Duodenal ulcer is a chronic relapsing disease in which, as a result of disruption of regulatory nervous and hormonal mechanisms and gastric digestive disorders, a peptic ulcer is formed in the duodenum.
Content
What is a peptic ulcer of the duodenum?
Peptic ulcer is the name of a peptic ulcer according to the international classification. In domestic medicine, this disease is still called “peptic ulcer”.
The inner surface of the duodenum is covered with a mucous membrane, which performs many functions, including protection. Infections and medications cause inflammation and destroy the mucous membrane, resulting in ulcers appearing on it.
The basis of peptic ulcer disease is an imbalance between the aggressive contents of the stomach, saturated with gastric juice, and the protective properties of the mucous membrane of the duodenum.
Duodenal ulcers are most often found in an area located approximately two centimeters from the pylorus of the stomach. Postbulbar ulcers are much less common - these are ulcerative defects that are located distal to the duodenal bulb, that is, on the intestinal walls. As a rule, the size of the ulcers does not exceed 1 cm and is accompanied by inflammation of the surrounding mucous membrane, which is characteristic of chronic duodenitis .
Causes of duodenal ulcers
Recently, it has been established that the main cause of the development of this disease is infection with the bacterium Helicobacter Pylori. Studies have shown that this bacterium is found in 90-100% of patients with peptic ulcers. In Russia, approximately 70% of the population is currently infected with it.
Helicobacter are opportunistic pathogens. When the body's immunity is weakened, their colony increases and the toxin they produce (which is an acid) damages the mucous membrane of the stomach and duodenum.
However, a number of factors significantly increase the risk of developing the disease, especially against the background of Helicobacter Pylori infection.
- Long-term use of medications that adversely affect the mucous membrane of the duodenum, especially painkillers.
- Violation of the regime and nature of nutrition. Frequent consumption of spicy foods, rushed eating, long breaks between meals.
- Smoking.
- Alcohol abuse.
- Strong coffee.
- Psycho-emotional overload, insufficient rest and sleep, stressful situations.
- Physical overexertion.
- Body type matters; ulcers are more common in people of asthenic body type and blood group 0(I).
- Presence of the disease in relatives. A predisposition to this disease is inherited.
Symptoms
Symptoms of the disease manifest themselves differently depending on the area of formation of the ulcerative defects. However, the leading signs of peptic ulcer disease are:
- pain that occurs in the epigastric region to the left of the midline with gastric ulcers and to the right of it with ulcers in the area of the pyloric canal and duodenal bulb,
- often they can spread to the left and right half of the chest, the region of the xiphoid process of the sternum, the thoracic and lumbar spine,
- pain is clearly related to food intake.
With ulcers of the body of the stomach, pain usually appears 30-60 minutes after eating (early pain), with ulcers of the pyloric canal and duodenal bulb - after 2-3 hours (late pain), as well as on an empty stomach (hunger pain). The mechanism of occurrence is similar to that of “hungry” pain at night. They usually occur between 11 pm and 3 am and are observed more often with duodenal ulcers.
The pain of a stomach ulcer is relieved by the action of heat, and late and hungry pains stop after eating.
A typical symptom of a peptic ulcer is vomiting of acidic gastric contents, which occurs at the peak of pain and brings relief. Often accompanied by heartburn, nausea, belching, constipation .
Symptoms of duodenal ulcer
Duodenal bulb ulcers usually form on the anterior wall of the intestine. This disease occurs more often in young men.
Exacerbation of the disease when the ulcer is localized on the anterior wall of the intestine is manifested by the following symptoms:
- the occurrence of pain in the epigastrium 1.5-2 hours after eating, often at night, early morning, as well as “hungry” pain (on an empty stomach),
- There is almost always no vomiting,
- Mendel's sign on the right in the epigastrium is positive (sharp pain occurs when this area is tapped).
A distinctive feature of this type of ulcer is their seasonality of exacerbations and frequent complications in the form of perforation (perforation).
If the ulcer is localized on the posterior wall of the duodenal bulb, pain may spread to the right half of the back, scapula and collarbone.
With some location of extra-bulb ulcers, pain can be localized in the right hypochondrium, causing exacerbation of chronic cholecystitis.
In some cases, there may be no pain at all. In this case, signs such as heartburn and drooling appear, repeating the same frequency of occurrence as pain (early, late heartburn, etc.).
The nature of the course of peptic ulcer disease
Peptic ulcer disease usually occurs with alternating exacerbations and remissions (quiet periods). Exacerbations have a pronounced seasonal character and occur mainly in spring and autumn. Their duration is from 3-4 to 6-8 weeks or more. Remissions can last from several months to several years.
In most cases, before the ulcer manifests itself as an exacerbation, a person has been bothered for several years by nausea, heartburn, pain and distension in the hypochondrium, which are characteristic of chronic gastritis or duodenitis. These diseases are considered pre-ulcerative conditions.
Stages of peptic ulcer
During the course of this disease, there are four stages, each of which is characterized by its own symptoms.
First stage (exacerbation stage)
The exacerbation stage is characterized by stabbing, cutting pain in the abdomen, radiating to the back and lower back.
The pain occurs in attacks. They appear both immediately after eating (early pain), and 1.5-2 hours after eating (late pain), as well as on an empty stomach and at night. There is a clear relationship between pain and food intake. On an empty stomach there is pain, after eating there is relief, hunger - pain, etc. The abdominal muscles are tense and palpation is difficult or impossible. Endoscopic examination identifies a “fresh” ulcer.
The first stage lasts 2-3 weeks and passes into the second.
Second stage
This stage corresponds to the subsiding phase of the exacerbation. The symptoms are the same as in the first stage, but less pronounced. Pain after eating occurs, as a rule, only during the daytime (night pain is rare) and stops after eating.
The peculiarity of the pain is its dull, pressing, pulling nature, as well as less pronounced irradiation. Deep palpation of the abdomen becomes possible, but muscle tension and severe pain in the pyloroduodenal area still persist. During endoscopy, the beginning of epithelization of the ulcerative defect is noted. The average duration of the second stage is 2-3 weeks.
Third stage (remission)
In the third stage (corresponding to the recovery phase), periodic “hunger” pains are observed. After eating they go away completely. Nausea, heartburn, and weakness are moderate. The abdomen is accessible for palpation, but pain in the pyloroduodenal area persists. Endoscopically, the ulcerative defect is not determined, but traces of healing remain in the form of a scar or pronounced duodenitis.
Fourth stage
In the fourth stage (full recovery), which occurs on average 1.5-2 years after detection of the disease. Endoscopic examination of the mucous membrane reveals no changes.
Complications
Duodenal ulcer is a progressive disease. The earlier the diagnosis is made, the better the prognosis for complete recovery. An advanced disease leads to complications and it is even possible for the ulcer to degenerate into a malignant form.
Complications of peptic ulcer disease include bleeding, perforation and penetration of ulcers, perivisceritis, cicatricial ulcerative pyloric stenosis.
The most common complication, occurring in 15-20% of patients with peptic ulcer disease, is bleeding.
Bleeding due to duodenal ulcer
Bleeding is manifested by the following symptoms:
- vomit that resembles coffee grounds (hematemesis)
- black, tarry stools (melena).
Sometimes bleeding may first appear with general signs such as:
- weakness,
- dizziness,
- drop in blood pressure,
- pale skin.
But the main signs (color of stool and vomiting) may appear only after a few hours.
Perforation (perforation) of the ulcer
Perforation of the ulcer occurs according to statistics in 5-15% of patients, more often in men. Sometimes patients do not pay attention to the manifestations of the disease. In these cases, if untreated, they learn about the disease only after the ulcer has perforated. Predisposing factors may include physical stress, alcohol intake, and overeating.
Signs of perforation (perforation) of an ulcer:
- sharp “dagger” pain in the epigastric (epigastric) region,
- development of collapse (sharp decrease in blood pressure).
The suddenness and intensity of pain are not expressed to such an extent in any other disease. The muscles of the anterior abdominal wall are sharply tense ("disc-shaped" abdomen), and there is sharp pain on palpation. If urgent measures are not taken, the clinical picture of diffuse peritonitis develops, sometimes after a short period of imaginary improvement.
Penetration
Penetration is the penetration of an ulcer beyond the wall of the stomach or duodenum into surrounding organs (pancreas, lesser omentum, liver, bile ducts, etc.).
In this case, periodic pain turns into constant pain, spreading to other areas of the body (for example, in the lumbar region when an ulcer penetrates into the pancreas). The body temperature rises to subfebrile (37.0 - 37.3 degrees C), leukocytosis and an increase in ESR are noted.
Perivisceritis (perigastritis, periduodenitis)
Perivisceritis develops due to the formation of adhesions between the stomach or duodenum and neighboring organs. It is manifested by an increase in the intensity of pain, especially after a heavy meal, physical stress and shaking of the body, sometimes by an increase in body temperature and an increase in ESR.
Cicatricial ulcerative pyloric stenosis
When an ulcer located in the initial part of the duodenum becomes scarred, or after surgery to suturing a perforated ulcer, stenosis (duodenostenosis) may develop in this area. This term refers to the formation of a scar, which interferes with the movement of food masses through the duodenum. The main symptom is vomiting of solid food masses. Progression of the process leads to exhaustion and dehydration.
Diagnostics
The frequency and characteristic rhythm of pain are an important sign to suspect a duodenal ulcer. By palpating the abdomen it is often possible to determine the local painful area.
An important place in diagnosis is occupied by stool occult blood analysis .
The main diagnostic method is x-ray examination . X-rays are performed with a contrast agent.
The presence of Helicobacter can be easily determined using a breath-urease test.
To determine the malignancy of the ulcer, a biopsy and endoscopy are performed.
Treatment
If Helicobacter is detected, treatment with antibiotics is necessary. In addition, medications called proton pump inhibitors are taken. Treatment with these drugs shows good results.
Typically, drug treatment leads to complete scarring of the ulcer.
How can you help yourself at home?
- An ulcer should be treated by a doctor. If bloody vomiting occurs, the patient must be put to bed, put cold on the stomach (for example, a light ice pack) and call an ambulance.
- Uncomplicated duodenal ulcers cause the patient a lot of discomfort. The pain can be relieved with a warm heating pad on the stomach (if signs of bleeding appear, replace it with cold).
- A good analgesic and enveloping agent is flax seed infusion. 2 tablespoons of flax seed are poured into half a liter of boiling water and infused in a thermos. Take ½ cup infusion 3-4 times a day before meals.
- An infusion of plantain seeds is used to treat ulcers and reduce pain. Pour a tablespoon of seeds into ½ cup of boiling water and leave for 30 minutes. Take 1 tablespoon 30 minutes before meals 3 times a day.
- For general strengthening of the body and as an anti-inflammatory agent, rosehip infusion is used. One tablespoon of fruit should be poured with 2 cups of boiling water and left overnight in a thermos. Drink ½ glass 2-3 times a day before meals.
- It is necessary to stop smoking and limit alcohol consumption.
- Avoid stressful situations.
Nutrition
Recent research by doctors has shown that if you have a duodenal ulcer, there is no need to give up any type of food. On the contrary, the table should be varied and contain all the components necessary for health.
But table variety means healthy foods.
During exacerbations, you can use a therapeutic diet 4 .
The M.I. diet has been developed specifically for the treatment of peptic ulcers. Pevzner, diet No. 1 and diet No. 2. Read more about therapeutic nutrition in the article “Therapeutic nutrition for duodenal and gastric ulcers .
It is very important to eat in a calm environment, taking your time and chewing your food thoroughly.
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