A stomach ulcer is a chronic disease in which defects appear in the wall of the stomach, that is, the ulcers themselves. In the process of the disease, other organs of the digestive system can be affected: often ulcers from not only in the stomach itself but also in the duodenum. Some studies suggest that duodenal ulcers are four times more common than gastric ulcers. The spread of a stomach ulcer can lead to life-threatening complications. As a rule, with an ulcer, periods of exacerbation alternate with periods of remission.
Gastric and duodenal ulcers are in many ways similar in terms of causes and signs. Therefore, in globally, specialists often combine these diseases and talk about gastric and duodenal ulcers.
According to statistics, approximately 13% of men and 10% of women can develop a stomach ulcer.
In recent years in the world, patients with uncomplicated ulcers are hospitalized less and less. At the same time, experts around the world note that complications in this disease occur more and more often. As a rule, these are bleeding and perforation. Experts cite an increase in the use of non-steroidal anti-inflammatory drugs as one of the reasons.
At the same time, complications are increasingly being cured due to the effectiveness of modern anti-ulcer therapy regimens, the increased availability of endoscopic diagnostics, and the active use of screening tests to detect harmful infections.
Types of ulcer
There is no recognized classification of gastric ulcers. However, there are different reasons for differentiating the types of diseases.
1. Along its course
2. Depending on the presence or absence of H. pylori infection
- Associated with infection
- Not associated with infection (idiopathic)
3. By independence
- As an independent disease (essential peptic ulcer)
- Symptomatic ulcers of the stomach and duodenum (drug, “stress”, with endocrine pathology, with other chronic diseases of the internal organs), which occur against the background of other diseases
4. Depending on the localization
- Gastric ulcers (cardiac and subcortical regions, body of the stomach, antrum, pyloric canal)
- Duodenal ulcers (bulbs, postbulbar region)
- Combined ulcers of the stomach and duodenum.
In this case, ulcers can be located on the lesser or greater curvature, the anterior and posterior walls of the stomach and duodenum.
5. According to the number of ulcers
- Solitary ulcers
- Multiple ulcers
6. According to the size of the ulcer
- Small ulcers (up to 0.5 cm in diameter)
- Medium-sized ulcers (0.6-1.9 cm in diameter)
- Large ulcers (2.0 – 3.0 cm in diameter)
- Giant ulcers (over 3.0 cm in diameter)
Causes of stomach ulcer
As a rule, disorders lead to this disease, which leads to an imbalance between the aggressive factors of the gastric environment and the protective mechanisms of the mucous membrane of the stomach and duodenum. Aggressive factors include several substances: for example, hydrochloric acid produced by the stomach, bile acids formed in the liver and entering the duodenum, and the contents of the duodenum entering the stomach. These substances are usually neutralized by the mucus of the mucosal cells. In addition, experts include normal blood circulation and timely restoration of mucosal cells as protective factors.
There is another reason for the development of stomach ulcers: infection with the bacterium Helicobacter pylori. Microorganisms were discovered in 1983 by Australian scientists. Some experts assign H. pylori a decisive role in the development of stomach ulcers. Bacteria act on the mucous membrane of the stomach and duodenum simultaneously from different sides. First of all, microorganisms produce several enzymes that injure the protective barrier of the mucous membrane. In addition, they produce cytotoxins.
When microorganisms begin to spread in the gastric mucosa, superficial antral gastritis and duodenitis may develop. Because of this process, the level of gastrin rises, then the secretion of hydrochloric acid increases.
Further, an excess of hydrochloric acid enters the duodenum, creating a favorable climate for the development of infection. In the future, all this leads to the appearance of an ulcer.
According to statistics, about 80% of duodenal ulcers and 60% of gastric ulcers occur due to H. pylori infection.
In addition, there are several factors contributing to the development of the disease and its exacerbation :
- Prolonged or often recurring neuro-emotional overstrain, stress;
- Increased acidity of gastric juice;
- The presence of chronic gastritis, gastroduodenitis;
- Violation of the diet;
- The presence of bad habits (smoking, drinking strong alcoholic beverages);
- The use of certain medications (acetylsalicylic acid, butadione, indomethacin, etc.);
- Genetic predisposition.
Relatively rarely, adenocarcinoma, carcinoid, invasion of neighboring organ tumors, sarcoma, leiomyoma, diabetes mellitus, foreign bodies in the stomach, Crohn’s disease, lymphoma, syphilis, tuberculosis, and HIV infection can lead to a stomach ulcer.
The first signs of a stomach ulcer
As we have said, an ulcer is a chronic disease. Therefore, the symptoms of the disease are most pronounced during exacerbations. In uncomplicated cases, exacerbations can last from 3-4 to 6-8 weeks and remissions – from several weeks to many years.
The main symptom during an exacerbation of a peptic ulcer is pain in the epigastric region (between the costal arches below the chest). Unpleasant sensations can also affect the left half of the chest, the left shoulder blade, as well as the thoracic or lumbar spine.
Symptoms of a stomach ulcer
Depending on the disease, the following pains may occur :
- Immediately after a meal (with ulcers of the cardiac and subcardinal sections of the stomach);
- Half an hour to an hour after eating (with ulcers of the body of the stomach);
- Late pain (2-3 hours after eating), “hungry” pain that occurs on an empty stomach and disappears after eating, as well as night pain (with ulcers of the pyloric canal and duodenal bulb).
As a rule, the discomfort disappears after taking antisecretory and antacid drugs.
With an exacerbation of peptic ulcer, sour belching, nausea, and constipation are also common. In addition, vomiting of acidic stomach contents has always been considered a symptom of the disease. Often it brings relief and therefore is often caused artificially by patients. But now it is relatively rare.
With an exacerbation, there is often a sharp weight loss. After all, despite the usual, and sometimes increased appetite, patients eat less food to avoid pain.
It often happens that pain intensifies seasonally – in spring and autumn. Under the influence of adverse factors (for examples, such as physical overexertion, taking drugs that reduce blood clotting, or alcohol abuse), complications may occur. These include bleeding, perforation and penetration of the ulcer, the formation of cicatricial-ulcerative pyloric stenosis, and malignancy of the ulcer.
Clinical symptoms during exacerbation of peptic ulcer can also occur in other diseases: for example, chronic gastritis and duodenitis with functional dyspepsia syndrome. Therefore, the diagnosis must necessarily be confirmed by other methods of research.
Diagnosis of the disease
Diagnosis of peptic ulcer begins with a consultation with a doctor. He studies complaints and conducts palpation.
If the examination reveals soreness and resistance of the muscles of the abdominal wall, the specialist may prescribe additional studies.
- Gastroduodenoscopy (endoscopic examination)
The most reliable method for detecting ulcers. Allows you to determine the nature of the disease, and take a biopsy.
- X-ray examination
This method mainly reveals a direct sign of a stomach ulcer. It is used in cases where for some reason (for example, with contraindications) it is not possible to conduct an endoscopic examination.
- Intragastric pH-metry
This diagnostic method allows you to determine the indicators of gastric secretion, depending on the localization of the ulcer.
- Blood analysis
In addition, for all patients suffering from stomach ulcers, it is desirable to do a blood test and determine the level of hemoglobin. This will eliminate anemia as a consequence of latent ulcer bleeding.
- Testing for H. pylori infection
Recommended for all ulcer patients. It is necessary to determine the indications for eradication therapy. Testing can be done with a 13C-breath urease test or H. pylori antigen detection in feces, and with simultaneous endoscopy, with a rapid urease test.
- Computed tomography of the abdominal organs
This examination is desirable for patients with suspected perforation. This method allows you to determine the presence of free gas in the abdominal cavity, the volume and nature of the effusion, localize pathological changes and determine the location of the perforation.
This examination is prescribed only in case of suspected complications of peptic ulcer.
- Ultrasound and plain radiography of the abdominal organs
Recommended for patients when CT is not possible. The procedure allows for diagnosing complications, and the possibility of perforation or penetration of the ulcer. This examination is prescribed in exceptional cases: the cause may be serious suspicion of complications of peptic ulcer.
Treatment of stomach ulcer
Treatment of peptic ulcer should be comprehensive. It is necessary not only to use medications in time but also to follow a diet, stop smoking and alcohol abuse, stop taking drugs with an ulcerogenic effect and normalize the regimen.
For patients with uncomplicated ulcers, conservative treatment is more often used, with the help of drugs. Most of it is done on an outpatient basis.
As a rule, with an ulcer, drugs are prescribed that reduce the acidity of gastric juice. The most common are proton pump inhibitors. If the ulcer is caused by H. pylori bacteria, doctors prescribe antibiotics.
Treatment for bleeding ulcers usually begins in the intensive care unit, as does treatment for the disease in combination with other complications of peptic ulcer disease. The main task of treatment in the intensive care unit is to stabilize the patient’s condition – replenishing the volume of circulating blood, combating the manifestations of hypovolemic shock, adequate pain relief, treatment of decompensated comorbidities and systemic inflammatory response syndrome, after which surgical and/or endoscopic methods of treatment can be applied.
Patients with ulcerative bleeding are advised to undergo gastroduodenoscopy as soon as possible.
Patients suffering from a complicated course of peptic ulcer, as a rule, need to be hospitalized in a hospital on an emergency basis. If complicated forms of gastric and duodenal ulcers are detected, it is recommended to be hospitalized for surgical treatment in a surgical hospital.
Surgical treatment of ulcerative bleeding is indicated when it is not possible to control it endoscopically – with ongoing bleeding or relapse. Untimely surgical treatment aggravates the prognosis for the patient and increases mortality.
Patients with peptic ulcers after surgical treatment are recommended to perform testing for H. pylori infection, as well as eradication and maintenance therapy to prevent the recurrence of PU and its complications.
The completed stage of surgical treatment does not reduce the risk of developing a new round of surgical complications of peptic ulcer, primarily bleeding, therefore it is important to continue the course of conservative treatment of the disease until the patient is completely cured.
Treatment of stomach ulcers and duodenal ulcers should be carried out only under medical supervision! It is strictly forbidden to treat a stomach ulcer with folk remedies. Theoretically, it is possible to use some folk recipes as an addition to drug treatment. But this is possible only with the permission of a doctor. As a rule, there is no such practice among specialists.
Diet for stomach ulcers
Diet therapy is recommended for all patients with peptic ulcer disease. The basic principles of dietary nutrition for patients with ulcers have remained relevant for many years.
The recommendations of frequent (5-6 times a day), fractional nutrition, and reduction of mechanical, thermal, and chemical processing of food remain valid.
From the diet, it is necessary to exclude products that irritate the gastric mucosa and stimulate the secretion of hydrochloric acid: strong meat and fish broths, fried and peppered foods, smoked meats and canned food, seasonings and spices (onion, garlic, pepper, mustard), pickles and marinades, carbonated fruit waters, beer, dry white wine, champagne, coffee, citrus fruits.
Preference should be given to products that can bind and neutralize hydrochloric acid: meat, fish, eggs, milk, and dairy products. Pasta, stale white bread, dry biscuits, dairy, and vegetarian soups are also allowed. Vegetables (potatoes, carrots, zucchini, cauliflower) can be cooked stewed or mashed and steamed soufflés.
In the diet, you can include cereals, kissels from sweet varieties of berries, mousses, jelly, raw grated and baked apples, cocoa with milk, and weak tea.
Prevention of stomach ulcers involves the following actions:
- Diet, including restrictions on the use of coffee and other harmful drinks;
- Compliance with hygiene rules;
- Timely dental treatment to ensure thorough grinding of food;
- Reduction of mental and psychological stress, avoidance of stress;
- Rejection of bad habits;
- Timely diagnosis and treatment of gastrointestinal diseases;
- Periodic medical examinations.
The complex of primary prevention, which will strengthen the immune system, also includes:
- Healthy eating;
- Favorable living conditions and regular wet cleaning indoors;
- Physical activity;
- Normalization of sleep and daily routine.
If a patient has an H. pylori infection, eradication therapy is recommended to avoid peptic ulcer disease.
In addition, people with peptic ulcer disease are advised to undergo annual dispensary observation for 5 years from the last exacerbation.
In a word, diseases of the stomach can bring much more problems than it seems. Therefore, you should not ignore the first signs, but it is better to take preventive measures and take care of the health of the stomach in advance.