One of the most severe and common gastrointestinal diseases is gastric ulcer - a chronic pathology characterized by the formation of erosion in the duodenum and stomach. Complete remission never occurs - moreover, the disease is prone to progression.
What causes the pathology? What reasons indicate its presence? How is the diagnosis carried out? And what is the treatment regimen? This and much more will now be discussed.
Causes
Chronic gastric ulcer (ICD-10 code - K25) occurs as a result of the harmful effects of bacteria such as Helicobacter pylori on the body. About 80% of people have it, and each person belonging to this majority is potentially at risk.
However, the pathogen begins to exert its destructive effect in tandem with provoking factors. They disrupt the work of the stomach, and therefore a favorable environment for the development of bacteria is formed. Provoking factors include:
- Diseases such as cholecystitis, gastritis, etc.
- Heredity.
- Unhealthy diet.
- Alcohol abuse.
- Depression and frequent stress.
- Drug abuse.
Chronic gastric ulcer (ICD-10 code - K25) is a chronic pathology, the course of which is irreversible. Indeed, a scar forms on the mucous membrane, and this area ceases to secrete gastric juice.
This disease occurs in approximately 10-12% of adults (mainly in men). As a rule, an ulcer affects the urban population. Doctors suggest that this is due to nutrition and the psycho-emotional factor.
Signs of the disease
Chronic gastric ulcer (ICD-10 - K25) is not asymptomatic. But the clinic of this ailment largely depends on the individual characteristics inherent in the patient's body.
However, in almost all people, a painful sensation is concentrated in the epigastrium. They intensify after eating food and physical exertion (even lungs), often give to the left shoulder.
Many also experience burning, aching discomfort and a feeling of excessive pressure. Even worse when the pain appears at night. So, the ulcer also affected the duodenum.
In addition, the following symptoms may occur:
- Nausea.
- Metallic taste in the mouth.
- Burping. It is common, but in some with fragments of undigested food.
- Problems with bowel movements.
- Insomnia.
- Increased irritability and irritability.
- Heartburn. It happens both day and night.
- Weight loss.
- Appetite problems.
- Thirst.
Many people, having noticed some of the symptoms listed above, suspect gastritis. Symptoms are really similar. That is why you need to immediately contact the gastroenterologist at the first manifestations of the ailment.
Diagnostics
To determine a person’s chronic gastric ulcer (ICD-10 - K25), the doctor should conduct a survey and palpation of the abdominal cavity. This will help to determine if the patient has pain in the left hypochondrium and epigastric zone.
After this, events are prescribed, the passage of which is aimed at specifying the diagnosis. Only on the basis of their results it will be possible to find out what a person suffers from - a chronic ulcer of the antrum, bulbar region of the duodenum, or even gastritis.
Here are the required laboratory tests:
- A blood test for glucose, albumin, total iron, cholesterol and protein.
- Examination of feces and urine.
- Detailed blood test.
- Fractional study of gastric secretion.
In addition to the above, instrumental studies are also conducted. As a rule, FGDS and ultrasound are prescribed.
If the doctor still has questions and doubts about the diagnosis even after these examinations, the patient is sent to determine the level of serum gastrin and undergo an endoscopic urease test.
If indicated, computed tomography, an X-ray of the stomach, and intragastric pH metering may be prescribed.
Antibiotics
These drugs are prescribed for chronic gastric ulcer. Their action is aimed at destroying the cell walls of bacteria, and they also get inside their cells, after which they destabilize metabolic processes. As a result, pathogenic microflora perishes.
Doctors often prescribe Clarithromycin. This drug is resistant to hydrochloric acid. It is quickly absorbed, and affects the body for a long time. If the patient has not been identified contraindications, then it is prescribed as the main tool for the treatment of chronic stomach ulcers.
Another prescribe Amoxicillin. This tool is also resistant to the damaging effects of gastric enzymes. It is absorbed by 90%. This fact determines its effectiveness and frequency of use - the drug can not be used more often 2 times a day.
A good tool is Metronidazole, which is a reliable, effective, long-used drug. Its components act directly on the DNA of a parasitic bacterium.
Some patients take tetracycline. The active substances of this drug disrupt the protein synthesis of bacterial cells, as a result of which they die.
Antacids
The use of drugs in this group helps to alleviate the symptoms of chronic stomach ulcers. The most popular remedies include:
- Almagel. Provides a long-lasting effect, but the metabolism does not upset. The drug is not absorbed, does not accumulate in the epithelium. This drug well envelops the walls of the digestive organ and neutralizes hydrochloric acid.
- Enterosgel. An excellent sorbent that absorbs harmful substances and promotes their excretion from the body. Aggressive components do not have time to damage the mucous epithelium.
- "Maalox." The composition of this drug includes magnesium hydroxide and aluminum. These substances in tandem neutralize bile acids. The tool has a cytoprotective, absorbent and enveloping action. A single dose of more than 3 hours relieves a person of pain, belching and other unpleasant symptoms.
- "Phosphalugel." It also has antacid, absorbent and enveloping effects. Another tool absorbs pathogenic bacteria and toxic substances within the gastrointestinal tract, and then removes them from the body.
- Gastal. A combined remedy that reduces the level of acidity in the stomach, and also enhances the regenerative and protective processes in the mucous membrane.
- Gaviscon. The drug has the ability to quickly interact with the acidic contents of the stomach. The gel protects it from aggressive substances, lasts up to 4 hours.
In addition to the above, other antacids can be prescribed. As a rule, the doctor prescribes nonabsorbable medicines - bismuth, Topalkan, Vakair, Vicalin, etc.
Antisecretory drugs
Their use in chronic stomach ulcers is necessary to minimize the production of hydrochloric acid. Your doctor may prescribe one of the following:
- Omeprazole. Not only reduces acid secretion. This drug also has a bactericidal effect on the ulcer pathogen.
- "Gastrosidine." The drug enhances the protection of the gastrointestinal mucous membranes, and also promotes the healing of lesions that were caused by exposure to hydrochloric acid.
- "Ranitidine." It has a similar effect, also reduces the amount of gastric juice and increases the pH of its contents.
- "Lecedil." Suppresses stimulated and basal hydrochloric acid production. Known for a long action - from 12 to 24 hours.
- "Torsid." Diuretic drug that enhances the action of other antihypertensive agents. Due to this feature, it must be taken with caution.
- "Rabeprazole." An effective antiulcer drug metabolized in the liver. It is a real salvation for many patients, but has a number of serious contraindications.
Also used for chronic gastric ulcer micropreparations "Famotidine", "Ultop", "Pirenzepine", etc.
Other medicines
As already understood, complex therapy is used to treat chronic gastric ulcers. In addition to the previously listed drugs, the patient may be prescribed:
- Cytoprotectors. They help increase the protective functions of the mucous membrane. You can drink Sucralfate or licorice preparations - Andapsin and Carbenoxalon.
- Antiulcer. This effect is produced by lithium preparations and calcium channel blockers. Famous medicines of this group are Isoptin, Verapamil, Kordafen and Nifedipine.
- Probiotics They help reduce the effects of reflux. The funds of this group include Propuls, Domperidon, Tserukal, Motilium, as well as chaga preparations.
- Sedative. Soothing effect have antipsychotics, selected individually, as well as motherwort and valerian.
- Antioxidants and vitamins. Necessary to strengthen the immune system.
As a rule, intensive treatment does not last more than 7 days. But everything is decided individually, depending on the general health of the patient and the stage at which the disease is located. In any case, he will have to be registered for at least 5 years.
And if it turns out that conservative therapy was ineffective, surgical treatment will be recommended to the patient.
Operation
If an exacerbation of a chronic gastric ulcer occurs or the patient's condition is steadily worsening, he is offered to solve the problem through surgery. Indications for surgery are:
- The occurrence of a through defect in the gastric or intestinal wall.
- Unstoppable bleeding from an ulcer.
- Cicatricial narrowing of the output section of the stomach, due to which the passage of food is difficult.
- Suspicion of the transition of an ulcer to a malignant form.
- Frequent relapses.
- The presence of diffuse polyposis in the stomach.
- Ulcers that do not heal for a long time.
As a rule, a stomach resection is performed, or a perforated hole is sutured. In rare cases, it is necessary to resort to operations such as pyloroplasty, vagotomy, local excision, and the application of gastroenteroanastomosis.
Any intervention is prohibited if a person is diagnosed with an acute infectious or chronic disease in the stage of decompensation or there is a malignant ulcer with distant metastases. Also, do not do surgery in case of a serious condition of the patient.
Effects
Like gastritis, a chronic gastric ulcer entails severe complications if a person ignores it. Here are some possible consequences:
- Constant pain that cannot be eliminated.
- Severe ulceration of the stomach wall, which leads to internal bleeding. The result of this can be anemia.
- Perforation of an ulcer. It is characterized by the appearance of a through hole in the wall of the stomach. Because of this, the contents of the stomach spills into the abdominal cavity. As a result, peritonitis may develop.
- Persistent cramping. Because of them, food will cease to pass through the stomach and move through the digestive tract.
- Penetration. An ulcer penetrates nearby organs. Most often, the pancreas suffers. As a result, acute pancreatitis develops.
- Stenosis of the pyloric part of the stomach. This complication can be eliminated only by a surgical method. Otherwise, the patency of food into the duodenum 12 cannot be restored.
- Perigastritis This phenomenon is fraught with the formation of adhesions connecting the serous membrane of the stomach with the liver or pancreas. As a result, the digestive tract is deformed.
- Malignancy. The rarest complication. But also the most life-threatening. After all, it involves the transformation of an ulcer into a malignant tumor.
You also need to remember about the complications that may occur after surgery. This is inconsistency of sutures, suppuration of a wound, peritonitis, bleeding, thrombophlebitis, paralytic intestinal obstruction, as well as pulmonary embolism. Fortunately, these consequences are extremely rare.
Proper nutrition
Of course, with a chronic stomach ulcer, a diet must be observed. Here are her rules:
- You need to eat 6 times a day in small portions.
- Prepare food in liquid, jelly-like and gruel-like form.
- Hardly digestible products, as well as any pathogens of secretion and irritants of the mucous membrane, are prohibited.
- Any bread is excluded.
- Soups can only be water or milk with cereals (rice, semolina and oatmeal). Mandatory mucous consistency. You can make them from flour for baby food.
- Calcined cottage cheese, cream (as an additive in soups), as well as whole milk (up to 4 glasses per day) are allowed.
- The main source of protein is steam omelet and soft-boiled eggs.
- It is forbidden to eat too cold or hot dishes. Comfortable temperature - 15-20 ° C and 50-55 ° C, respectively.
Depending on the condition of the patient, a diet No. 1A, No. 1B and No. 1 is prescribed. If the patient's well-being improves, then the timing of proper nutrition is reduced to 2-3 months. All recommendations regarding the diet are voiced by the doctor, taking into account the condition of his patient.