GASTRIC OR PEPTIC ULCER CAUSES AND TREATMENT
Peptic ulcer is a chronic
recurrent inflammation of the gastric mucosa, accompanied by the formation of
ulcers (ulcers of the inner lining of the organ) of the stomach or duodenum.
According to available statistics,
peptic ulcer disease affects 6-10% of the population in each country, depending
on the level of medicine and food quality. The most characteristic group of
patients are men aged 30-40 years.
Here you can choose a doctor who
treats peptic ulcer disease. If you are unsure of the diagnosis, make an
appointment with a physician or general practitioner to clarify the diagnosis.
In the development of ulcers of
the gastric mucosa and duodenum, the leading role is played by the imbalance
between the factors of protection and aggression that affect its functional
state. A separate role in this process is played by the violation of
neurohumoral regulation of production and secretion of digestive juices.
The values of each of the
factors and their comparison are clearly reflected in the scheme, which is
called "neck weight". The balance between the two groups of factors
is ensured by the combined effect of the nervous and hormonal systems of the
body.
Factors of aggression
Increased production of hydrochloric
(hydrochloric) acid and digestive enzyme - pepsin in the stomach;
Injuries and other damage to the
mucous (internal) wall of the stomach and duodenum, which lead to a lack of
blood supply to the body or disrupt its integrity;
Impaired motility (motor function
of the stomach and duodenum);
Disruption of the antroduodenal
acid brake - a protective mechanism that is normally responsible for stopping
the production of hydrochloric acid by excessively lowering the pH of the
stomach;
Helicobacter pylori infection is
an infection of the body with the bacterium Helicobacter pylori. The pathogenic
effect of Helicobacter pylori on the mucous wall is due to the fact that during
its existence the bacterium secretes the enzyme urease to break down urea
contained in the stomach. As a result, there is a local (at the site of the
bacterial colony) increase in the concentration of ammonia, due to which the pH
of the stomach contents increases. In response to this process, regulatory
mechanisms are triggered, which is responsible for increasing the production of
hydrochloric acid and pepsin, which leads to damage to the inner shell.
In addition, the metabolic
products of Helicobacter pylori affect the composition and structure of the
gastric mucosal barrier, which contribute to the weakening of its protective
function and damage to the body wall.
Protection factors:
Protective mucous (gel) barrier
that covers the inner wall of the stomach and duodenum and protect it from
ulcerative action of hydrochloric acid and pepsin;
High regenerative activity of
cells of the superficial epithelium of the stomach and duodenum (cell renewal
occurs every 3-5 days), which will lead to rapid healing of various lesions;
Sufficient blood supply to the
lining of the stomach and duodenum, which provides high regenerative activity
of its cells and prevents the accumulation of hydrochloric acid;
Production of bicarbonate ions
that have an alkaline reaction, which allows them to capture and neutralize
free hydrogen ions, thereby preventing the excessive formation of hydrochloric
acid.
The imbalance between the factors
of defense and aggression occurs due to the combined action of external and
internal attracting and realizing factors.
The predisposing factors (factors
that lead to the weakening of protective mechanisms and the predominance of
factors of aggression) include:
Heredity. To date, many genes
have been identified that contribute to peptic ulcer disease, most of which are
inherited from the paternal line. It was also found that people with 0 (I)
blood group are more prone to the disease than representatives of other blood
groups;
Impaired blood supply in the
lining of the stomach and duodenum, caused by anatomical features, tumor, cyst,
thrombus, etc .;
Violation of sympathetic and
parasympathetic regulation of the vagus nerve, the increase in tone of which is
characterized by spasm of blood vessels of the stomach and duodenum and
increased production of digestive enzymes.
By implementing factors (factors
is the trigger levers of defects in the mucous membrane of the body) include:
Helicobacter pylori infection. In
80% of cases of peptic ulcer disease, it is the presence of Helicobacter pylori
and led to ulceration of the mucous membrane of the body, and gastric ulcer in
60-90% of cases is formed on the background of gastritis caused by this
bacterium;
Long-term use or abuse of
nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids in the form of
tablets, capsules, etc .
·
Smoking;
·
Alcohol abuse;
·
Coffee abuse (more than 5 cups a day);
·
Chronic stress, neurosis, traumatic shock;
·
Eating undercooked, too hot, rough and
irritating food (fast food, "dry meat", etc.).
Symptoms
Depending on the location of the
ulcer defect (duodenum, any part of the stomach), the symptoms of the disease
may differ or have their own characteristics.
The most characteristic of peptic
ulcer disease are pain, dyspepsia and asthenic syndromes. The pain caused by
peptic ulcer disease depends on food intake, time of day and year, and by its
nature can be acute, subacute and give in different parts of the body.
Depending on the time of day and meal, the pain can be:
·
early - the appearance of pain is observed in
20-30 minutes after eating;
·
late - the appearance of pain is observed in
1.5-2 hours after eating;
·
hungry - the appearance of pain is observed in
5-6 hours after eating;
·
night - the appearance of pain is observed at
night.
The ulcer formed in the
subcardiac part of the stomach is manifested by early pain, acute in the
epigastric and upper abdomen, which often give in the sternum and heart.
The ulcer formed in the middle
and lower third of the stomach is manifested by late pain, which begins with a
fraction of minor pain, which increases over time and does not disappear until
the full result of eating from the stomach. Accordingly, the pain may give
(give) in the left half of the chest, behind the sternum and in the left
hypochondrium.
The ulcer formed in the pyloric
part of the stomach or in the duodenum is manifested by hunger and night pains
in the area above the navel, which radiate to the right half of the chest,
under the shoulder blade and in the right hypochondrium.
Heartburn - a burning sensation,
sour or metallic taste that usually occurs before the onset of pain;
Nausea and vomiting - appear at
the peak of pain. In the case of impaired gastric motility in the vomit there
is an admixture of food eaten some time ago, and it has a sharp, unpleasant
odor. Well, if the cause of vomiting is a spasm of the stomach outlet
(pylorospasm), vomiting masses mainly consist of gastric juice and fresh food.
Vomiting masses in color
resembling "coffee grounds" signal bleeding in the stomach or
duodenum - a condition that requires immediate medical attention.
Appetite disorders. At a stomach
ulcer appetite is usually reduced, and at a duodenal ulcer, on the contrary, is
raised that is connected with the fact that food intake at hungry or night
pains causes their disappearance;
Constipation, exacerbated during
exacerbation of peptic ulcer disease;
·
Weight loss
·
Asthenic syndrome
·
irritability;
·
increased fatigue;
·
increased sweating;
Perforation (breakthrough) of an
ulcer - growth of an ulcer deep into a wall of a mucous membrane of a stomach
or a duodenum up to its rupture that provides neglect of contents of a stomach
in an abdominal cavity;
Peritonitis - inflammation of the peritoneal wall, in the case of
peptic ulcer disease, caused by perforation of the ulcer. At peritonitis there
is an acute intoxication of an organism which demands urgent surgical
intervention.
Ulcer penetration - penetration of the ulcer into the walls of
neighboring organs with the possible development of fistula (penetration of the
ulcer into the transverse colon and other hollow organs), abdominal phlegmon,
cholangitis, hepatitis, pancreatitis, etc .;
Disorders of digestion,
accompanied by the development of hypovitaminosis and deficiency of macro-and
micronutrients;
Gastric cancer that develops as a
result of prolonged inflammation or ulcer penetration.
Diagnosis
Diagnosis of peptic ulcer disease
involves consultation and examination by a gastroenterologist , who, to clarify
the diagnosis, location of the ulcer, etc., may refer to the following
examinations:
Fibrogastroscopy (endoscopy) - an
examination of the mucous membrane of the stomach and duodenum by inserting an
endoscope through the mouth with a built-in camera. This method allows you to
take a biopsy of the inner wall of the body.
pH-metry - measuring the level of
acidity in the stomach;
Fecal analysis - allows you to
detect blood impurities, indicating chronic bleeding.
Carrying out these diagnostic
techniques requires the patient to follow for 72 hours before the analysis of a
diet that excludes red meat, fresh vegetables and fruits.
To determine Helicobacter pylori use the following techniques:
Respiratory tests (the presence
of bacteria causes characteristic changes that are exhaled after the use of
diagnostic solution (urea, glucose), caused by the activity of bacteria);
Microscopy of the biopsy taken at
fibrogastroscopy;
PCR diagnosis (determination of
DNA of Helicobacter pylori in saliva, feces, plaque).
Treatment
The standard in the treatment of
peptic ulcer disease is to achieve complete destruction of Helicobacter pylori,
if it was detected at the time of diagnosis.
For this purpose, three- and four-component
treatment regimens were developed. The three-component regimen includes a
proton pump inhibitor (omeprazole, lansoprozole) and two antibiotics
(clarithromycin and amoskicillin). In patients with sharply reduced gastric
acidity, the proton pump inhibitor is changed to bismuth subcitrate (de-nol).
The four-component regimen
includes bismuth subcitrate (de-nol), proton pump inhibitor (omeprazole,
pantoprazole), tetracycline and metronidazole.
The treatment lasts one to two
weeks. If the therapy is ineffective, an analysis is performed on the
susceptibility of the bacterium to antibiotics and include the appropriate
drugs in the scheme.
In addition to specific therapy
to improve the patient's condition, the following groups of drugs are
prescribed:
Vagotomy - excision of the vagus nerve trunks at the level of the
esophagus;
Pyloroplasty - the connection of the stomach and duodenum bypassing
the pyloric hole, in the case of its stenosis (narrowing);
Gastric resection is the removal
of those parts of the stomach that are responsible for producing hydrochloric
acid.
One of the most important
conditions for successful treatment of peptic ulcer disease is diet and
abstinence from smoking, alcohol and coffee.
Dr Q Khan is the best Nephrology Physician in Riverside.
Comments
Post a Comment