the ulcer heals with the formation of a scar, even in remission, scar defects remain on the mucous membrane. If exacerbations are frequent and a lot of scars are formed, they can deform or narrow the intestinal lumen.

About ten percent of the world's population suffers from duodenal ulcers. These are predominantly young and middle-aged people.

Why does she appear?

There is no single view on the occurrence and development of duodenal ulcers. There are several equivalent theories of the occurrence of ulcers.

• On the one hand, several years ago there was a very popular assumption that peptic ulcer disease is the result of the colonization of the stomach and intestines by a microbe such as Helicobacter pylori. The microbe infects cells that secrete mucus. During development, it quickly colonizes the stomach and duodenum, stimulating the release of gastrin and releasing cytokines (substances that damage cells). Later it turned out that not all types of this microorganism living in humans cause disease. Therefore, blaming everything on infection is still wrong.
• An earlier assumption was an imbalance between the ability of the mucous membrane to defend itself and aggressive factors in the form of gastric acid and pepsin, which enter the intestine when the function of the obturator muscle of the gastric outlet is insufficient. It was also believed that the intestine was scratched by rough food. Today, these assumptions have been supplemented by the fact that a decrease in protective prostaglandins has been found in the mucous membrane of patients with peptic ulcer disease.
• A relationship has been found between the incidence of ulcers and blood type. Carriers of the first group with a Rh-positive factor are at greater risk.
• Soviet physiology was of the opinion that ulcers develop in people with excessive irritation of the cerebral cortex against the background of chronic stress or nervous experiences, when the release of gastric juice and inflammatory mediators (gastrin) is stimulated through the autonomic nervous system.
• Another interesting conclusion is associated with gastrin: prolonged exposure to the sun stimulates the release of this hormone and, accordingly, provokes an exacerbation of peptic ulcer disease or worsens its course.
• Taking medications such as corticosteroids and non-steroidal anti-inflammatory drugs can provoke ulcerations of the intestinal mucosa.
• Alcohol and nicotine worsen the condition of the mucous membrane, change the nature of the secretion of hydrochloric acid and pepsin by the stomach, affect the level of gastrin and somatostatin, and also reduce the protective properties of the mucus. Alcohol directly damages mucosal cells.

What are the symptoms of a duodenal ulcer?

The symptoms of stomach and duodenal ulcers are very close to each other. These are: pain, heartburn, nausea, vomiting, appetite disorders.

With ulcers, the duodenum is called late. They occur an hour and a half after eating. Hunger pains that occur if food has not been received for more than 4 hours are also characteristic. A type of such pain is night or early morning, similar to very acute hunger and sucking in the right hypochondrium. The nature of pain may vary from patient to patient. There are stabbing, aching, cutting, sucking or spasmodic pains of varying intensity and duration. In this case, the pain is located in the right half of the epigastric region (bulb ulcer). They can radiate to the right hypochondrium or to the back. With an ulcer located at the end of the intestine, the pain shifts more to the midline of the epigastrium or to its left half. The basis of the pain is a violation of the integrity of the intestinal wall, inflammation and accumulation of under-oxidized metabolic products.

• Heartburn

accompanies about a third of duodenal ulcers. It is due to the fact that the acidic contents of the stomach are thrown into the esophagus against the background of impaired motor activity of the stomach and intestines and inflammatory changes in the mucous membrane.

• Nausea and vomiting

eaten food or gastric contents are characteristic of high duodenal ulcers. With the development of secondary inflammation of the pancreas or gallbladder against the background of a peptic ulcer, vomiting of bile may occur.

• Appetite disorders

can manifest itself as an increase (sucking in the stomach is somewhat smoothed out by food intake) or an aversion to food and fear of it, since in the presence of an ulcer, food can provoke pain.

Complications of peptic ulcer

If the ulcer is not detected and treated in a timely manner, it may heal on its own. However, there is a high risk of developing a number of complications, which not only aggravate the course of the disease, but complicate treatment and worsen the prognosis for the patient. All complications are divided into:

Destructive - destroying the intestine:

• it's bleeding
• perforation - perforation
• penetration - penetration into a neighboring organ

Dysmorphic complications that change its structure:

• malignancy - the development of a malignant tumor at the site of the ulcer
• cicatricial deformation - a change in the structure of the walls and narrowing of the intestinal lumen until it is completely closed due to scars from ulcers.

Ulcers located on the anterior wall of the intestine are more likely to perforate. Ulcers of the posterior wall often penetrate the head of the pancreas.

Bleeding from the duodenum

Physical work and heavy lifting can provoke bleeding. But most often the cause is alcohol intake, if treatment with medications is not carried out or is inadequate. Therefore, up to 80% of this complication occurs in men. In this case, blood loss can be of different volumes.

When bleeding occurs, tar-colored stools or vomit with a color similar to coffee grounds appear. Minor bleeding may only result in diarrhea or pasty, dark stools. At the same time, with heavy blood loss, rapidly increasing weakness, dizziness, and even vomiting will be added. Bleeding is an emergency that requires calling an ambulance or going to a hospital emergency room on your own.

Symptoms of a perforated duodenal ulcer

Perforation of an ulcer means not only bleeding, but also the entry into the abdominal cavity of the contents of the duodenum, where pancreatic enzymes and bile are released. These are quite aggressive substances that quickly cause irritation of the peritoneum and lead to inflammation of the abdominal cavity (peritonitis).

If acute stabbing pain in the abdomen occurs against the background of a peptic ulcer, you should immediately call an ambulance. This pain appears more often in the right half of the epigastric region and can radiate to the right shoulder or scapula. The pain is so severe that the patient takes a forced position, lying on his side or back with his legs brought to his stomach. At the same time, the skin becomes very pale. The abdominal muscles tense, the person avoids any movement.

The most dangerous period is the period of imaginary well-being, which develops a few hours after the onset of perforation. Here the pain subsides somewhat, the patient begins to move and assures that he is feeling better. During this period, patients often recklessly refuse surgery that could save their life. But, if 6-12 hours pass from the onset of perforation, and the patient does not undergo surgery, his condition will sharply worsen:

• vomiting appears
• temperature increase
• the pain will return
• bloating will appear
• pulse and heartbeat increase
• peritonitis will develop, which will need to be operated on, and the prognosis for which at this stage is already worse.

Cicatricial stenosis of the duodenum

If exacerbations of duodenal ulcer follow one after another or the ulcerative defects are very large and deep, scars from ulcers can significantly deform or narrow the intestinal lumen. In this case, problems arise with the passage of food, and a narrowing (stenosis) of the intestine develops, which requires surgical treatment. Clinically, decompensated stenosis is manifested by vomiting, impaired passage of food and distension of the stomach. At the same time, disturbances in the content of salts and water in the body develop, which lead to lethargy, weakness, drowsiness, increased muscle tone, and a feeling of goosebumps running on the skin of the arms and legs.

Diagnostics

Today, the main and most informative method for identifying peptic ulcers is FGDS (fibrogastrodudenoscopy), in which, by inserting an endoscope (optical probe) into the stomach and duodenum, you can see the ulcer, assess its size and depth, and take the mucous membrane for examination (biopsy). or conduct a rapid urease test for the presence of Helicobacter pylori.

X-ray diagnostics, which is indispensable in clarifying complications, is of auxiliary importance.

Patients are also prescribed a clinical blood test, blood biochemistry, and a stool test for the Gregersen reaction (detection of occult blood).

Treatment of duodenal ulcers

With timely detection of duodenal ulcer in the acute stage, treatment is reduced to the prescription of conservative therapy (prescription of tablets, less often injections or drips). The times when surgical treatment methods were used for uncomplicated peptic ulcers are a thing of the past. If the peptic ulcer is complicated, then hospitalization in a surgical hospital is mandatory, and refusal to do so can be fatal. This does not mean that any bleeding will be operated on, but timely observation is indicated for every complicated duodenal ulcer.

Previously, it was customary to carry out seasonal (spring and autumn) preventive treatment of duodenal ulcer. Currently, this practice is not supported, as it has not brought the expected results. Treatment is prescribed for the period of exacerbation of duodenal ulcer.

Diet for ulcers

In case of duodenal ulcer, a 4g diet is prescribed for the period of exacerbation, which involves mechanical, chemical and temperature sparing. It is recommended to eat 5-6 meals a day in small portions. Food should be heated to a temperature of 36-37 degrees. Hot, cold and dry food are excluded (see). Alcohol and smoking on an empty stomach are prohibited.

• Preference is given to boiled, pureed food. Slimy porridges, non-rich creamy soups, mashed potatoes, pasta, rice and buckwheat are desirable. Steamed fish, poultry, boiled meat in the form of soufflé or minced meat and cutlets. Watermelons and bananas are allowed as fruits.
• You will have to give up fried, spicy, rich meat and bone broths, marinades, soda, strong tea, coffee, and yeast baked goods. The greatest harm is caused by fruits and vegetables containing fiber. You will have to forget about tomatoes, cucumbers, apples, pears, cabbage, carrots, radishes and other garden delights until the ulcerative defect heals.
• It is strictly forbidden to chew gum, which stimulates gastric secretion.
• Milk in this situation becomes an ambiguous product. In some patients, whole milk can irritate the ulcer due to calcium ions, while others drink it with pleasure, as it significantly reduces heartburn.

Drug treatment of duodenal ulcers

Peptic ulcer of the duodenum is currently treated with the following groups of drugs.

Medicines that reduce the production of gastric juice

The leading positions in this group are held by proton pump blockers, which slow down the secretion of hydrochloric acid:

• Funds on base- omez, gastrozole, bioprazole, demeprazole, lomac, zerocid, krismel, zolser, omegast, lossek, omezol, omitox, omepar, zhelkizol, peptikum, omipix, promez, peptikum, ricek, orthanol, romsec, sopral, ultop, helicid, cisagast , helol.
• Medicines based on pantoprazole- Controloc, Sanpraz, Nolpaza, Peptazol.
• Lansoprazole preparations- helicol, lanzap, lansofed, lanzotope, epicure, lancid.
• Based on rabeprazole- Zulbex, Zolispan, Pariet, Ontime, Khairabezol, Rabeloc.
• Esomeprazole - Nexium.

H2-histamine receptor blockers have practically ceased to be used to treat peptic ulcers, as they cause withdrawal syndrome (with abrupt cessation of use, the symptoms of the disease return).

• These are ranitidine (Gistac, Rannisan), famotidine (quamatel, ulfamid, gastrsidine), cimetidine (Belomet).

Selective blockers of M-cholinergic receptors (gastrocepin, pirencipin) reduce the production of pepsin and hydrochloric acid. Used as auxiliary medications for severe pain. May cause palpitations and.

Agents that increase the protective properties of the mucous membrane

• Sucralfate (Venter) forms a protective coating at the bottom of the ulcer.
• Sodium carbenoxolone (Ventroxol, Biogastron, Kaved-s) accelerates the restoration of the epithelium of the mucous membrane.
• Colloidal bismuth subcitrate () forms a film on the ulcer.
• Synthetic prostaglandins (enprostil) stimulate mucus production and cell restoration.

Other drugs

• Medicines that calm the central nervous system. Tranquilizers (seduxen, elenium, tazepam), (amitriptyline), sedatives (tenoten, valerian preparations, see).
• Blockers of central dopamine receptors (metoclopramide, raglan, cerucal) normalize intestinal motor activity.

The course of treatment for ulcers can take from two to six weeks, depending on the size of the defect and the general condition of the body.

It should be noted that a competent doctor who can monitor the treatment process and evaluate its results should prescribe treatment for duodenal ulcers, select medications and dosage regimens.

Treatment of duodenal ulcers with antibiotics

Antibiotic therapy for peptic ulcers has appeared since the undoubted participation of Helicobacter pylori microorganisms in the development of the disease was proven. In the early stages of the use of antibiotics, it was believed that the war should be waged until a victorious end, that is, the complete disappearance of the microbe, which was confirmed by culture, a urease test during FGDS, or a blood test for antibodies to the bacterium. Later it turned out that not all types of Helicobacter cause disease, that it is unrealistic to destroy all Helicobacter, since when it dies in the stomach and duodenum, it moves to the lower intestines, causing severe dysbiosis and inflammation.

Re-infection is also possible when using someone else's or shared utensils and the same FGDS, which therefore must be performed only according to strict indications.

However, today it is advisable to carry out one or two courses of therapy with antibacterial drugs (amoxicillin, clarithromycin or tetracycline) for proven Helicobacter infection. If after one course of antibiotics the bacteria are not killed, then this drug is not worth repeating. A different treatment regimen is selected.

Ulcer treatment regimen

First line Helicobacter pylori eradication scheme:

• Double dose proton pump inhibitor twice daily (eg 40 mg omeprazole or esomeprazole twice).
• Clarithromycin 500 mg twice daily or Josamycin 1000 mg twice daily.
• Amoxicillin 1000 mg 2 times a day.
• De-nol 240 mg twice a day.

Scheme of the second row (in the absence of FGD dynamics of ulcer size)

• Proton pump inhibitor in double dose 2 times a day (same as scheme 1)
• De-nol 240 mg twice a day.
• Metronidazole 500 mg three times a day.
• Tetracycline 500 mg 4 times a day.

Before starting therapy, Helicobacter pylori is detected using an immunological blood test (antibodies to the pathogen). Control – detection of Helicobacter antigens in feces. The urease breath test is not very informative.

The duration of eradication therapy is from 10 to 14 days. If treatment is ineffective with sequential regimens 1 and 2, Helicobacter pylori is typed and its sensitivity to drugs is determined.

Today, regimens with levofloxacin can only be used in regions of the Russian Federation where Helicobacter remains sensitive to this drug.

If duodenal ulcer is not associated with Helicobacter pylori infection, then treatment is carried out with medications that reduce the production of gastric juice. After 7-14 days of combination therapy, treatment is prescribed for another five weeks.

Alternative treatment for duodenal ulcers

Complete or partial distrust of traditional medicine most likely does not bode well for an ulcer sufferer. There are drugs for the treatment of ulcers, the effect of which has been proven in serious random studies in humans. Also, the effect of drugs is checked by everyday medical practice. Schemes are being refined and side effects of drugs are being identified. At the same time, no one canceled the alternative possibility of being treated with folk remedies.

One of the most effective traditional medicine for stomach and duodenal ulcers is considered freshly squeezed potato juice. It tastes rather unpleasant, but you can get used to it quite easily. It is better to use the Morning Rose or American varieties, but any unspoiled potato tuber will do. Preparing juice is quite labor-intensive, given that you only need to drink it fresh and 3 times a day, but you can get the hang of it if you want. The raw potato tuber is peeled, grated and squeezed through several layers of gauze. The juice should be drunk immediately, otherwise it turns black and loses its medicinal properties. The first 3 days only take a tablespoon before meals 30 minutes, preferably 3 times a day, then 3 days 2 tablespoons, gradually increasing to half a glass per dose and so on for 21-28 days. This requires adherence to a diet. After 2-3 weeks the course can be repeated. This really helps!

You can resort to traditional medicine, use or (1 dessert spoon on an empty stomach for 3 months), honey, propolis, herbs (plantain,), after going on a duodenal-friendly diet and taking 20 mg of omeprazole twice a day.

The diagnosis of peptic ulcer is made on the basis of a carefully collected anamnesis, relevant clinical signs of the disease, data from X-ray, endoscopic, morphological examination of the mucous membrane of the stomach and duodenum, laboratory, including biochemical, immunological and radioimmunological examination of gastric juice, blood and gastric mucosa .

Questioning the patient (history)

The clinical manifestations of peptic ulcer disease are multifaceted. The variability of symptoms is associated with age, gender, general condition of the patient’s body, duration of the disease, frequency of exacerbation, localization of the ulcer, and the presence of complications. Anamnesis data and analysis of patient complaints are of great importance for recognizing this disease. Particular attention is paid to two symptoms - pain and heartburn.

The main symptom of peptic ulcer disease is pain, characterized by periodicity during the day, seasonality (spring-autumn period), the presence of light intervals - the absence of relapses of the disease for several years (Troitsky triad). Pain in peptic ulcers is associated with food intake: there is night pain, hungry pain, pain on an empty stomach, early (after 20-30 minutes), late (after 1.5-2 hours) after eating (at the height of digestion). After vomiting, eating, antacids, using a heating pad, myogenic antispasmodics, anticholinergic drugs, the pain of a peptic ulcer decreases or disappears. There is a natural connection between pain and the quality and quantity of food: rich, spicy, sour, salty, rough food always causes pain.

Early pain is typical for localization of ulcers in the stomach, late pain is typical for ulcers located near the pylorus and in the duodenum, night and fasting pain is possible with both localizations of the ulcerative process. High ulcers of the stomach (cardiac region) are characterized by early pain that occurs immediately after eating food, especially spicy and hot food; There is an aching, pressing, bursting pain localized under the xiphoid process or in the left hypochondrium. The pain radiates up the esophagus, persistent belching and heartburn are noted, since the ulcer is often combined with cardia insufficiency and gastroesophageal reflux. When the ulcer is localized in the area of ​​the body and fundus of the stomach (mediogastric ulcers), pain occurs 20-30 minutes after eating, occasionally at night.

The pain reaches particular intensity when the ulcer is localized in the pyloric canal; it occurs 40 minutes to 1 hour after eating. According to clinical manifestations, a pyloric ulcer resembles a duodenal ulcer. However, the intensity of the pain, irradiation to the right hypochondrium, to the back, behind the sternum, persistent vomiting with large amounts of acidic contents, large loss of body weight makes one suspect a pyloric ulcer of the stomach.

When the ulcer is localized in the duodenal bulb or the antrum of the stomach, pain most often occurs on an empty stomach (hunger pain), at night and 1.5-2 hours after eating (late pain). The pain usually subsides after eating. The symptom of heartburn is determined by hypersecretion of the main glands of the stomach and (or) the presence of duodenogastric and gastroesophageal reflux.

Peptic ulcer disease with ulcer localization in the postbulbar region occurs mainly in middle-aged and elderly people. Persistent pain radiating to the right shoulder, right or left hypochondrium indicates involvement of the biliary tract and pancreas in the pathological process. Often, patients with subbulb ulcers experience persistent vomiting and symptoms.

Based on the nature and time of pain, depending on the location of the ulcer, the following scheme can be used:

• Subcardial ulcers: eating → early pain (within the first 30 minutes after eating) → feeling good.
• Ulcers of the middle and lower third of the stomach: food intake → feeling good (within 30 minutes - 1 hour) → pain (within 1-1.5 hours until complete evacuation of food from the stomach) → feeling good.
• Ulcers of the pyloric stomach and duodenal bulb: hunger pain → eating → feeling good for 1-1.5 hours until complete evacuation of food from the stomach; late pain.

Peptic ulcer disease is characterized by seasonality of pain (spring-autumn exacerbations). Periods of exacerbation of pain are followed by periods of remission with an uncomplicated ulcer, even in the absence of treatment. The nature of the pain can be dull, burning, aching, paroxysmal, sharp, accompanied by vomiting. During an exacerbation, patients often take a comfortable position lying on the right side with their legs pulled up, often resorting to a warm heating pad. Most patients note increased pain in the afternoon and try not to eat in the evening. Constant pain indicates complications in the form of peri-processes (perigastritis and periduodenitis) or penetration of the ulcer into neighboring organs.

Irradiation of pain is not typical for peptic ulcer disease and is most often observed when the ulcer penetrates:

• When an ulcer penetrates into the pancreas, symptoms of pancreatitis appear: after eating, the pain does not calm down, but intensifies, nausea with the urge to vomit, belching, and unstable stools occur. The pain becomes girdling or radiates to the back. There is a fear of eating due to pain, intolerance to dairy and fatty products, fruit and vegetable juices.
• When the ulcer penetrates into the hepatoduodenal ligament and liver, pain appears soon after eating, is localized in the right hypochondrium, radiates to the right half of the chest, to the right shoulder and back. Decreased appetite, dry mouth, nausea, and sometimes vomiting in the morning are often observed.
• With cardiac, high-lying gastric ulcers, it radiates to the heart area, behind the sternum.
• Penetration of the ulcer into the omentum is accompanied by persistent pain with irradiation to the back, usually to one point.

Perforation of the ulcer is accompanied by dagger pain in the abdominal cavity, up to loss of consciousness, pallor of the skin, pointed facial features, thread-like pulse, and further symptoms of peritoneal irritation. A perforation covered by an omentum or a piece of food that is stuck in the perforation can create false rest, and then, for example, when coughing, a piece of food comes out of the perforation and the symptoms resume. Often, due to the anatomical features of the structure of the intestines, the contents of the stomach collect in the right iliac region and a picture of acute appendicitis occurs (pain, fever, vomiting, leukocytosis); Such patients end up on the operating table. And only during the operation the surgeon determines the inflamed appendix, “bathing” in food debris. Usually an appendectomy and suturing of the perforated window are performed.

The most common and early symptoms of a peptic ulcer are heartburn, reflux of acidic stomach contents into the esophagus, a burning sensation in the chest, a sour or metallic taste in the mouth. Heartburn is often accompanied by pain. There are late, hungry, night heartburn. The occurrence of heartburn is associated not only with strong acidity of gastric juice, but also with upper gastroesophageal reflux, which is caused by a decrease in the tone of the cardiac sphincter. Thus, heartburn, even painful, can occur with low acidity of gastric juice.

Belching, nausea, vomiting, and drooling are somewhat less common than pain and heartburn. Belching occurs more often with subcardial localization of the ulcer. Vomiting is associated with pain: it usually occurs at the height of pain (often the patient causes it himself) and brings relief to the patient. Vomit has a sour taste and smell. The release of active gastric juice on an empty stomach is also often accompanied by vomiting. Vomiting is often a sign of a violation of the evacuation-motor function of the stomach with pyloric stenosis - in such cases, the vomit contains remnants of food eaten the day before. A dangerous symptom of bleeding is bloody vomiting. Some patients experience nausea with salivation instead of vomiting.

Physical examination

Physical examination provides little information. When examining the oral cavity, carious teeth, periodontal disease, white-yellow plaque at the root of the tongue, and sometimes erosion along the edges of the tongue are discovered; In a significant proportion of patients, no changes were detected when examining the tongue. In uncomplicated forms of peptic ulcer, the tongue is usually clean and moist. As complications develop, the tongue becomes dry and thickly coated. Typically, in an uncomplicated form of the disease, hypertrophy of the filiform and mushroom-shaped papillae of the tongue is observed. As gastritis progresses with a decrease in the secretion of hydrochloric acid, the papillae of the tongue become smooth.

The most common finding on physical examination is epigastric tenderness. When percussion of the abdomen, local pain is noted - Mendel's symptom, caused by irritation of the visceral and parietal peritoneum. On palpation of the abdomen - local pain and muscle protection - Glinchikov's symptom. The area of ​​pain is usually located midway between the navel and the xiphoid process, and in approximately 20% of patients it is to the right of the midline. Determination of these signs near the xiphoid process indicates the cardiac location of the ulcer; in the right half of the epigastric region - for a duodenal ulcer, and in the midline above and to the left of the navel - for an ulcer of the lesser curvature of the body of the stomach.

When an ulcer perforates, tension in the muscles of the anterior abdominal wall (board-shaped abdomen) appears; in most cases, a positive Shchetkin-Blumberg sign is determined. Bowel sounds first intensify and then weaken or disappear. With pyloric stenosis, a splashing noise can be detected, caused by the accumulation of fluid and gas in a distended stomach.

Instrumental research methods

X-ray and, above all, endoscopic examination are of decisive importance in the diagnosis of this disease.

X-ray examination

The X-ray method makes it possible to identify morphological and functional changes in the organ being studied. Identification of a “niche” is a direct sign of disease. The most important indirect signs include cicatricial deformation of the organ, convergence of folds, increased motility, hypersecretion, local spasm, accelerated evacuation of barium mass from the stomach and its rapid movement through the duodenum. But the level of diagnostic errors during X-ray examinations of patients with peptic ulcer disease is quite high and amounts to 18-40%. Particular difficulties arise when the ulcer is localized on the anterior wall of the stomach, in the cardiac zone, pyloric canal, or subbulb part of the duodenum.

Endoscopic examination

It is now generally accepted that the endoscopic method is the most reliable in diagnosing peptic ulcer disease. The advantages of the method include:

• direct examination of the mucous membrane;
• establishing the benign or malignant nature of the ulceration;
• visual and morphological control over the rate of ulcer healing;
• identification of concomitant lesions of the mucous membrane of the upper digestive tract;
• determination of gastric juice acidity.

Contraindications to gastroduodenoscopy have been significantly revised. There are practically no absolute contraindications to its implementation. Relative contraindications to endoscopy are severe heart rhythm disturbances, acute periods of myocardial infarction, stroke, often recurrent attacks of angina and bronchial asthma, chronic heart failure stages IIB-III, acute and chronic infectious diseases in the acute stage.

An ulcer is a specific morphological substrate of the disease. The International Endoscopic Association provides recommendations on the terminology of mucosal injuries: erosion- surface defect determined histologically; ulcer- an in-depth defect in the wall of an organ, determined macroscopically, having a configuration, boundaries, surroundings, and bottom. An acute ulcer is characterized by necrosis and destruction, affecting not only the mucosal epithelium, but also spreading to the submucosal and muscular layers. This is the main difference between an ulcer and erosion, which is characterized by a defect in the epithelium.

Ulcer healing occurs through scarring (the damaged muscle layer does not regenerate, but is replaced by connective tissue), while erosion is epithelialized without scarring. A post-ulcer scar in the phase of fading exacerbation has the appearance of a hyperemic area of ​​the mucous membrane with a linear or stellate retraction of the wall (stage of an immature “red” scar), a mature scar acquires a whitish appearance due to the replacement of granulation tissue with connective tissue and the absence of inflammation (stage of a “white” scar). On average, healing of a stomach ulcer before the formation of a “red” scar occurs in 5-6 weeks, and of a duodenal ulcer - in 3-4 weeks. The formation of a “white” scar ends after 2-3 months.

Laboratory research methods

Laboratory research methods are widely used to confirm the diagnosis. In this case, the most common objects of research are gastric juice and blood, less often - urine and feces.

Blood analysis

When examining blood in patients, hemogram values ​​in uncomplicated forms of the disease do not differ from normal values. In many patients, the level of hemoglobin and the content of red blood cells in the blood are close to the upper limits of normal, and in some patients erythrocytosis appears with a decrease in ESR. In the complicated form of the disease, in particular the condition after bleeding, hypochromic posthemorrhagic anemia is observed. In the presence of penetration of the ulcer and pronounced peri-processes, leukocytosis with a neutrophil shift is possible. ESR increases in the presence of complications or its combination with other diseases of adjacent organs - pancreatitis, hepatitis,. In the presence of anemia, it is necessary to examine the level of serum iron and the iron-binding capacity of blood serum, as well as ferritin, which more accurately characterizes the iron content in the body.

Study of gastric secretion

A study of gastric secretion is necessary to identify functional disorders. The state of acid secretion is determined by intragastric pH-metry. In case of duodenal ulcer, the secretion of hydrochloric acid exceeds the norm: basal - 2-3 times, stimulated - 1.5-1.8 times, night secretion exceeds the basal level by 3.5-4.0 times. In patients with peptic ulcers with localized ulcers in the stomach, especially with mediagastric ulcers, most often normal or slightly reduced production of hydrochloric acid, stimulated production may be increased. When examining intragastric pH in patients with pyloroduodenal localization of ulcers, pronounced hyperacidity in the body of the stomach (pH 0.6-1.5) with continuous acid formation and decompensation of alkalization of the environment in the antrum (pH 0.9-2.5) is determined.

Fecal occult blood test

A stool test for occult blood has a certain diagnostic value, especially if occult bleeding is suspected. Usually the Gregersen or Waber reaction is performed. A positive stool reaction is observed during exacerbation of peptic ulcer disease, but a negative reaction does not exclude the disease. With slightly positive results, we can talk about an exacerbation of a peptic ulcer, while with a sharply positive reaction, we can talk about the presence of hidden bleeding. To carry out the reaction, preparation of patients is necessary: ​​exclusion from the diet for 3 days of foods containing hemoglobin and chlorophyll (meat, fish, strong broths, green vegetables), as well as fruits and preparations with a coloring effect (beets, bismuth-containing preparations, activated carbon). The disappearance of a positive reaction to occult blood in the stool is important for diagnosis, since it is a sign of the beginning of scarring of the ulcer. Reactions to occult blood in the stool are of relative diagnostic importance, since they can also be observed with malignant tumors of the digestive system, bleeding gums, nosebleeds, internal hemorrhoids, etc.

Detection of Helicobacter pylori infection

In the etiology of chronic gastritis and peptic ulcers, the bacteria Helicobacter pylori are important. These S-shaped spiral-shaped bacteria have the ability to penetrate under the protective layer of mucus and damage the surface epithelial cells of the antrum of the stomach and duodenal bulb, causing an inflammatory process in the mucous membrane. The bacteria infect the epithelium of the antrum of the stomach metaplastic into the duodenal bulb. The mucus layer underneath protects these bacteria from hydrochloric acid. High sensitivity of bacteria to many antibiotics, metronidazole, colloidal bismuth preparations, in particular de-nol, omeprazole, was determined.

To detect Helicobacter pylori infection, invasive and non-invasive tests are performed. Invasive tests include examination of a biopsy of the gastric mucosa obtained during fibroesophagogastroduodenoscopy. They use morphological (histological examination of sections of biopsy specimens of the gastric mucosa, stained according to Romanovsky-Giemsa and Warthin-Stary) and cytological (examination of smears - impressions of biopsy specimens, stained according to Romanovsky-Giemsa and Gram) methods and a breath test for the presence of urease in the stomach with a urea solution , labeled with radioactive isotopes 13 C or 14 C.

Test methods for detecting Helicobacter pylori:

• Histological examination. In histological preparations, Helicobacter pylori is clearly visible with Giemsa staining and Warthin-Starry silver staining and is weakly stained with hematoxylin.
• Bacteriological research. For inoculation, material obtained from a biopsy under conditions of maximum sterility is used. Incubation of crops is carried out in microaerophilic conditions, with an oxygen content of no more than 5% using special gas recovery packages.
• Urease test with biopsy of the mucous membrane. Consists of a carrier gel containing 20 g/l urea, a bacteriological agent and phenolrot as a pH indicator. The indicator changes color from yellow to crimson when, under the influence of Helicobacter pylori urease, urea is hydrolyzed to form ammonia, which shifts the pH of the medium to the alkaline side.
• Breath test. The test is based on the ability of Helicobacter pylori to produce urease. Before testing, the patient takes orally a solution containing labeled 13 C or 14 C urea. In exhaled air samples, the isotope of carbon dioxide is quickly determined after the breakdown of urea in the presence of urease. The method is the only non-invasive research method.
• Serological studies. In people infected with Helicobacter pylori, specific IgG and IgA antibodies are detected in the serum by enzyme immunoassay. The Keefe test is also used to determine Helicobacter pylori antigen in stool by polymerase chain reaction.

Differential diagnosis

Differential diagnosis is carried out with exacerbation of chronic gastritis, hiatal hernia, exacerbation of chronic cholecystitis, pancreatitis, stomach cancer, pancreatic cancer, symptomatic ulcers.

• In chronic HP-associated gastritis, the pain syndrome is ulcer-like in nature; in autoimmune gastritis, heaviness in the epigastrium, belching, nausea, and heartburn are noted. Definitive diagnosis is made by endoscopy.
• A hiatal hernia is accompanied by pain in the epigastrium, but unlike a peptic ulcer, the pain syndrome is associated with the position of the body: the pain intensifies after eating in a lying position. X-ray examination confirms the diagnosis.
• In chronic cholecystitis, pain is localized in the right hypochondrium, often radiating to the right scapula and shoulder. There may be nausea, constipation, flatulence. On palpation, pain is noted in the right hypochondrium, at the point of the gallbladder, a positive phrenicus symptom. The diagnosis is confirmed by ultrasound examination of the abdominal cavity and endoscopic retrograde cholepancreatography.
• With exacerbation of chronic pancreatitis, pain is localized in the left hypochondrium, often of a girdling nature. The diagnosis is confirmed by the results of a biochemical blood test for pancreatic enzymes, stool digestibility, ultrasound and computed tomography.
• Gastric cancer is characterized by middle and older age of the patient. At the beginning of the disease, the pain is often dull, and the connection with eating is lost. In addition, there may be complaints of decreased and perverted appetite, nausea, vomiting, and general weakness. The diagnosis is confirmed by endoscopy with biopsy.

Duodenal ulcer is a chronic relapsing disease that occurs with periods of exacerbation and remission.

The main symptom of an ulcer is the formation of a defect (ulcer) in its wall. Often, ulcers affect not only the duodenum, but also the stomach (stomach ulcer), and other organs of the digestive system with the development of dangerous complications.

The main symptom of exacerbation of a duodenal ulcer is abdominal pain, which can radiate to the lumbar spine, right hypochondrium, and various parts of the abdomen.

Causes

Peptic ulcer of the stomach and duodenum occurs due to increased acidity. Under the influence of acid, destructive processes occur in the mucous membrane, which subsequently lead to ulcers.

There are quite a lot of reasons that provoke the development of this disease, they are known to everyone, everyone faces them. These are stress, nervous tension, improper and irrational nutrition. Modern medicine has also established that the bacterium Helicobacter Pylori becomes a common cause of stomach and duodenal ulcers.

Here main 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;
• gastrin-producing tumor (gastrinoma).

Long-term treatment of various inflammatory pathologies (ketorolac, diclofenac, indomethacin, ibuprofen, aspirin) also negatively affects the walls of the duodenum and can give rise to the development of ulcers.

Symptoms of duodenal ulcer

The disease may not show any symptoms for a long time. True, in the initial stages of the disease there is discomfort in the upper abdomen and minor digestive disorders.

The most characteristic symptoms of a duodenal ulcer occur as the disease progresses:

1. Often pain may be the only symptom, by which peptic ulcer disease can be recognized. The type of pain can be different: stabbing, cutting, periodic, constant, squeezing, etc. Usually it is localized in the upper abdomen in the middle or on the right, but if a person feels it in the left hypochondrium, one can suspect that he has a mirror ulcer. Pain most often appears before eating (hunger pain) or after it. Sometimes, a couple of hours after eating, patients feel hungry. Night pains are also typical; they occur in the middle of the night, and the person wakes up due to discomfort in the stomach.
2. Nausea, feeling of fullness in the stomach, heartburn, belching.
3. General weakness, weight loss, decreased performance.

If you notice similar symptoms, you should consult a specialist. Treatment of duodenal ulcer should be comprehensive and include not only drug therapy, but also other treatment methods, such as diet therapy, physiotherapy, therapeutic exercises and sanatorium treatment.

Diagnostics

Duodenal ulcers can be diagnosed using endoscopy: this method gives the doctor complete information about the patient’s condition. When an ulcer is detected, it evaluates its location, size, type, and presence of scars. During the procedure, a sample of the mucous membrane is taken along the edge of the defect to be examined for the presence of Helicobacter.

They also use x-rays, perform stool and blood tests, and do a biopsy.

Complications

If a duodenal ulcer is not treated in a timely manner, the disease can cause: bleeding, perforation and penetration of the intestine, and narrowing of its lumen.

1. Penetration of an ulcer is characterized by penetration into adjacent organs through a defect affecting the intestine.
2. Narrowing of the lumen of the duodenum is the result of scar formation or edema.
3. Ulcer bleeding is a consequence of the involvement of mucosal vessels in the pathological process. Hidden bleeding may be characterized by anemia.
4. Perforation of an ulcer is the formation of a gap through which the entire contents of the intestine penetrates into the abdominal cavity and causes the development of an inflammatory process - peritonitis.

Treatment of duodenal ulcers

If the diagnosis of duodenal ulcer is confirmed, treatment should begin immediately. This disease requires an integrated approach, otherwise the desired result may not be achieved.

An exacerbation of an ulcer, that is, an attack with intense pain, is treated in a hospital setting. An acute ulcer leads to the need to provide the patient with strict bed rest and emotional rest in order for scarring to occur, because an ulcer in the white scar stage does not pose a threat to the patient’s life.

Drug treatment

Groups of medications that are used to treat duodenal ulcers:

1. When Chylacobacteria are detected, treatment consists of antibacterial therapy. For this purpose, the following drugs are used: amoxicillin; clarithromycin; Metronidazole. If after one course of antibiotics the bacteria are not killed, then this drug is not worth repeating. A different treatment regimen is selected.
2. To eliminate pain by reducing the secretion of hydrochloric acid, the following are used: omez, gastrozol, bioprazole, controloc, sanpraz, helicol, lanzap, zulbex, zolispan, etc.
3. Drugs that relieve pain by forming a protective film on the duodenal mucosa: Almagel, Algel A, Almagel Neo, Maalox.

The course of treatment for ulcers can take from two to six weeks, depending on the size of the defect and the general condition of the body. It should be noted that a competent specialist who can monitor the treatment process and evaluate its results should prescribe treatment for duodenal ulcers, select medications and dosage regimens.

Surgery

In a number of emergency cases, such as perforation of an ulcer, severe gastrointestinal bleeding, obstruction of the pyloric canal, surgical treatment is resorted to. In this case, two types of operations are performed:

1. Vagotomy is the intersection of nerves that stimulate gastric secretion and lead to relapses of peptic ulcer disease.
2. Gastric resection– this is the removal of 2/3 of the stomach and the connection of the remaining part with the intestines; often, during resection, vagotomy is also performed.

In case of ulcerative dysplasia, surgical intervention is indicated only in special cases, since complications often occur (inflammatory processes, bleeding, severe metabolic disorders).

Diet for ulcers

There are several types of diets for duodenal ulcers. For example, a fasting diet, which is called Table No. 1 according to Pevzner and corresponds to the ulcerative group of gastrointestinal diseases. There is also Table 0, which is characterized as a complete lack of food intake in the first few tens of hours after surgery on the gastrointestinal tract.

The main recipe for a diet for peptic ulcer disease is Table No. 1, which is divided into Tables 1a and 1b depending on the stage of the disease (exacerbation or subsidence).

Below we will look at the basic principles of proper nutrition; a more detailed menu can be found by diet number.

• spicy dishes;
• fried food;
• salty food;
• smoked meats;
• various canned foods;
• fatty meats and fish (pork);
• pickled foods (sauerkraut, tomatoes, cucumbers);
• rye bread and bakery products made from butter dough;
• fruits that increase acidity in the stomach (citrus fruits, tomatoes, and others);
• All hot, cold, and spicy seasonings are excluded from the diet to reduce the activity of gastric juice production.

Products and dishes that can be consumed:

• light vegetable soups;
• dairy products (milk, low-fat cottage cheese, low-fat sour cream, kefir);
• low-fat fish or dishes made from it (pike perch, perch and others);
• low-fat meats (rabbit, chicken, veal);
• various types of porridge (buckwheat, oatmeal, rice and others);
• crackers and dried bread;
• vegetables and fruits, fresh or boiled (red beets, potatoes, carrots, zucchini);
• dishes prepared with vegetable oils (olive, sea buckthorn and others);
• all food should be boiled, baked, stewed or steamed

Prevention

The main preventive measure is to do everything possible to avoid the cause of the ulcer. By strengthening one’s health, a person minimizes the possibility of getting sick. Even if infected through an infectious route, he will cope much easier and recover faster. Scientists have clearly established that health is half dependent on lifestyle.

Peptic ulcer of the stomach and duodenum (DU) is characterized by a deep defect in the mucous membrane. The cause of its occurrence is an imbalance of protective factors (mucin that envelops the mucous membrane) and aggression factors (hydrochloric acid and pepsin). A huge amount of digestive enzymes from the pancreas and the acidic contents of the stomach are released into the lumen of the duodenum, which is why ulcers occur in this part of the intestine.

Diagnosis of an ulcer is the task of a gastroenterologist, who, based on complaints, anamnesis, laboratory and instrumental studies, forms a diagnosis

Indications are symptoms:

• heartburn;
• sour belching;
• nausea;
• vomiting, which brings relief (for this reason, patients often cause it themselves);
• constipation

Pain with this disease occurs in the left hypochondrium if the ulcerative defect is localized in the stomach, in the right hypochondrium if the ulcer is localized in the duodenum. The occurrence of pain within 30-60 minutes after eating gives reason to suspect a process in the stomach. If pain appears 2-3 hours after eating, then attention should be paid to the duodenum. Patients with ulcers complain of so-called hunger pains, which stop after a snack.

It is worth remembering that in some patients pain does not appear at all. Such ulcers are called “silent”. They are often detected when complications occur - bleeding or perforation.

The disease has a relapsing course with periods of exacerbations and remissions. Exacerbations are characterized by seasonality - they occur in spring and autumn.

Diagnostic methods

When diagnosing ulcers, laboratory and instrumental methods are used. There are no differences in research methods between males and females.

Laboratory research

The gold standard for diagnosing any disease involves laboratory tests, and ulcers are no exception:

1. Blood analysis of patients with peptic ulcer does not provide valuable information. In most cases, changes are not detected. The presence of anemia indicates hidden bleeding.
2. Stool blood test. The study is necessary to detect bleeding.
3. pH-metry. In case of duodenal ulcer, the levels of stimulated and basal secretion exceed the norm. If the defect is located in the subcardial zone or in the body of the stomach, then these values ​​will be normal or reduced.

Instrumental studies

Gastroduodeno- and fluoroscopy are the main diagnostic methods for gastrointestinal diseases:

1. X-ray, which reveals a niche in the relief of the mucous membrane.
2. Endoscopy is necessary to confirm the diagnosis, clarify the location, shape, size and condition of the ulcer.
3. carried out to detect Helicobacter pylori. The role of this bacterium in the occurrence of ulcers has been known for a long time: 90-95% of duodenal ulcers and 70% of gastric ulcers are Helicobacter. The test is based on identifying the enzyme urease, which is secreted by Helicobacter pylori to break down urea into ammonia and carbon dioxide. This diagnostic procedure is performed during endoscopy. A section of the mucous membrane (biopsy) is taken from the stomach and placed in a medium containing urea and phenol red. If there are bacteria in the stomach, urease will break down urea into ammonia, which will increase the pH of the environment and change the color of the indicator from yellow to red. The more Helicobacter pylori in the biopsy sample, the faster the solution will change color.

Complications of ulcers and their diagnosis

The greatest threat to the patient’s life is precisely the complications that arise when there is an ulcer in the wall of the stomach or duodenum.

Bleeding

The main symptoms are:

• vomiting “coffee grounds” (under the influence of acid and digestive enzymes, hematin hydrochloride is formed from blood hemoglobin, which in appearance resembles coffee grounds);
• tarry stools (feces also become black under the influence of hydrochloric acid and gastrointestinal enzymes);
• tachycardia;
• weakness;
• dizziness;
• loss of consciousness;
• decrease in blood pressure;
• pale skin.

Research that is necessary if there is suspicion of:

• clinical blood test - a decrease in the number of red blood cells, an increase in the number of leukocytes and platelets is detected;
• ESR - increases;
• coagulogram - after bleeding, the activity of the coagulation system always increases;
• stool examination for occult blood;
• endoscopy.

Perforation

This complication is the most dangerous. It is manifested by the presence of a through defect in the wall of the organ. Perforation occurs much more often in men.

Perforation of gastric ulcer

Symptoms:

• sharp pains, which are called “dagger”;
• severe pain on palpation of the epigastric region;
• abdominal wall muscle tension;
• the presence of a positive Shchetkin-Blumberg sign (symptom of peritoneal irritation).

Penetration

This is the name for the penetration of an ulcer into neighboring organs and tissues (most often into the pancreas and lesser omentum).

Signs of penetration:

• the appearance of persistent pain (if the ulcer penetrates into the pancreas, then the pain is localized in the lumbar region);
• pain loses connection with nutrition;
• temperature increase;
• increase in ESR.

X-ray and endoscopic examinations are used to confirm penetration.

Differential diagnosis

Many gastrointestinal diseases have common symptoms with ulcers, so it is extremely important to differentiate them:

1. . Inflammation of the gastric mucosa differs from an ulcer by a more pronounced dyspeptic syndrome (digestive disorders in the form of belching, heartburn, nausea, vomiting) and less severe pain. An endoscopic or x-ray examination will allow an accurate diagnosis.
2. . In the early stages, stomach cancer clinically resembles an ulcer. Differential diagnosis is especially difficult in the case of ulcerative-infiltrative cancer. Cytological examination of a biopsy specimen is the most accurate and informative method in this case.
3. Cholecystitis and cholelithiasis (GSD). These diseases, like ulcers, are manifested by epigastric pain and digestive disorders. The main differences are that with cholecystitis and cholelithiasis, pain is associated with the nature of the food that a person eats. As a rule, pain appears after eating fatty, spicy, spice-rich foods. Also, pain in diseases of the gallbladder is cramping in nature.
4. . Pain in chronic pancreatitis, as well as in ulcers, is localized in the upper abdomen. They appear 30-60 minutes after eating fatty foods. Biochemical analysis will help to exclude pancreatitis during diagnosis. With inflammation of the pancreas, increased levels of trypsin, amylase and lipase are found in the blood.

About the symptoms of pre-ulcerative erosive gastritis.

Rationale for diagnosis

The diagnosis is made based on:

• patient complaints;
• general examination;
• life history data;
• results of instrumental and laboratory tests.

Peptic ulcer disease is a pathology that a gastroenterologist encounters more often than any other in his practice. There are many factors that contribute to the development of ulcers, starting with poor diet and activity. The ability to recognize the process and prescribe the necessary diagnostic procedures will help to identify the disease in a timely manner and avoid life-threatening complications.

What symptoms can you use to identify a stomach ulcer?

Peptic ulcer of the stomach and duodenum is a fairly common disease and has been known since ancient times, the clinical manifestations of which have been well studied. It has a chronic, wave-like course with periods of exacerbation and remission, and people for a long time may not seek help in a timely manner without feeling any symptoms. And this can ultimately lead to serious consequences, as well as to numerous complications of peptic ulcer disease. Therefore, it is so important to identify a stomach ulcer in time and begin to treat it.

What is the most common complaint?

The main characteristic complaint is pain in the upper abdomen (between the costal arch and the navel) without clear localization. They can be sharp, cutting, quite intense, aching, pressing. The most interesting thing is that depending on the type of pain, the doctor can guess where the ulcer is located.

So, we can distinguish the following types of pain:

• early - appear immediately after eating and disappear after 2 hours as food is pushed into the duodenum. This nature of the symptom suggests that the ulcer is localized in the upper sections of the stomach (cardiac section).
• late - do not appear immediately after eating, but only 2 hours later. These symptoms indicate a problem in the lower parts of the stomach.
• hungry or at night, occurring on an empty stomach and more often at night, passing some time after eating, speak of a duodenal ulcer.

Knowing the nature of the pain, the doctor can guess the approximate location of the disease.

Although there are cases when the disease occurs without a painful attack and the problem is found only when complications arise (bleeding, perforation). This is possible when people, for example, take nonsteroidal anti-inflammatory drugs such as diclofenac, aspirin, nimesulide, ketorolac, etc., for a long time. These drugs suppress pain receptors and the disease may be asymptomatic. Plus, this group of people includes older people, whose pain receptors acquire qualitative and quantitative changes with age and become less susceptible to pain. In such cases, the disease first manifests itself with its complications.

Along with pain, a symptom of the disease is attacks of nausea and vomiting with sour contents, which bring relief. This is why some patients induce vomiting on their own to relieve their suffering, which is not correct. Some patients complain of sour heartburn, which is associated with the reverse reflux of gastric contents into the esophagus due to weakness of the cardiac (lower, where it passes into the stomach) sphincter of the esophagus and reverse peristalsis.

In the case of acute pain, some patients experience general weakness, decreased appetite, and patients may specifically refuse to eat, which leads to exhaustion and a more severe course of the disease. If the pain is aching and not very pronounced, then the appetite may be normal or even increased.

50% of patients experience constipation, which is caused by impaired intestinal motility and food digestion processes.

How to distinguish a stomach ulcer from a duodenal ulcer?

Correctly distinguishing a stomach ulcer from a duodenal ulcer, as well as from another disease, will not help to analyze the symptoms, but only to conduct a full examination. A gastroenterologist specifically deals with this disease.

What is included in the examination plan?

1. Correctly collected medical history (anamnesis).

The slightest information about symptoms, complaints, and the presence of other ailments is asked. For example, here are some questions your doctor might ask you:

• When did the pain start?
• Where exactly does it hurt?
• What kind of pain is this - aching, sharp, burning?
• Does it hurt more or less after eating?
• What time of day does it hurt more often?
• Do you drink alcohol or smoke?
• Are you often stressed?
• Do you take anti-inflammatory drugs such as diclofenac, ketorolac, nimesulide, aspirin, etc.?
• Have you had any cases of peptic ulcers in your family?
• Have you ever had a fibrogastroduodenoscopy performed before? If so, when?
• Are you taking any medications?
• How did your illness begin?
• Do you have any other health problems?

After collecting your medical history and life history, the doctor examines your body, paying special attention to feeling (palpating) your abdomen in order to find the place where the symptoms will be most painful.

Pain will be felt in the upper abdomen, between the costal arch and the navel (in the epigastrium), and in some cases, with the development of complications (perforation), the abdominal muscles will tense during palpation and, along with acute, dagger-like pain, it will be hard as a board. The tongue is also examined - it may be covered with a dirty gray coating.

3.Instrumental and laboratory examination methods.

• General blood analysis.

Very important in diagnosis. Since the disease can be accompanied by bleeding, this will certainly affect the blood. In case of acute blood loss, the analysis will show a rapid decrease in the level of hemoglobin and red blood cells; in the case of chronic blood loss, the analysis will show a gradual decrease in these indicators. There may be an increase in white blood cells with the development of inflammation of the mucous membrane.

• Fecal occult blood test.

It is necessary when there are no obvious signs of blood loss, but there is anemia. Helps in the diagnosis of anemia of unknown etiology in order to identify hidden blood loss from the gastrointestinal tract.

And if with a stomach ulcer the patient may vomit with pure blood or vomit “the color of coffee grounds,” then with bleeding from an ulcer of the duodenum, the blood mostly enters the intestines and then the stool will be black.

• Fibrogastroduodenoscopy with biopsy.

This is the most informative diagnostic method. Today this is a completely common examination method. In this case, the doctor visually sees through a fiberscope (thin probe) the wall of the stomach and duodenum and the source of the disease, its location, from which a piece of the mucous membrane is taken for examination (biopsy). Using a biopsy, it is subsequently possible to distinguish an ulcer from an oncological process and identify Helicobacter pylori.

• Ultrasound examination of the abdominal organs.

Helps identify another cause of pain, if any. In ultrasound, the doctor sees the liver, gallbladder, and pancreas. The stomach and duodenum cannot be clearly assessed.

• Radiography.

Allows you to identify a defect in the wall of the stomach and its location. The stomach is filled with an x-ray contrast agent - barium - and the contour of the stomach wall is assessed. If there is an ulcer, then a defect in the contour of the wall will be visible.

• ph - metric

Observation and control of pH (acidity) for 24 hours. For better wound healing, it is necessary to maintain a pH of at least 3 - 4 for 18 - 20 hours.

• Electrogastrojeunography and anteroduodenal monitoring

The motor-evacuation function of the stomach is examined and, if any, its violation is identified.

If you listen to yourself in time and consult a doctor in a timely manner, you can get help on time.

And in the following materials we will talk about the main approaches to the treatment and prevention of ulcers.

In contact with