A duodenal ulcer (ICD 10: K26) is a fairly common disease, diagnosed already in advanced stages. This is because people are accustomed to attribute any uncomfortable sensations in the stomach to stale food or a violation of the diet. A person suffers pain, drowns it with drugs, and yet the disease progresses. Such a patient will go to the doctor when it becomes unbearable to ignore your body.
Epidemiology
Duodenal ulcer, as a rule, is secondary to damage to the gastric mucosa. Therefore, the diagnosis usually says "stomach ulcer and duodenal ulcer", without specifying the location.
About 5% of all people on Earth have this pathology. In men, it occurs 4 times more often than in the fair sex. And the ratio of townspeople and rural residents is about 2 to 1. Most likely, this is due to the quality of products, food habits and labor activity of residents of urbanized areas.
Causes
An ulcer of the duodenal bulb occurs due to the corrosive effect of hydrochloric acid (which is part of the digestive juice) on the mucous membrane of the small intestine. There are several reasons that cause an increase in acidity:
excessive secretion of gastrin (a hormone that regulates digestion);
passion for spicy, bitter, salty, sour, fried and fatty foods;
insufficient food during the day and overeating in the evenings;
prolonged use of hormonal or anti-inflammatory drugs;
regular exposure to stress;
smoking and drinking alcohol, especially on an empty stomach.
In rare cases, the appearance of erosion and ulcers in the duodenum can be associated with an increase in the level of calcium in the body, a decrease in the function of the liver and kidneys, and chronic obstructive pulmonary diseases.
Pathogenesis
An ulcer of the duodenal bulb is manifested in a wavy course with alternations of remission and exacerbation. Three stages are conventionally distinguished:
acute course (symptoms are pronounced, there are ulcers and erosion on the mucosa);
process attenuation (no complaints, ulcers scarring);
remission (no symptoms, scars epithelialize).
The main role in the appearance of an ulcer is played by a violation of the acid-base balance on the intestinal mucosa. If hydrochloric acid is formed more than alkali, then it is not completely neutralized and damages the surrounding tissue. Cells break down, release enzymes and increase damage. In this area of the mucosa, inflammation forms, which increases with each new portion of chyme. In addition, increased peristalsis and an increase in the number of secretory cells in the stomach allows acid to be secreted even outside of meals.
Symptoms
How does an ulcer of the duodenal bulb manifest itself? Symptoms and its treatment are closely related, so it is important to understand exactly which syndrome prevails. The clinical phenomena are very intense and cause a lot of inconvenience to the patient.
The very first and main symptom is pain in the umbilical region. It can be either acute or aching, it all depends on the quantity and quality of meals. In addition, at first it is easy to get rid of it by drinking antacids. Sometimes the pain can return at night and radiate to the lower back.
Every ulcer knows: to get rid of nausea, belching or pain, you just need to have a bite. It is desirable with something like jelly. But this remedy is not universal, because vomiting can come back after eating, “bringing” with you as a “bonus” heartburn and a feeling of heaviness. Periodically, these people suffer from stool disorders in the form of constipation and flatulence.
Complications
Acute duodenal ulcer is a life-threatening disease. In severe cases, severe bleeding, perforation of the intestinal wall and the formation of sepsis are possible.
An ulcer can not only corrode the wall of a hollow organ, but also seep into an adjacent one. So, for example, from the bulb of the duodenum, the pathological process goes to the pancreas, forming fistulas and abscesses.
Chronic complications include stenosis (narrowing) of the intestinal tract. This complicates the passage of food, provokes its stagnation and decay in the stomach. In humans, this is manifested by a feeling of heaviness, weakness, pallor, exhaustion, lack of appetite. In some cases, there may be vomiting with pieces of undigested food eaten a few days ago.
Diagnostics
A duodenal ulcer is easily diagnosed, given that patients seek help from a doctor already at the height of the disease, when discomfort interferes with their normal life.
First, the doctor collects a medical history and conducts an examination. Of course, palpation of the abdomen does not give high information content, but it is possible to suspect, with a high degree of probability, the ulcerative process. Then the patient goes to take a blood test, biochemical markers, stool analysis for occult blood, and also determine the level of gastrin and Helicobacter pylori activity.
Esophagogastroduodenoscopy, or, more simply, endoscopy, remains the most common diagnostic procedure. It allows you to examine the mucous membrane of the digestive tube, cauterize all identified ulcers, take tissues and fluids for examination. Radiography is also informative. In pictures with contrast, the places of ulcers and the state of the gastric mucosa and duodenum will be clearly visible.
Treatment of duodenal ulcer
First of all, you need to prepare yourself for the fact that this is a long and painstaking process, consisting of a diet, physiotherapy and medication. Do not be afraid, all this must be done not at the same time, but according to a clearly developed plan and in consultation with a doctor.
To begin with, a gastroenterologist determines the cause that caused the ulcer and directs all efforts to get rid of it. For this, there is drug therapy. These are antacids, and prokinetics, and proton pump inhibitors, and many other pharmacological miracles. In addition, lung sedatives and sleeping pills can help in the fight against stress ulcers , but they should be used with caution. Penicillin antibiotics and macrolides are excellent against Helicobacter pylori.
At the stage of recovery, to maintain the strength of the body, the patient is shown balneological procedures, novocaine electrophoresis and warming.
Folk remedies
Treatment of duodenal ulcers with folk remedies is fraught with unpleasant health consequences. Therefore, before starting such experiments, warn your doctor. He will be grateful to you for this.
On the Internet, as well as our grandmothers, there are many recipes for treating ulcers. In order to reduce acidity and increase the resistance of the mucosa, people drink fresh potato juice, a mixture of honey and butter, or simply dissolve honey in warm water and eat before eating. There are more exotic recipes, such as using a teaspoonful of sea buckthorn seed oil before each meal.
All these methods can remove the discomfort, some even contribute to the healing of ulcers, but still, preference should be given to traditional methods of treatment.
Diet for duodenal ulcer
During periods of exacerbation of the disease, patients should adhere to a fairly strict diet, which will help reduce the intensity of pain, as well as accelerate recovery. A few tips for a similar diet:
Fractional nutrition every 3 hours in small portions.
You need to eat slowly, chewing food thoroughly.
The food should be warm so as not to irritate the already sensitive intestines.
Selected products should not stimulate the additional production of hydrochloric acid, so nothing fried, spicy, salty, pickled and spicy.
Some delicacies and pickles may have to be abandoned for life. But milk, fruits, mashed potatoes and jelly, steamed vegetables and eggs can be eaten in unlimited quantities.