Duodenal ulcer often begins
gradually with sucking pains under the spoon, aggravated feelings of hunger
in the morning, mild nausea.
But just as often these signals that the body gives are not
taken seriously. The man is simply not aware of the scale.
looming problem. After all, persistent pain, as well as
terrible complications of this disease develop much later.
If there is the slightest doubt about the presence of the disease, it is worth
Immediately complain to a general practitioner or
a gastroenterologist, so as not to get on the table to the surgeon later
or God forbid pathologist.
To help navigate the variety of manifestations of ulcerative
diseases of the duodenum, in this article are collected and
highlights the main issues associated with this disease.
What is an ulcer?
The wall of the duodenum, which in Latin is called
duodenum, consists of mucous, submucosal and muscular layers.
An ulcer is a defect in the wall, the bottom of which is located in the muscle layer,
that is, mucous and submucosa are destroyed.
In the duodenum ulcer is most often located in
initial section (bulb or bulb), since here the most
favorable conditions for casting acidic gastric contents and
a wonderful breeding ground for bacteria that provoke ulcers
disease. Sometimes not one duodenal ulcer is formed.
guts, but several at once. More often it is paired, located each
напротив друга, “целующиеся” ulcers.
A peptic ulcer is a repetitive formation of ulcers.
defects in the wall of the duodenum, flowing with periods
обострения (наличия ulcers) и ремиссии (отсутствия открытого дефекта
intestinal wall). Since the ulcer heals with scar formation, even
cicatricial defects remain in remission on the mucous membrane. If a
frequent exacerbations, and scars are formed a lot, they can
deform or narrow the lumen of the intestine.
KDP ulcer disease affects about ten percent of the population.
the planets. Mostly these are young and middle-aged people.
Why does she appear?
Единого взгляда на возникновение и развитие ulcers дуоденум нет.
Существует несколько равнозначных теорий возникновения ulcers.
- On the one hand, it was very popular a few years ago.
the assumption that peptic ulcer is the result of the colonization of the stomach and
кишки таким микробом, как Helicobacter pylori. Microbe strikes
mucus-secreting cells. With развитии быстро заселяет желудок и
duodenum, stimulating the release of gastrin and highlighting
cytokines (substances damaging cells). Later it turned out
that not all species of the microorganism living in humans
вызывают disease. Therefore, blame everything on the infection
- An earlier assumption was an imbalance between
mucosal defenses and aggressive factors in the form of gastric
acids and pepsin that enter the intestine when there is insufficient
functions of the locking muscles of the output section of the stomach. It was also believed
that the gut is scratched by coarse food. Today these assumptions
supplemented by the fact that a decrease in protective prostaglandins in the
mucous membrane of patients with peptic ulcer.
- Обнаружена связь между частотой возникновения ulcers и группой
blood. Carriers of the first group with
- Soviet physiology was of the opinion that the ulcer
develops in people with excessive irritation of the cerebral cortex
against the background of chronic stress or nervous experiences when
the vegetative nervous system stimulates the release of gastric juice
and inflammatory mediators (gastrin).
- Another interesting conclusion is connected with gastrin: long
sun exposure stimulates the release of this hormone and
respectively, provokes an aggravation of a peptic ulcer or
worsens its course.
- Withем таких медикаментов, как кортикостероиды, нестероидные
anti-inflammatory can provoke mucosal ulceration
- Alcohol and nicotine worsen the condition of the mucous membrane, change
the nature of the secretion of hydrochloric acid and pepsin by the stomach, affect
the level of gastrin and somatostatin, as well as reduce the protective properties
mucus. Alcohol directly damages mucous cells.
What are the symptoms of duodenal ulcers
Симптомы ulcers желудка и двенадцатиперстной кишки очень близки
between themselves. it: боль, изжога, тошнота, рвота, расстройства
With язве дуоденум называются поздними. They arise through
an hour and a half after eating. There are also hungry pains arising,
if food has not arrived for more than 4 hours. A variety of such pains –
nocturnal or early morning, like very sharp hunger and sucking in
right hypochondrium. The nature of the pain may be different for different
patients. There are stabbing, aching, cutting, sucking or
spastic pains of varying intensity and duration. With
this pain is located in the right half of the epigastric region
(bulbous ulcer). They can give to the right hypochondrium or in
back. With an ulcer located at the end of the bowel, the pains are more shifted to
midline of the upper trunk or into its left half. At the heart of the pain –
violation of the integrity of the intestinal wall, inflammation and accumulation
oxidized oxidation products.
accompanies about a third of duodenal ulcers. She is
due to the fact that the acidic contents of the stomach is thrown into
esophagus on the background of impaired locomotor activity of the stomach and intestines
and inflammatory mucosal changes.
- Nausea and vomiting
eaten food or gastric contents are characteristic of high
duodenal ulcers. With the development of secondary inflammation of the pancreas
gland or gallbladder on the background of peptic ulcer may
appear vomiting bile.
- Appetite disorders
may manifest as an increase (sucking in the stomach
smoothed by eating) or by disgust for food and its fear, so
as in the presence of an ulcer, food can provoke pain.
Complications of peptic ulcer
If the ulcer is not timely detected and treated, it can
healed and on their own. However, the risk of developing the whole is high
a number of complications that not only make the course of the disease worse, but
complicate treatment and worsen the prognosis for the patient. All complications
are divided into:
Destructive – destroying the gut:
- it’s bleeding
- perforation – perforation
- penetration – penetration into a neighboring organ
Dysmorphic complications that change its structure:
- malignancy – the development of a malignant tumor in place
- cicatricial deformity – changing the structure of the walls and narrowing
lumen of the intestine until its complete closure due to scarring from
Перфорируют чаще ulcers, расположенные на передней стенке guts.
Ulcers of the back wall often penetrate into the head of the pancreas
Bleeding from duodenum
Physical work, lifting, can trigger bleeding
weights. But most often the cause is alcohol intake, if not
medication is inadequate or inadequate. Therefore, up to 80%
This complication is accounted for by men. At the same time blood loss
may be of different volume.
When bleeding appears stool color of tar or vomiting with
colored like coffee grounds. Minor bleeding can
manifest only diarrhea or pasty dark stools. At that
same time with abundant blood loss, vomiting will be added quickly
increasing weakness, dizziness and even loss of consciousness.
Bleeding is an emergency that requires an emergency call.
help or self-treatment in the emergency room
Symptoms of perforated duodenal ulcers
Ulcers perforation is not only bleeding, but also getting into the duodenum, where pancreatic enzymes and bile are secreted. It is a harmful agent that peritoneal irritation and leading to inflammation of the abdominal cavity (peritonitis).
If the background of peptic ulcer acute dagger pain in
should call an ambulance immediately. Such pain
appears more often in the right half of the epigastrium, may
give to the right shoulder or shoulder blade. The pain is so strong that
the patient takes a forced position, lying on its side or back with
legs brought to the belly. In this case, the skin becomes very pale. Muscle
belly tense, man avoids all stirring.
The most dangerous is the period of imaginary well-being,
developing a few hours from the start of perforation. Here
the pain subsides somewhat, the patient begins to move and assures that
he is better During this period, patients are often imprudent.
refuse an operation that could save their lives. But if
it will take 6-12 hours from the start of perforation, and the patient will not
the operation is performed, then his condition will deteriorate sharply:
- vomiting appears
- temperature rise
- pains will resume
- abdominal distention will appear
- heart rate and palpitations become frequent
- peritonitis will develop, which will need to be operated, and
the forecast for which at this stage is already worse.
Cicatricial duodenal stenosis
If exacerbations of duodenal ulcer follow one another or
ulcerative defects are very large and deep, scars from ulcers can
significantly deform or narrow the lumen of the intestine. In this case
there are problems with the passage of food, such a narrowing develops
(stenosis) of the intestine, which requires surgical treatment. Clinically
decompensated stenosis manifests vomiting, violation
passage of food and stretching of the stomach. At the same time developing such
impaired salt and water levels in the body that lead to
lethargy, weakness, drowsiness, increased muscle tone, feeling
goose bumps on the skin of the hands and feet.
To date, the main and most informative method
identify peptic ulcer becomes FGDs
(fibrogastrododenoscopy), by introducing into the stomach and
The 12 gut endoscope (optical probe) can be riddled with an ulcer,
evaluate its size and depth, take the mucosa on the study
(biopsy) or perform a quick urease test for the presence of
The auxiliary value is given to x-ray diagnostics, which
irreplaceable in clarifying the complications.
Also, patients are assigned a clinical blood test, biochemistry.
of blood, feces analysis on the reaction Gregersen (revealing hidden
Treatment of duodenal ulcers
With timely detection of duodenal ulcer in stage
exacerbation treatment is reduced to the appointment of conservative therapy
(prescription tablets, rarely injectable or drip
drugs). The times when uncomplicated peptic ulcer disease
used surgical treatments are a thing of the past. If
peptic ulcer disease complicated, then hospitalization in surgical
the hospital is obligatory, and the rejection of it is fraught with death. it
does not mean that any bleeding will begin to operate, but
timely observation is indicated for each complicated ulcer
Previously it was decided to hold a seasonal (spring and autumn)
prophylactic treatment of duodenal ulcer. Currently
this practice is not supported because it did not bring the expected
results. Treatment is prescribed for the period of acute ulceration.
болезни duodenal ulcer.
Diet with ulcer
With peptic ulcer 12 duodenal ulcer for the period of exacerbation
prescribed diet 4g, suggesting mechanical, chemical and
temperature schazhenie Recommended 5-6 meals per day
in small portions. Food should be heated to a temperature in
36-37 degrees. Hot and cold and dry food are excluded (see
what can you eat with gastritis). Alcohol is prohibited, on an empty stomach
- Preference is given to boiled, pureed food. Desirable
mucous porridges, unpouched mashed soups, mashed potatoes,
pasta, rice and buckwheat. Steam fish, poultry, boiled meat in the form
soufflé or minced meat and patties. Fruit allowed watermelons and
- We’ll have to give up fried, spicy, rich meat and
bone broths, marinades, soda, strong tea, coffee,
yeast baking. The greatest harm is caused by fruits and vegetables,
containing fiber. About tomatoes, cucumbers, apples, pears,
cabbage, carrots, radish and other garden and garden delights
have to forget until the ulcer defect is scarring.
- It is strictly forbidden to chew chewing gum, stimulating
- Milk in this situation becomes an ambiguous product. Have
a number of patients whole milk is capable due to calcium ions
irritate the ulcer, and others drink it with pleasure, as it
significantly reduces heartburn.
Более подробно см. Diet with ulcer двенадцатиперстной кишки,
list of products menu.
Drug treatment of ulcers duodenum
Duodenal ulcer is treated today by the following groups.
Drugs that reduce the production of gastric juice
Leading positions in this group are proton pump blockers,
which slow down the secretion of hydrochloric acid:
- Means based on omeprazole – omez, gastrozole, bioprazole,
demeprazole, lomac, zerocide, chrismel, zolser, omegast, loskey,
Omezol, Omitox, Omepar, Yellowstone, Pepticum, Omipix, Promez,
Pepticum, Rishek, Orthanol, Romsek, Sopral, Ultop, Helicide,
- Pantoprazole-based drugs – controllers, sanpraz,
- Lansoprazol preparations – gelicol, lanzap, lansofef, lanzotop,
- On the basis of rabeprazole – zulbeks, zolispan, pariet, ontime,
- Esomeprazole – Nexium.
Blockers of H2-histamine receptors practically ceased
treat a peptic ulcer, as they cause withdrawal syndrome (with
abrupt cessation of symptoms of the disease return).
- it ранитидин (гистак, раннисан), фамотидин (квамател,
ulfamid, gastrsidin), cimetidine (bemet).
Selective blockers of M-cholinergic receptors (gastropin,
pirentsipin) reduce the production of pepsin and hydrochloric acid.
Used as ancillary drugs when expressed
pains. May cause palpitations and dry mouth.
Means that increase the protective properties of the mucous membrane
- Сукральфат (вентер) образует на дне ulcers защитное
- Sodium carbenoxolone (ventroxol, biogastron, caved s) accelerates
restoration of the epithelium of the mucous membrane.
- Bismuth subcitrate colloidal (de-nol) forms a film on
- Synthetic prostaglandins (Enprostil) stimulate
mucus formation and cell repair.
- Medications to soothe the central nervous system.
Tranquilizers (seduksen, Elenium, tazepam), antidepressants
(amitriptyline), sedatics (tenoten, preparations of valerian, see
- Central dopamine receptor blockers (metoclopramide,
raglan, cerrucal) normalize the motor activity of the intestine.
Курс лечения ulcers может занимать от двух до шести недель, в
depending on the size of the defect, the general condition of the body.
Следует отметить, что назначать лечение ulcers двенадцатиперстной
intestines, a competent doctor should select drugs and regimens,
who can control the treatment process and evaluate it
Treatment of duodenal ulcers with antibiotics
Therapy of peptic ulcer with antibiotics appeared from the moment
as has been proven undoubtedly involved in the development of the disease
microorganisms Helicobacter pylori. In the early stages of use
antibiotics it was believed that the war should be fought to the victorious
end, that is, the complete disappearance of the microbe, which was confirmed
sowing, urease test with FGDS or blood test for antibodies to
bacteria. Later it turned out that not all types of Helicobacter
cause a disease that the entire Helicobacter destroy unrealistic, so
as with death in the stomach and duodenum, it moves
in the lower intestine, causing a powerful dysbiosis and
Re-infection is also possible when using someone else’s or
common utensils and the same FGDs, which therefore need only be performed
according to strict indications.
However, today it is advisable to spend one or two
course of therapy with antibacterial drugs (amoxicillin,
clarithromycin or tetracycline) with proven infection
Helicobacter. If after one course of antibiotics the bacterium does not
died, then repeat this drug is not worth it. Choose another
Ulcers treatment regimen
The first-line Helicobacter pylori eradication scheme:
- Double dose proton pump inhibitor twice a day
(for example, 40 mg of omeprazole or esomeprazole twice).
- Clarithromycin 500 mg twice a day or Josamycin 1000 mg
twice a day.
- Amoxicillin 1000 mg 2 times a day.
- Де-нол 240 мг twice a day.
Scheme of the second row (in the absence of FGDS-dynamics of sizes
- Proton pump inhibitor in a double dose 2 times a day
(similar to scheme 1)
- Де-нол 240 мг twice a day.
- Metronidazole 500 mg three times a day.
- Tetracycline 500 mg 4 times a day.
Before starting therapy, Helicobacter pylori is detected by
immunological blood tests (antibodies to the pathogen).
Control – detection of Helicobacter antigens in feces. Respiratory
The urease test is not very informative.
The duration of eradication therapy is from 10 to 14 days. With
treatment failure consistently 1 and 2 schemes, prrvoditsya
typing of helicobacter pylori and establishing its sensitivity
Schemes with levofloxacin today are possible to use only in
regions of the Russian Federation, where the sensitivity of Helicobacter persists to this
If duodenal ulcer is not associated with Helicobacter pylori
infection, the treatment is carried out with drugs that reduce the production of
gastric juice. After 7-14 days of combination therapy treatment
appointed for another five weeks.
Folk treatment ulcers duodenum
Full or partial distrust of traditional medicine, rather
all, does not promise the ulcer anything good. There are drugs for
лечения ulcers, чей эффект доказан серьезными выборочными
human research. Also the effect of the drugs is checked.
daily medical practice. Perfected schemes are detected
побочные эффекты drugs. With этом никто не отменял
alternative opportunity to be treated with folk remedies.
One of the most effective means of traditional medicine for ulcers
stomach and duodenum is considered freshly squeezed juice of potatoes. He is enough
not pleasant to the taste, but you can easily get used to it.
Лучше использовать сорта Haveтренняя роза или Американка, но подойдет
any spoiled potato tuber. Withготовление сока достаточно
laborious, given that it should be drunk only fresh and 3 times a
day, but if you want you can adapt. Raw Potato Tuber
cleaned, rubbed on a grater and wrung out through several layers
gauze Juice should be drunk immediately, otherwise it turns black and loses its
medicinal properties. The first 3 days just a tablespoon before meals
30 minutes, preferably 3 times a day, then 3 days, 2 spoons,
gradually bringing up to half a cup at the reception and so 21-28 days. With этом
Dieting is required. After 2-3 weeks, the course can be repeated.
it действительно помогает!
You can resort to traditional medicine, use treatment
sea buckthorn or olive oil (1 dessert spoon on an empty stomach in
for 3 months), honey, propolis, herbs (calendula,
plantain, St. John’s wort), pre-sitting on the gentle
duodenum diet and taking twice a day for 20
mg of omeprazole.