The diagnosis of peptic ulcer disease is made on the basis of a carefully collected history, relevant clinical signs of the disease, x-ray, endoscopic, morphological studies of the gastric mucosa and duodenal ulcer, laboratory, including biochemical, immunological and radio-immunological studies of gastric juice, blood and gastric mucosa .
Patient questioning (history)
Clinical manifestations of peptic ulcer are multifaceted. The variability of symptoms is related to the age, sex, general condition of the patient, the duration of the disease, the frequency of exacerbations, the localization of the ulcer, and the presence of complications. Anamnesis data and analysis of patient complaints are of great importance for recognition of this disease. Pay particular attention to two symptoms - pain and heartburn.
The main symptom of a peptic ulcer is pain, characterized by periodicity throughout the day, seasonality (spring and autumn), the presence of light gaps — the absence of a relapse of the disease for several years (the Trinity triad). The pain of a peptic ulcer is associated with food intake: there is nighttime, hungry, fasting pain, early (after 20-30 minutes), late (after 1.5-2 hours) after eating (at the height of digestion). After vomiting, eating, antacids, the use of heating pads, myogenic antispasmodics, anticholinergic drugs, the pain during peptic ulcer decreases or disappears. There is a natural connection between pain and the quality and quantity of food: plentiful, spicy, sour, salty, coarse food always causes pain.
Early pain is typical for localization of ulcers in the stomach, late - for ulcers located near the pylorus and in the duodenum, nocturnal and fasting pain is possible with both localizations of the ulcerative process. For high gastric ulcers (cardiac), early pain occurs immediately after eating, especially acute and hot, sometimes aching, pressing, bursting pain, located under the xiphoid process or in the left hypochondrium. Pain radiates up along the esophagus, persistent belching, heartburn, as the ulcer is often combined with cardia failure, gastro-esophageal reflux. With the localization of ulcers in the body and the bottom of the stomach (mediogastric ulcers), pain occurs 20-30 minutes after a meal, occasionally at night.
Pain reaches particular intensity when the ulcer is localized in the pyloric canal, it occurs 40 minutes to 1 hour after meals. According to clinical manifestations, pyloric ulcer resembles duodenal ulcer. However, the intensity of pain, irradiation in the right hypochondrium, in the back, behind the sternum, persistent vomiting with a large amount of acidic contents, a large loss in body weight makes suspect the ulcer of the pyloric part of the stomach.
With the localization of ulcers in the duodenal bulb or antrum of the stomach, pain often occurs on an empty stomach (fasting pain), at night and 1.5-2 hours after a meal (late pain). The pain, as a rule, after eating, subsides. Heartburn symptom is determined by hypersecretion of the main glands of the stomach and (or) the presence of duodenogastric and gastroesophageal reflux.
Peptic ulcer disease with localization of the ulcer in the post-bulbar region occurs mainly in middle-aged and elderly people. Persistent pain radiating to the right shoulder, right or left hypochondrium indicates involvement in the pathological process of the biliary tract and pancreas. Often, persistent vomiting and cholestasis are observed in patients with zalukovic ulcers.
Based on the nature and time of pain, depending on the location of the ulcer, you can use the following scheme:
- Subcardiac ulcers: food intake → early pain (during the first 30 minutes after eating) → well-being.
- Ulcers of the middle and lower third of the stomach: food intake → well-being (for 30 min - 1 h) → pain (for 1–1.5 h until complete evacuation of food from the stomach) → well-being.
- Pyloric ulcers of the stomach and duodenal ulcer: hunger pain → food intake → good state of health for 1-1.5 hours until the complete evacuation of food from the stomach is late pain.
For peptic ulcer disease is characterized by seasonality of pain (spring and autumn exacerbations). Periods of exacerbation of pain are replaced by periods of remission with an uncomplicated ulcer, even without treatment. By the nature of the pain can be dull, burning, aching, paroxysmal, sharp, accompanied by vomiting. During an exacerbation, patients are more likely to take a comfortable position lying on their right side with their legs taut, often resorting to a warm water bottle. Most patients report increased pain in the afternoon and try not to eat in the evening. Constant pain indicates complications such as periprocesses (perigastritis and periduodenitis) or penetration of an ulcer into neighboring organs.
Irradiation of pain is not characteristic of a peptic ulcer and is most often observed with the penetration of an ulcer:
- With the penetration of an ulcer into the pancreas, pancreatitis symptoms join: after eating, the pain does not calm down, but increases, there is nausea with retching, belching, unstable stool. The pain becomes shingles or radiates to the back. There is a fear of eating due to pain, intolerance to dairy and fatty foods, fruit and vegetable juices.
- When an ulcer penetrates into the hepatoduodenal ligament and liver pain appears soon after eating, it is localized in the right hypochondrium, radiating to the right half of the chest, to the right shoulder and back. Often there is a decrease in appetite, dry mouth, nausea, and sometimes vomiting in the morning.
- In case of cardiac, high-grade ulcers of the stomach, it radiates to the region of the heart, behind the sternum.
- Penetration of an ulcer in the omentum is accompanied by persistent pain with irradiation to the back, often at 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, filamentous pulse, and further symptoms of peritoneal irritation. Perforation covered with an omentum or a piece of food that is stuck in the perforated hole can create false rest, and then, for example, when coughing, a piece of food comes out of the perforated hole and the symptoms resume. Often the contents of the stomach due to the anatomical features of the structure of the intestines is collected in the right iliac region and there is a picture of acute appendicitis (pain, fever, vomiting, leukocytosis), such patients fall on the operating table. And only during the operation, the surgeon determines the inflamed appendix, "bathing" in the remnants of food. Usually produce appendectomy and suturing of the perforated window.
The most frequent and early symptoms of peptic ulcer are heartburn, the reflux of the acidic contents of the stomach into the esophagus, a burning sensation behind the sternum, an acidic or metallic taste in the mouth. Often, heartburn is combined with pain. Distinguish late, hungry, nocturnal heartburn. The occurrence of heartburn is associated not only with a 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 excruciating, can be with low acidity of gastric juice.
Belching, nausea, vomiting, salivation are less common than pain and heartburn. Belching is more common with subcardiac ulcer localization. Vomiting associated with pain: it usually occurs at a height of pain (often the patient himself causes it) and brings relief to the patient. Vomit have 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 impaired evacuator-motor function of the stomach during pyloric stenosis - in such cases, the vomit contains the remnants of food eaten the day before. A dangerous symptom of bleeding is bloody vomiting. Some patients have nausea with saliva instead of vomiting.
Physical examination provides little information. On examination of the oral cavity, carious teeth, periodontal disease, white-yellow bloom at the root of the tongue, and sometimes erosion along the edges of the tongue are found; With uncomplicated forms of peptic ulcer, the tongue is usually clean and moist. With the development of complications the tongue becomes dry and densely laid. Usually, in an uncomplicated form of the disease, hypertrophy of the filiform and fungoid papillae of the tongue is observed. With the progression of gastritis with a decrease in the secretion of hydrochloric acid, the nipples of the tongue are smoothed.
The most common finding in a physical examination is pain in the epigastrium. With 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 - a symptom of Glinchikov. The zone of pain is usually located in the middle between the navel and the xiphoid process, and in about 20% of patients - to the right of the median line. The determination of these signs near the xiphoid process indicates the cardiac location of the ulcer, in the right half of the epigastric region, the duodenal ulcer, and in the midline above and to the left of the navel, the ulcer of the lesser curvature of the stomach.
When perforation of the ulcer appears, the muscles of the anterior abdominal wall (the stomach-like abdomen) are strained; in most cases, the positive symptom of Shchetkin-Blumberg is determined. Intestinal noise first intensifies, and then weakens or disappears. In case of pyloric stenosis, splashing noise can be identified, due to the accumulation of fluid and gas in the distended stomach.
X-ray method allows to identify morphological and functional changes of the studied organ. Identifying a “niche” is a direct sign of illness. The most important indirect signs include cicatricial deformity of the organ, the convergence of folds, increased motility, hypersecretion, local spasm, accelerated evacuation of barium mass from the stomach and its rapid advancement through the duodenum. But the level of diagnostic errors in radiological examinations of patients with peptic ulcer disease is quite large and amounts to 18–40%. Particular difficulties arise in the localization of an ulcer on the anterior wall of the stomach, in the cardiac zone, the pyloric canal, and the lumen of the duodenum.
Currently, it is generally accepted that the endoscopic method is the most reliable in the diagnosis of peptic ulcer disease. The advantages of the method include:
- direct examination of the mucosa,
- establishing the benign or malignant nature of ulceration,
- visual and morphological control over the rate of ulcer healing,
- detection of concomitant lesions of the mucous membrane of the upper digestive tract,
- determination of gastric acidity.
Significantly revised contraindications to gastroduodenoscopy. There are practically no absolute contraindications to its implementation. Relative contraindications to endoscopy are severe cardiac arrhythmias, acute myocardial infarction, stroke, often recurrent attacks of angina and bronchial asthma, chronic heart failure IIB – III stages, acute and chronic infectious diseases in the acute stage.
An ulcer is a specific morphological substrate of the disease. The International Endoscopic Association makes recommendations on the terminology of mucosal lesions: erosion - superficial defect, determined histologically, ulcer - a deep defect in the wall of an organ, determined macroscopically, having a configuration, borders, surroundings, bottom. An acute ulcer is characterized by necrosis and destruction, which captures not only the mucosal epithelium, but also extends to the submucosal and muscular layers. This is the main difference between ulcers and erosion, which is characterized by a defect in the epithelium.
Ulcer healing occurs by scarring (the damaged muscle layer does not regenerate, but is replaced by connective tissue), but erosion is epithelized without scarring. The post-ulcer scar in the phase of damped exacerbation has the appearance of a hyperemic section of the mucous membrane with linear or star-shaped wall retreat (stage of immature red scar), the mature scar acquires a whitish appearance due to replacement of granulation tissue with connective tissue and the absence of inflammation (stage of white scar). On average, the healing of stomach ulcers before the formation of a "red" scar occurs in 5-6 weeks, and duodenal ulcers - in 3-4 weeks. The formation of a "white" scar ends in 2–3 months.
In the study of blood in patients, the hemogram indices in the uncomplicated form 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 the norm, 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 post-hemorrhagic anemia is observed. In the presence of ulcer penetration and pronounced periprocesses, leukocytosis with a neutrophilic shift is possible. ESR increases in the presence of complications or its combinations with other diseases of adjacent organs - chronic cholecystitis, pancreatitis, hepatitis, cirrhosis of the liver. In the presence of anemia, it is necessary to investigate the level of serum iron and the iron binding capacity of serum, as well as ferritin, which more accurately characterizes the iron content in the body.
Study of gastric secretion
The study of gastric secretion is necessary to identify functional disorders. The state of acid excretion is determined by the method of intragastric pH-metry. In duodenal ulcer, the secretion of hydrochloric acid exceeds the norm: the basal - 2-3 times, stimulated by 1.5-1.8 times, night-time exceeds the basal level by 3.5-4.0 times. In patients with peptic ulcer disease with localization of ulcers in the stomach, especially with mediagastric ulcers, most often normal or slightly reduced production of hydrochloric acid, stimulated production can be increased. In the study of intragastric pH in patients with pyloroduodenal ulcer localization, pronounced hyperacidity in the body of the stomach (pH 0.6–1.5) with continuous acid production and decompensation of alkalization of the environment in the antrum (pH 0.9–2.5) is determined.
Analysis of fecal occult blood
Certain diagnostic value has a fecal occult blood test, especially in cases of suspected latent bleeding. Usually conduct the reaction Gregersen or Weber. A positive reaction of feces is observed during the exacerbation of a peptic ulcer, but a negative reaction does not reject the disease. With slightly positive results, we can talk about the exacerbation of peptic ulcer, while with a sharply positive reaction - the presence of latent bleeding.To carry out the reaction, it is necessary to prepare patients: 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 coloring action (beets, bismuth-containing drugs, activated carbon). The disappearance of a positive reaction to occult blood in the feces is important for diagnosis, since it is a sign of the onset of scarring of the ulcer. Reactions to occult blood in the feces have a relative diagnostic value, since they can also be observed in malignant tumors of the digestive system, bleeding gums, nosebleeds, internal hemorrhoids, etc.
What are the symptoms of a stomach ulcer?
How to find out if you have a stomach ulcer, if at the moment there is no opportunity to consult a specialist? A stomach ulcer can be identified by the symptoms inherent in the disease. There are seven basic signs that will help determine the ulcer of the stomach on its own.
- Pain is the main symptom for determining ulcers. Pains appear to the right of the chest area. Depending on the type of patient's ulcer, the pain makes itself felt at different times of the day: on an empty stomach, at night, immediately after taking a meal. Often the pain occurs after eating something sharp, sour, salty. The pain can be described as sharp, and as dull (aching) (depending on the characteristics of the patient and the type of ulcer).
Important! If the pain is sharp, dagger, it is necessary to hospitalize the patient in order to avoid pain shock.
- Vomiting that occurs during food digestion and is accompanied by sharp pain is an exact symptom that indicates a stomach ulcer. Often, after vomiting, pain is relieved. Some patients purposely cause a gag reflex to relieve pain. You should not do this systematically. In case of peptic ulcer, there are often blood admixtures in vomitus. With such obvious signs, the patient himself can accurately diagnose a gastric ulcer.
In order to avoid dehydration during vomiting and further destruction of the stomach walls, at the first manifestations of blood in the vomit, be sure to consult a doctor.
What else should you pay attention to?
- Cal coal color indicates that blood from erosions in the stomach enters the intestine. This symptom helps to accurately detect stomach ulcers when bleeding begins.
- Dyspeptic disorders. The patient manifests disorders of the gastrointestinal tract for a long time, namely: nausea, constipation, heaviness in the abdomen, fetid eructations, sourish eructations, heartburn. This symptom does not give an accurate diagnosis of a peptic ulcer, as it is a sign of other diseases (for example, gastritis). It can not do without additional diagnosis of gastric ulcers.
- Sharp and noticeable weight loss. Because of the pain, the patient begins to limit himself to food, or to replace harmful foods with dietary ones. Often, due to symptoms such as nausea and heaviness, the patient refuses to eat.
- Salivation for no apparent reason is a secondary indicator to find out if you have a stomach ulcer. This symptom is useful when the peptic ulcer is asymptomatic. With increased salivation should be done ultrasound.
- External symptoms. Often the appearance of ulcers in the stomach indicate the appearance: fatigue, impotence, pallor of the skin, lack of sleep, sweating, bitter taste in the mouth.
For such symptoms, it is difficult to diagnose a stomach ulcer at home, so be sure to go to an appointment with a specialist.
Diagnosis of gastric ulcers
If a person has found signs of a peptic ulcer at home, he should definitely come to the specialist’s appointment in order for the doctors to make a qualitative diagnosis.
First of all, you should visit a therapist. The doctor will conduct an external examination and during palpation will be able to determine the focus of the disease. The patient should clearly state the complaints, describe in detail the symptoms that he found in himself. After this, general tests are assigned:
- blood and urine
- feces for blood,
- blood donation for protein, cholesterol, amylase and iron levels,
- on blood type.
After receiving the results of the analyzes, the physician is assisted by a surgeon, a radiologist and a morphologist in diagnosing gastric ulcers.
Diagnosis of gastric ulcer divided into three methods:
Fibrogastroduodenoscopy and x-ray
- FGDS. An effective research method with an optical device that is equipped with flexible optics. Due to the existing method of instrumental examination, doctors see the location of the ulcer, its condition (open or scar), can take a tissue for a biopsy. When using FGDs, it is possible to establish comorbid diseases with an accuracy of up to 90%. The method of research is not dangerous, does not produce complications, but still has some contraindications: stroke patients, a heart attack, the esophagus, which is narrowed, esophageal burns, heart failure.
FGDs - the most effective method for determining stomach ulcers. If, for psychological reasons, you cannot perform this procedure (fear of suffocation), try to find the strength to overcome fear, and then you will be able to avoid wasting time on additional procedures.
- X-ray with gastric ulcer is often compared with the endoscopic method. It is carried out when FGDS is contraindicated for the patient. The method is accurate at 80%. When performing x-rays, radiologists describe the ulcer as a spot-niche, opposite which are the muscles that are in the spasm. X-ray examination is divided into traditional, biphasic, emergency and double contrast. For the diagnosis of peptic ulcer disease used x-ray double contrast. In this method, a contrast agent is used. X-ray of the stomach is prescribed to people who have:
- acute pain
- rapid weight loss
- tight belly
- epigastric discomfort.
Ultrasound and Biopsy
- Ultrasound. Many patients may doubt whether a stomach ulcer is visible on ultrasound. However, ultrasound of the stomach and duodenum help to eliminate the pathology of organs. In addition, whether the ultrasound reveals an ulcer depends on the readiness for examination. It is best to conduct a study on an empty stomach with an apparatus that displays real-time data. In case of peptic ulcer ultrasound helps to identify the place of concentration of pain. With this method of research draws attention to the walls of the stomach, and if there are ulcers on them, then ultrasound will show.
- Biopsy. This method of research consists in taking a sample of tissue from a specific part of the mucous membrane. Biopsy is essential for the diagnosis of peptic ulcer disease. The sampling material for research is carried out using a probe. Sometimes this method gives a false negative result. In order to avoid this, the specialist should eliminate inaccuracies in the procedure. The procedure is carried out scrupulously. Take on the study of 6 pieces of cloth at least.
Morphological diagnosis of gastric ulcer
The morphological method consists in the study of bacteria and staining in histological section. Aims to identify Helicobacter pylori, which leads to peptic ulcer. There are varieties of morphological methods.
- The test for Helicobacter pylori is a non-invasive test. Bacteria are taken with the help of air, which exhales the patient, and are subjected to research. With the aid of the test provided, the course of the disease and the healing of ulcers are controlled.
- Biochemical method. This is a quick test in which material is placed in urea. If Helicobacterium is present in the collected liquid, the liquid is converted into ammonia, under the influence of urea. Effective method.
- The immunological test includes the study of biological fluid (saliva, urine, blood, feces) for the presence of specific antibodies that Helicobacterium causes. It is used if breathing tests are not possible.
- Bacteriological test. The most effective test for diagnosis and research. Gives one hundred percent result. For carrying used expensive devices and reagents. Time to study takes a week. The test isolates a pure culture of bacteria and shows their susceptibility to drugs.
Differential diagnosis of peptic ulcer
Differential diagnosis of gastric ulcer is a diagnostic method that excludes inappropriate factors and symptoms of the disease in order to arrive at the only correct diagnosis. Differential diagnostics is divided into three stages:
- The first is a thorough examination of all the symptoms and complaints of the patient. Then find out the reason. Sometimes, in order to cure a disease, it is simply to remove the cause, and the disease, as a result, disappears.
- Then the patient is examined and the connection of the doctor’s observations with the patient’s complaints is observed. This stage is central to the differential diagnosis of peptic ulcer disease. Especially the second stage is important for emergency workers, when there are no necessary laboratory tools for research at hand. Doctors have to correctly diagnose and provide medical care based on the results of this stage of diagnosis.
- The third and final stage of the differential diagnosis of peptic ulcer disease consists in the fact that all laboratory and instrumental methods are being studied, the conclusions of several doctors are examined and the correct diagnosis is made to the patient based on the conclusions. Correct diagnosis is the key to a speedy recovery.
To date, there is a computer method of differential diagnosis. It allows you to fully or partially conduct a study that facilitates the work of doctors.
So, the treatment of the disease occurs only after careful research and diagnosis. An ulcer is not treated on its own. The doctor prescribes medication, prescribes an individual diet (suitable for a certain acidity of the gastric juice), and sometimes advises traditional treatment methods. Often, doctors prescribe additional differential diagnostics for the presence of tumors, primary ulcers. An ESR analysis helps determine if stomach cancer has not begun to develop. Finally, such a diagnosis can be made only after histological examination.
Causes of ulcers
Most often, peptic ulcer disease develops for such reasons:
- The stomach is infected with a bacterium. After it enters the organ cavity, this bacterium disrupts its acidic environment, which causes the death of mucous cells and the formation of an ulcer.
Moreover, Helicobacter can cause other gastrointestinal diseases (for example, gastritis).
- Frequent use of alcohol-containing beverages.
- Smoking for several years.
- Drinking coffee with a high content of caffeine (especially harmful to the stomach to drink coffee on an empty stomach, when the body is most susceptible to damage).
- Improper nutrition. This item includes the use of junk food (spicy, fatty), eating dry food, as well as ingestion of excessively hot food, which injures the gastric mucosa.
- Frequent nerves and stress can also give a strong impetus to the development of a stomach ulcer.
- Uncontrolled long-term treatment with some medications. The most dangerous for the stomach are: corticosteroids, analgesics (painkillers) and anti-inflammatory drugs.
Important! When treating drugs without a doctor's prescription, a person risks not only hurting his stomach, but also getting malfunctioning of the liver, heart, kidneys and the central nervous system. Moreover, the situation will only worsen if the patient chooses the wrong dosage of the drug. This runs the risk of undesirable complications and deterioration in health.
Symptoms of the disease
To make it easier to identify the ulcer, you should pay attention to such characteristic symptoms and signs:
- Acute pain in the left side of the chest, which can give to the lumbar region, shoulder blades and lower abdomen. The nature of pain: piercing, sharp, aching.
Usually this symptom appears in the morning when the person has not eaten yet. After eating, the pain subsides a bit, because food suppresses excessive acid in the stomach.
- During periods of acute ulceration, a person may experience severe heartburn and sour belching.
- In more advanced cases, there is vomiting with blood, frequent nausea and sudden weight loss.
- A decrease in appetite is associated with indigestion, as well as the fear of a person to experience pain again after eating.
- The appearance of increased gas.
- Frequent feeling of heaviness in the abdomen.
- A quick feeling of fullness, even after eating a small portion of food.
- Breaking stool
Important! Statistics show that more than 50% of all patients with an ulcer face the problem of constipation and diarrhea. At the same time, it is necessary to be extremely attentive in the diagnosis, because these symptoms may indicate the development of a wide variety of pathologies.
It should also be said that in about 20% of cases, patients with an ulcer do not feel the above symptoms. Their disease is monotonous and for a long time may not even be felt. The only way to diagnose it will be to conduct special studies. The development of ulcers is more likely in people who have ever suffered from gastritis.
Since the symptoms of stomach problems are often similar to other diseases, it is imperative that a diagnosis be made in order to make an accurate diagnosis.
Diagnosis for the detection of gastric ulcers provides for such mandatory studies and procedures:
- Initial examination by a doctor, palpation of the abdominal cavity and history taking.
- Blood and urine tests.
- The analysis of feces for the presence of hidden blood.
- Study on the level of acidity of the stomach. It is usually done with intragastric pH-metry.
- Radiography is done to identify more obvious signs of an ulcer - scars and indentations in the gastric mucosa.
- Endoscopic examination is aimed at identifying the severity of the disease, localization of the ulcer, its shape and assessment of the general state of the stomach.
- A biopsy involves taking a small tissue of the stomach for further research under a microscope. This method will reveal a severe degree of ulcers, which is accompanied by oncological education.
Important! An ulcer, if left untreated, can cause a malignant tumor of the stomach.
- Manometry will help identify the motility of the upper zones of the gastrointestinal tract.
- Diagnosis on the identification of bacteria Helicobacter. This study provides for the conduct of respiratory tests, the detection of bacterial DNA in the saliva and blood of the patient.
After all diagnostic measures have been taken, treatment is prescribed. It is selected for each patient individually, and depending on the cause of ulcers, symptoms and neglect of the disease. Also, therapy will largely depend on the age of the patient and the presence of chronic diseases. A mandatory part of the complex therapy of gastric ulcers is diet. Read more here.
Classical therapy for the detection of ulcers provides this:
- Patient compliance with clinical nutrition. The diet provides for a complete rejection of alcohol, smoking, salt, fatty, spicy, sour and hot. The basis of the diet should be boiled vegetables and meat, cereals and soups.
- To suppress the activity of bacteria, antibiotics are prescribed (Metronidazole).
- Antacid drugs are needed to envelop the stomach (Almagel).
- Preparations to suppress the secretion of the stomach (Ranitidine).
- Analgesics for pain.
- Acid lowering drugs in the stomach.
It should be remembered that the ulcer does not develop in one day. Her education is necessarily accompanied by more subtle symptoms: heaviness in the stomach, belching, nausea. The sooner you start taking preventive measures, the more likely it is to stop the further development of the disease.
To reduce the risk of stomach ulcers, you need to follow these doctor's advice:
- Eat right.
- Do not smoke or drink alcohol.
- Avoid stress and nerves.
- Observe oral hygiene.
- Do not take any medicine without a prescription.
When the first signs of the disease appear, immediately contact a gastroenterologist and carry out a diagnosis.
Work experience over 7 years.
Professional skills: diagnosis and treatment of diseases of the gastrointestinal tract and biliary system.
Causes of development
If earlier, malnutrition and alcohol abuse were considered the causes of gastric ulcer, then modern studies have shown that the main cause of the disease in question is the bacterium Helicobacter pylori. It is a helical microorganism that perfectly survives in the aggressive environment of the stomach, neutralizes the acid in the gastric juice. But with the life and development of bacteria, small fragments begin to separate from the mucous membrane - this is what leads to the formation of an ulcer. Moreover, it is very easy to get Helicobacter pylori - the bacterium of this species is transmitted through kisses, dirty hands, when using common utensils, through dirty medical instruments, from mother to fetus.
There are a number of factors that are not definitely the causes of the disease under consideration, but in 84% of cases it is provoked. These include:
- Long-term medication - most often the formation of gastric ulcers contributes to aspirin, diclofenac and other nonsteroidal anti-inflammatory drugs. There is a greater risk in patients over 65 years of age, or at the same time taking these drugs and coagulants, glucocorticoids.
- The presence of major diseases in the body - tuberculosis, syphilis, diabetes mellitus, lung cancer, cirrhosis of the liver, pancreatitis and others.
- Any abdominal trauma - blows / bruises, internal and external burns, frostbite.
Some doctors believe that a hereditary factor plays a large role in the occurrence of a peptic ulcer. In fact, only 40% of parents with a diagnosed stomach ulcer have the same disease in the future.
Separately, it is worth listing the factors that, under certain circumstances, increase the likelihood of the disease being considered to a possible maximum:
- smoking - it's not just about cigarettes / cigarettes, but also about cigars and hookahs,
- alcohol abuse
- too much carbonated drinks and coffee
- regular use is very hot, or vice versa ice, food and drinks,
- frequent depression, neurosis,
- regular use of nonsteroidal anti-inflammatory drugs for medical reasons,
- violation of the diet.
Possible causes of stomach ulcers are described in the video review:
Symptoms of stomach ulcers
Peptic ulcer has quite bright symptoms - it allows you to consult a doctor in a timely manner for diagnosis and treatment. Signs of a stomach ulcer include:
- Pain syndrome. Most often it occurs in the upper abdomen - fixed in 75% of patients. Moreover, in half of the cases the pain has a weak intensity, and the second half of the patients complains of thrills. Pain syndrome increases significantly after drinking alcoholic beverages, acute / smoked products, physical exertion.
- Heartburn. It is observed in 80% of patients, characterized by a strong burning sensation in the epigastrium. Heartburn is the entry of acidic contents of the stomach into the lumen of the esophagus. Feeling very unpleasant, occurs approximately 2 hours after eating food.
- Reduced appetite. This symptom is psychological. The fact is that pain and heartburn occur in patients with a stomach ulcer always after eating - this fear makes you refuse to eat.
- Nausea. Sometimes a symptom is accompanied by vomiting, this contributes to the violation of gastric motility. If there is a stomach ulcer, then vomiting may occur 2 hours after a meal, accompanied by pain. It is noteworthy that as the stomach becomes free from its contents, it becomes easier for the patient.
- Feeling of heaviness. It occurs in the stomach immediately after eating and does not depend on how much food was eaten.
- Increased gas production.
- Belching. There is a splash of gastric contents into the oral cavity, after which there is a bitter or sour taste.
In addition, patients complain of bowel dysfunction - most often it is manifested by constipation. There are several atypical symptoms - plaque on the tongue (it indicates pathologies in the gastrointestinal tract in general), increased sweating of the palms, pain when pressing on the stomach.
The most pronounced pain syndrome - often it is he who is the basis for making a preliminary diagnosis of a gastric ulcer. The pain can be completely different, by its nature, it is possible to determine in which part of the stomach the defective mass is located.
Characteristics of ulcer pain:
- If the ulcer is located in the cardinal or subcardinal part of the stomach, then the pain syndrome appears 20 minutes after eating the food, its localization is very high - almost in the area of the solar plexus. Very often, pain radiates to the heart, so a heart attack can be mistakenly diagnosed (this happens during self-diagnosis). With such an arrangement of defective formation, there is never pain after physical exertion, and after consuming even a small amount of milk, the patient's condition stabilizes.
- With the localization of peptic ulcer in the lesser curvature of the stomach, the pain will be particularly intense in the left iliac region. The syndrome occurs 1 hour after a meal, the condition stabilizes after the stomach has digested the contents. Most often, complaints from patients for pain come in the evening, sometimes they are accompanied by vomiting.
- An ulcer located in the upper curvature of the stomach has a very latent course and can be quickly diagnosed very rarely, and it is the ulcers of the upper curvature of the stomach that are malignant in nature.
- The defeat of the antral ulcer of the hollow organ is characterized by pain in the evening and at night, may be completely unrelated to food intake. The pain is constant, aching, accompanied by belching and heartburn.
- If the ulcer is located in the pyloric region of the stomach, the pain will be acute, paroxysmal, prolonged (in some cases, one attack lasts more than 40 minutes).
In very rare cases, gastric ulcer is characterized by an atypical pain syndrome - for example, arising in the lower back or right side of the abdomen. Doctors can not quickly diagnose the disease in question with such symptoms, which leads to various complications.
Possible complications of gastric ulcers
A gastric ulcer is a dangerous disease that can lead to serious consequences, resulting in death. The most commonly detected complications of the disease in question are:
- Penetration. This is a condition that is characterized by destruction of the stomach wall, and the ulceration is relocated to the surface of an organ located behind the collapsed wall of the stomach. Most often, doctors determine the ulcerative lesion of the pancreas, the acid from the gastric juice begins to literally eat the cells of the affected organ - acute destructive pancreatitis develops. The fact that the patient develops penetration is confirmed by severe pain in the anatomical location of the affected organ, a significant deterioration, dizziness, nausea and vomiting. It is possible to determine the considered complication of gastric ulcer by X-ray or femd.
- Perforation of the stomach. There is a destruction of the stomach wall, and the contents of the body falls into the abdominal cavity. This complication most often occurs against the background of drinking large amounts of alcohol, strong physical exertion. Complaints of the patient on acute abdominal pain, signs of intoxication of the body and confusion will indicate the perforation of the stomach. If this complication occurs suddenly, the patient's condition deteriorates dramatically, after a maximum of 10 hours the patient falls into a state of shock. In this case, it is strictly prohibited to do FEGDs as part of a diagnostic examination, only a X-ray of the stomach is shown.
Peptic ulcer is a very complex and dangerous disease that is only chronic and difficult to treat. And yet, with a diet, courses of therapy can achieve long-term remission. The symptoms, causes and methods of diagnosis of gastric ulcer are described in detail in the video review:
Yana Alexandrovna Tsygankova, medical reviewer, general practitioner of the highest qualification category.
25,273 total views, 3 views today
Detection of Helicobacter pylori infection (Helicobacter pylori)
In the etiology of chronic gastritis and peptic ulcer disease, Helicobacter pylori is important. These S-shaped helical bacteria have the ability to penetrate under the protective layer of mucus and damage the surface epithelial cells of the antrum and duodenal bulb, causing inflammation in the mucosa. The epithelium of the antrum of the stomach is infected by bacteria in the duodenal bulb. It protects these bacteria from hydrochloric acid mucus layer under which they are located. The high sensitivity of bacteria to many antibiotics, metronidazole, preparations of colloidal bismuth, in particular de-nol, and omeprazole was determined.
To identify Helicobacter pylori infection, invasive and non-invasive tests are performed. Invasive tests include a study of biopsy specimens of the gastric mucosa obtained during fibroesophagogastroduodenoscopy. Use morphological (histological study of sections of biopsy specimens of the gastric mucosa, stained by Romanovsky-Giemsa and Worthin-Stari) and cytological (study of smears - imprints of biopsy materials stained by Romanovsky-Giemsa and Gram) and respiratory test for the presence of urease in the stomach with a solution of urea labeled with radioactive isotopes of 13 C or 14 C.
Research methods for detecting Helicobacter pylori:
- Histological examination. In histological preparations, Helicobacter pylori is clearly visible when stained by Giemsa and Worthin-Starry silvering and stained slightly with hematoxylin.
- Bacteriological research. For seeding using the material obtained by biopsy under conditions of maximum sterility. Incubation of crops is carried out in microaerophilic conditions, with an oxygen content of not more than 5% using special gas recovery packages.
- Urease test with biopsy of the mucous membrane. Consists of a gel carrier containing 20 g / l of urea, a bacteriological agent and phenolote as a pH indicator. The indicator changes color from yellow to crimson when, under the influence of Helicobacter pylori urease, hydrolysis of urea occurs with the formation of ammonia, which shifts the pH of the medium in the alkaline direction.
- Respiratory test. Use of the test is based on the ability of Helicobacter pylori to produce urease. Before testing, the patient takes an oral solution containing labeled 13 C or 14 C urea. In exhaled air samples, the isotope in carbon dioxide is quickly determined after the breakdown of urea in the presence of urease. The method is the only non-invasive method of research.
- Serological studies. In people infected with Helicobacter pylori, specific IgG and IgA antibodies are detected in serum by enzyme immunoassay. A Kif test is also used to determine the Helicobacter pylori antigen in the feces of the polymerase chain reaction.
Differential diagnosis of peptic ulcer
As practice shows, a significant part of patients with gastric ulcer in the past suffered from gastritis or suffered inflammation of the duodenal mucosa. The main phase in gathering information is to ascertain the evolution of the symptoms of the disease since its first signs. Detailed diagnosis of gastric ulcers makes it possible to recognize the defect at an early stage of development and to make a clinical picture of the reasons that caused the pathological disorders of the organ. Based on the history data, a chart is made of further methods of examination in order to make a clear differential diagnosis of peptic ulcer, excluding gastrointestinal diseases with identical symptoms.
In the next phase of diagnosis, the doctor conducts a contact inspection. It compares weight with respect to the body constitution, since in case of a peptic ulcer a person may deliberately refuse to eat because of the discomfort that occurs after eating. Performs a finger scan of the abdomen for pain or induration in the epigastric region. Differential diagnosis of gastric ulcer provides an opportunity to take into account the differences between such processes as chronic cholecystitis and pancreatitis. These diseases have a similar clinical picture: pain in the hypochondrium, flatulence, constipation, or loose stools after eating fatty foods.
The main distinguishing feature of the disease are erosive foci by which peptic ulcer is recognized. The diagnosis is also necessary to distinguish from secondary erosive lesions of Zollinger-Ellison syndrome or as a result of the use of anti-inflammatory drugs. And before you give a final conclusion - a stomach ulcer, it is important to exclude the symptoms of primary ulcerated cancer of the digestive organ. The method of examination is a histological study of erosive material.
Methods for the diagnosis of gastric ulcer
Many patients are concerned about the question of how to diagnose a stomach ulcer for an accurate and objective conclusion about the nature of the disease? Experts trust only paraclinical methods of examination. To the collected history, including patient complaints, heredity, nature of pain, cyclical exacerbations and touch the state of the tissues and organs of the abdominal wall, attach the results of instrumental diagnostic methods.
Currently used the following instrumental and laboratory tests for gastric ulcer:
- A blood test for the presence of the bacterium Helicobacter pylori. By the way, high rates of red blood cells and hemoglobin are also often observed in peptic ulcer disease.
- Intragastric pH-metry is a measure of the acidity of the gastric environment (first on an empty stomach, and then after a test breakfast).
- X-ray of the stomach. X-ray examination is highly effective and allows you to detect the exact localization of erosive foci, as well as to identify or eliminate serious complications, such as perforation of the walls of the digestive organ and stenosis.
- Endoscopy. With the help of the study, the doctor assesses the condition of the mucous membrane and the lumen of the esophagus.
- Microscopic analysis of the material of the mucous membrane of the stomach, obtained by taking an intravital tissue sample.
Based on the findings of the etiology and pathogenesis of the disease, the formulation of the diagnosis of a gastric ulcer is based. Diagnosis and treatment are interrelated concepts, and the further assignment of therapeutic actions and the prognosis for curing the defect depend on a correctly established pathogenesis.