Gastric ulcer is one of the most common diseases of the digestive tract. This chronic pathology significantly affects daily life, needs medical intervention and lifelong therapeutic control.
Description of the disease
Gastric ulcer is a chronic recurrent disease characterized by the appearance of a defect in the mucous membrane that penetrates the muscular layers of the organ. It is the involvement of the muscle plate that distinguishes the ulcer from erosion. The pathological focus can be localized both in the stomach and in the duodenum.
The ulcer has the appearance of a local inflammation, which practically has no protective layer against corrosive hydrochloric acid and other aggressive substances. Therefore, without timely therapy, the condition of the gastric wall is rapidly deteriorating, and the risk of life-threatening complications increases significantly. The phases of exacerbation and remission are characteristic of GU. It is classified as a seasonal disease, as it often worsens in the spring and autumn periods.
The main age group of patients is from 20 to 65 years. In men aged 25-40 years, the disease occurs 4-5 times more often than in women. This is due to the fact that male sex hormones increase the acidity of the stomach, and female — reduce it.
Causes and pathogenesis of GU
The pathogenesis of GU is based on the destructive effect of gastric juice on the mucous membrane of the organ. In 70% of people with GU, the presence of Helicobacter pylori is detected. The bacterium damages the cells of the mucous membrane and inhibits local immunity, which provokes the development of a defect in the form of an ulcer. The influence of other bacteria has not yet been proven, so it is H. pylori that is considered the main etiological factor.
The precursor of stomach ulcers is gastritis and other gastrointestinal pathologies, accompanied by an increase in stomach acidity. But these are far from the only reasons for the appearance of GU. Often its occurrence is the result of a complex impact of adverse factors. Among the ulcer – provoking factors , a special role is played by:
- frequent stress;
- improper and irrational nutrition;
- smoking, alcohol and coffee abuse;
- excessive consumption of sour and spicy food;
- injuries in the gastrointestinal tract;
- burdened heredity;
- long-term use of NSAIDs and glucocorticosteroids, citromone.
Classification and stages of gastric ulcer development
The main classification of GU is based on the presence or absence of Helicobacter pylori. She divides the disease into two types:
- associated with H. pylori;
- not associated with pylori (another name is idiopathic).
Based on the independence of the course of the pathological process , the disease of GU is divided into:
- symptomatic — develops with chronic diseases of internal organs, due to stress or taking certain medications.
According to the localization of the pathological process , the disease is classified as follows:
- stomach ulcer;
- ulcer of the 12th duodenum;
- combined ulcer — in both organs.
Stages of GU:
- Exacerbation is a bright clinic, deterioration of well—being.
- Scarring — an endoscopic examination reveals a “red” and “white” scar.
- Remission — symptoms subside, well-being improves.
Symptoms of the disease
Gastric ulcer has a vivid clinical manifestation. During an exacerbation, a classic triad of symptoms appears:
- Pain syndrome. The pain is localized in the middle part of the abdomen, sometimes radiates into the hypochondrium. Most often it is sharp and burning, but sometimes it can be cutting or stabbing. A distinctive feature of ulcerative pain is its appearance 30-60 minutes after eating and disappearance after 2 hours. Pain in the night hours, in the morning.
- Dyspepsia. Characteristic: heartburn, nausea and vomiting of eaten food. After vomiting, there is an improvement in well-being.
- Weight loss. Weight loss occurs less sharply than with cancer, and has a different mechanism of development. With GU, patients simply refuse to eat, because they are afraid of getting a sharp attack of pain after eating it.
Bright signs of GU often occur in the autumn-spring periods. In addition to the symptoms described above , patients note:
- heaviness in the epigastrium;
- unpleasant odor from the oral cavity;
- plaque on the tongue;
- belching with air, sour taste;
- bloating, flatulence.
With the development of ulcerative bleeding, vomiting of “coffee grounds” and black stools occur. When an ulcer is perforated, a person experiences dagger pain in the epigastrium, nausea and painful tension of the abdominal muscles. Both of these conditions are life-threatening and require emergency medical intervention. There are no symptoms during remission.
Diagnosis of stomach ulcers
Diagnosis of GU begins with an examination and a conversation with the patient. At the first visit to the doctor, a visual examination, palpation of the abdomen and collection of anamnesis are carried out: complaints and features of the course of the disease. Often these data become enough to suspect peptic ulcer disease. But it is possible to finally confirm the diagnosis only with the help of additional examination methods:
- fibrogastroduodenoscopy — the condition of the gastric wall is visually assessed, a biopsy is performed for further microscopic examination of the biomaterial;
- blood test for antibodies to Helicobacter pylori; IgG;
- C13-urease breathing test — for the detection of H. Pylori;
- pH-metric of the stomach;
- contrast radiography with barium — to determine the location and depth of the lesion, used when it is impossible to perform FGDS;
- general and biochemical blood analysis — to assess the work of internal organs, to detect signs of inflammation.
The main purpose of the diagnosis is to detect the H. pylori bacterium and assess the condition of the gastric wall to select the optimal therapy tactics.
Treatment of GU
A stomach ulcer should be treated by a therapist or gastroenterologist. Only a doctor can explain what GU is, how it is treated, what can and cannot be done with this disease. The main objectives of the treatment of GU are:
- Removal of the infectious agent — Helicobacter pylori from the mucous membrane.
- Regulation of gastric juice acidity.
- Normalization of the diet.
With an early visit to the doctor, it is possible to cope with the ulcer by conservative methods. Properly selected therapeutic tactics allow for long-term and stable remission. It is important to note that it is almost impossible to completely cure GU — it turns into a chronic form and periodically recurs.
Conservative therapy includes:
Medical treatment. The following medications are prescribed:
- prokinetics — enhance the motility of the stomach and accelerate the evacuation of food;
- antisecretory agents — reduce the production of hydrochloric acid;
- antacids — neutralize hydrochloric acid, adsorb pepsin;
- antispasmodics — eliminate pain;
- bismuth preparations.
When Helicobacter pylori is detected, the patient is prescribed treatment with the addition of antibacterial drugs. The scheme is drawn up individually, taking into account the current state of the person and the course of pathology. It includes a combination of the following medications:
- proton pump inhibitors;
- bismuth preparations.
- Diet. This is an important component of the treatment, prevention of relapses and complications of GU. It involves a fractional diet of 5-6 meals a day. Heavy, spicy and fatty foods should be excluded from the diet. It is recommended to eat porridge on water, dietary poultry meat and lean fish. It is better to steam the dishes, and chop or grind the food.
- Giving up bad habits. Quitting smoking, alcohol and coffee helps to improve the condition of the mucous membrane.
- In the absence of contraindications — discontinuation of NSAIDs and glucocorticosteroids.
Surgical intervention is rarely performed in the case of GU. As a rule, surgical treatment is the result of ineffectiveness of conservative therapy or the development of complications. Depending on the clinical case, different types of operations are performed:
- suturing the wound;
- elimination of the source of bleeding;
- expansion of the digestive tube;
- removal of a part of the damaged organ.
Complications of stomach ulcers
With late or incorrect treatment , the following complications develop:
- bleeding — with an increase in the size and depth of the ulcer, the rupture of blood vessels occurs;
- ulcer perforation — the appearance of a through hole in the gastric wall;
- ulcer penetration — the appearance of a hole in the gastric wall with access to a neighboring organ;
- pyloric stenosis — narrowing of the junction of the stomach into the duodenum;
- malignancy is the degeneration of healthy cells into cancerous ones.
Prognosis and prevention of gastric ulcer
Prevention of GU includes the following measures:
- quitting smoking and alcohol;
- taking medications strictly for medical purposes;
- proper nutrition: eat fractional and varied, in small portions;
- limiting the consumption of spicy and fatty foods;
- oral hygiene, timely treatment of dental diseases;
- minimizing stressful situations;
- contacting a doctor when the first pathological symptoms are detected;
- preventive gastroenterological examinations — at least once a year.
With early detection and proper treatment, gastric ulcer has a favorable prognosis. Conservative therapy and diet help to minimize the number of exacerbations and prevent the development of complications.