Симптомы ulcers желудка, схемы лечения,drugs

Update: December 2018

  • Читайте по теме: Лечение ulcers двенадцатиперстной кишки
  • Diet for stomach ulcers

A gastric ulcer is a chronic pathology, often recurrent,
the main symptom of which is the formation of an ulcer
in the wall of the stomach, penetrating into the submucosal layer. Leaking this
pathology with alternating periods of exacerbation and remission.

In developed countries, the incidence of the disease is
about 10-15% of the population, and these are very big numbers. Also
There is a tendency of growth of pathology among women, although earlier
it was believed that a gastric ulcer is predominantly male
disease. People from 30 to 50 suffer from this pathology.
years old.

Why and how does an ulcer develop?

Infection with Helicobacter pylori (Helicobacter pylori) The main cause of the disease. This spiral
бактерия вызывает 45-75% всех случаев ulcers желудка. Source of
infection is a sick person or bacteria carrier.
Microbe can be transmitted through:

  • saliva (with a kiss)
  • dirty dishes
  • contaminated water food
  • плохо простерилизованные honeyицинские инструменты (например,
  • from mother to fetus
Вследствие приема honeyикаментов Вторая по частоте причина появления pathology. To such
medications include:

  • неселективные нестероидные противовоспалительные drugs –
    acetylsalicylic acid (aspirin), diclofenac, indomethacin,
    ibuprofen, ketoprofen, butadione;
  • corticosteroids – prednisone, dexamethasone, betamethasone,
  • cytostatics – imuran, azathioprine, fluorouracil;
  • drugs калия – калия хлорид, панангин, аспаркам;
  • антигипертензивные drugs центрального действия –
As a complication of various chronic diseases
  • hyperparathyroidism
  • tuberculosis
  • Crohn’s disease
  • chronic renal failure
  • diabetes
  • sarcoidosis
  • lungs’ cancer
  • chronic viral hepatitis
  • cirrhosis of the liver
  • pancreatitis
  • Chronical bronchitis
  • celiac disease
  • syphilis
As a result of acute diseases and conditions (the so-called
«стрессовые ulcers»)
  • all kinds of shocks
  • extensive burns
  • frostbite
  • sepsis
  • acute renal and hepatic failure
  • injuries
Social reasons
  • negative emotions
  • constant stress
  • gross nutritional errors
  • alcohol and cigarette abuse
  • financial well-being

Какие бывают виды ulcers желудка?

Localization emit: According to the number of ulcerative lesions: By defect size: By stages of development:
  • cardiac part
  • субcardiac part
  • body of the stomach (large or small curvature)
  • antrum
  • pyloric
  • single
  • multiple
  • small – up to 0.5 cm
  • medium – 0.6-1.9 cm in diameter
  • large – 2-2.9 cm
  • gigantic – more than 3 cm
  • active stage
  • healing stage
  • cicatrization stage (red or white scar)
  • remission stage

Симптомы ulcers желудка

Symptoms of pathology can be quite diverse, they depend
on the size and location of the defect, the individual
sensitivity to pain, phases of illness (exacerbation or remission),
the presence of complications, the age of the patient and concomitant

Pain is the main symptom of a stomach ulcer. Pain syndrome has
Some features:

  • the pain may be early (in the first couple of hours after eating, if
    the defect is located in the body or cardia of the stomach), late (more
    two hours, usually with localization in the gatekeeper), toshchakova or
    hungry (worried before meals) and night (usually appear during
    the second half of the night);
  • pain may appear and disappear, depending on the activity
    inflammatory process;
  • pain tends to spring-autumn exacerbation;
  • by nature, it can be sharp, cutting, pulling, piercing,
    stupid and so on;
  • боль проходит после приема антисекреторных honeyикаментов и
  • its intensity is different, from slight malaise to
    unbearable sensations;
  • usually experiencing pain in the epigastrium, the left half of the chest
    cells, behind the sternum, left arm or in the back. Atypical localization
    pain is the right hypochondrium, lumbar region, small

It should be remembered that about 20% of patients do not have pain
syndrome Usually this happens in old age, with
diabetes, taking NSAIDs.

Other signs of peptic ulcer disease:

  • heartburn – burning sensation in the epigastric region. Cause of it
    the appearance of an aggressive acidic gastric
    contents into the lumen of the esophagus;
  • nausea and vomiting – caused by a violation of gastric motility. Vomiting
    occurs a couple of hours after meals and causes
  • belching – a sudden involuntary abandonment of a small amount
    gastric juice in the oral cavity. It is characterized by sour or
    bitter feeling in mouth. Belching due to disruption
    cardiac sphincter.
  • loss of appetite – due to impaired motor function
    GIT or a person deliberately refuses to eat because of fear
    the appearance of pain;
  • constipation – delay of feces for more than 2 days. Originate from
    increased secretion of hydrochloric acid and delayed products in
  • feeling of heaviness in the abdomen that occurs after eating;
  • rapid saturation;
  • feeling of bloating belly.


Like many other diseases, a stomach ulcer can have
complications, sometimes quite dangerous. These include:


Penetration – это разрушение стенки желудка, при этом дном ulcers
becomes a nearby organ. Usually it is a pancreas
gland. Hydrochloric acid and pepsin destroy its structure, causing
острый деструктивный pancreatitis. The first symptoms of penetration
is a sharp zoster in the abdomen, fever and rise in
blood alpha amylase.


Perforation – это разрушение стенки органа и попадание его
contents into the abdominal cavity or retroperitoneal space.
Occurs in 7-8% of cases. Breaking the integrity of the wall can
provoke weightlifting, hard physical labor,
eating fatty and spicy foods, drinking. Clinical picture
characterized by all signs of peritonitis (general
weakness, abdominal pain all over, intoxication and

Observation of the perforation of the stomach helps to diagnose
рентгенография брюшной полости в вертикальном
On it you can see discoid enlightenment.
(gas) under the dome of the diaphragm.


Malignancy – это перерождение ulcers в рак желудка. Is encountered
this complication is infrequent, in about 2-3% of patients. It is noteworthy that
что ulcers двенадцатиперстной кишки никогда не трансформируются в
malignant tumor. With the development of cancer, patients begin to lose
in weight, they have an aversion to meat food, reduced appetite.
Over time, symptoms of cancer intoxication appear (fever,
nausea, vomiting), pale skin. Man can lose
weight up to cachexia (complete exhaustion of the body).

Pyloric stenosis

Pyloric stenosis возникает, если язвенный дефект локализуется
in the pyloric department. The gatekeeper is the narrowest part of the stomach.
Frequent relapses lead to scarring of the mucous membranes and narrowing
pyloric. This leads to disruption in the passage of food in
intestine and its stagnation in the stomach.

There are 3 stages of pyloric stenosis:

  • compensated – the patient has a feeling of heaviness and
    overflow in the epigastrium, frequent belching sour, but common
    condition remains satisfactory;
  • subcompensated – patients complain that even a small
    food intake causes a feeling of fullness and heaviness in the stomach. Vomiting
    happens often and brings temporary relief. Patients lose weight
    afraid to eat;
  • decompensated – the general condition is severe or extremely
    heavy The eaten food no longer passes into the intestine due to the full
    constriction of the gatekeeper. Vomiting обильная, многократная, случается сразу
    after eating foods. Patients are dehydrated, they have
    loss of body weight, electrolyte imbalance and
    pH, muscle cramps.


Gastrointestinal bleeding occurs due to destruction
стенки сосуда на дне ulcers (см. причины кровотечения из заднего
passage). This complication is quite common (about 15%
patients). It is clinically manifested by vomiting “coffee grounds”,
melena and common signs of blood loss.

Vomiting «кофейной гущей» получила свое название из-за того, что
blood, entering the lumen of the stomach, enters into a chemical reaction with
hydrochloric acid. And it looks brown and black with
small grains.

Melena is a tarry or black stool (see causes of feces
black color). The color of feces is also due to the interaction of blood with
gastric juice. However, it should be remembered that some
honeyикаменты (drugs железа, активированный уголь) и ягоды
(blackberry, blueberry, black currant) can stain the chair black

Common signs of blood loss include general pallor,
lowering blood pressure, tachycardia, shortness of breath. Leather
covered in sticky sweat. If the bleeding is not stopped, the person
may lose too much blood and die.

How to identify the disease?

Patient’s complaints help the doctor to suspect a peptic ulcer
history of the disease. However, in order to accurately diagnose the disease,
therapists prescribe a number of special procedures.

Методы обнаружения ulcers желудка:

  • Complete blood count – Reducing the number of red blood cells and
    hemoglobin (anemia), increased ESR
  • Fibroesophagogastroduodenoscopy (FEGDS) – Using a special
    a rubber tube with a camera (fibrogastroscope) the doctor can
    see with your own eyes the condition of the mucosa
    digestive tract. Also этот метод позволяет провести
    biopsy of the organ wall, that is, pinch off a small
  • Radiography of the stomach with contrast – The method is currently
    time is somewhat outdated. Its essence is as follows: patient
    drinks a contrast barium mixture. Then a radiologist
    conducts a series of shots that show how the contrast is progressing
    on the mucous. The picture of the ulcer is usually described as
    �”Niche symptom”.
  • pH-metry and daily monitoring of the pH of the gastric juice – This
    invasive and painful technique to assess how
    aggressive gastric juice in relation to the mucous membrane.

Ways to identify Helicobacter:

  • Serological – Detection of antibodies in the blood to H.pylori
  • Radionuclide Urease Breathing Test – Based on Excretion
    urea microbe that goes with the air. The technique is
    safe, to detect Helicobacter it is only necessary to breathe
    in a special container.
  • Fecal test – Detection of Helicobacter antigen in the stool,
    used to determine the effectiveness of treatment
  • Fast urease test – Conducted after fibrogastroscopy.
    The resulting piece of mucous is tested with a special indicator, which
    reveals H.pylori

Stomach ulcer treatment

Therapy for this disease is multicomponent. Compulsory
is the eradication (destruction) of Helicobacter pylori, reducing
acidity of gastric juice, elimination of unpleasant symptoms
(heartburn, nausea) and the prevention of complications.

Antibiotic Therapy

When the connection of Helicobacter pylori ulcer was proven,
treatment is not without antibiotics. It was previously thought
that the treatment should last until the complete disappearance of the microbe, that

  • blood test for antibodies
  • sowing
  • urease test with FGDs

Then it turned out that not all species cause the disease.
Helicobacter, and their complete destruction can not be achieved,
since when they die in the duodenum and stomach, he
moves lower into the intestines, leading to inflammation and strong
dysbacteriosis. Re-infection is also possible during use.
common utensils and during the FGD procedure that should be performed
only according to strict indications.

Today, it is advisable to conduct 1 or 2 courses
antibiotic therapy, if after the first course the bacterium is not
died, another treatment regimen is selected, the following are used

  • Macrolides (Clarithromycin)
  • Semisynthetic penicillins (Amoxicillin)
  • Tetracycline
  • Nitroimidazole derivatives (Metronidazole) with proven
    Helicobacter infection

Antisecretory drugs

  • Antacids – Almagel, maalox, sucralfat, keal. They
    envelop the mucous membrane, also neutralize hydrochloric acid
    and have anti-inflammatory action.
  • H2-histamine receptor blockers – Ranitidine, rhinitis,
    famotidine, quamel. Histamine receptor blockers inhibit
    action of histamine, interacts with parietal cells
    mucous and enhances the secretion of gastric juice. But they are practically
    stopped using because they cause withdrawal
    (when symptoms return after discontinuation of therapy).
  • Proton Pump Blockers – Omeprazole, Omez, Pantoprazole,
    Rabeprazole, Esomeprazole, Lansoprazole, Controllers, Women, Nexium
    (see more complete list of duodenal ulcer). Blocking
    Н++-АТФазу или протонный насос, тем самым
    preventing the formation of hydrochloric acid.
  • Синтетические аналоги простагландина Е
    Misoprostol, Cytokotek. Inhibit the secretion of hydrochloric acid,
    increases the formation of mucus and bicarbonate.
  • Selective blockers of M-cholinergic receptors (pyrencipin,
    gastrotsepin) reduce the production of hydrochloric acid and pepsin.
    Used as an adjuvant therapy for severe pain, among
    side effects dry mouth and palpitations.

Means that increase the protection of the mucous membrane

  • Sucralfate (Venter) – creates a protective coating on the bottom
  • Sodium carbenoxolone (biogastron, ventroxol, caved s) helps
    speed up the recovery of the mucous membrane.
  • Bismuth colloidal subcinate – De-nol. Forms
    peptide bismuth film that lines the wall of the stomach. Besides
    This bismuth ion has a bactericidal effect against
  • Synthetic prostaglandins (Enprostil) stimulate
    cell repair and mucus formation.

Other drugs

  • Soothing agents (Tenoten, valerian), antidepressants
    (amitriptyline). tranquilizers (seduxen, elenium, tazepam).
  • Prokinetics – Domperidone, motilium, metoclopramide, cerrucal,
    itopride, primer. Improves the motility of the digestive tract,
    contribute to the passage of food into the intestines.
  • Antispasmodics – Mebeverin (Duspatalin), drotaverine, no-shpa.
    Eliminate muscle cell spasm of the stomach wall, reduce pain
  • Probiotics – Enterohermina, bifiform, Linex (see list
    probiotics). They are prescribed for antibiotic therapy.

Курс лечения ulcers желудка 2-6 недель в зависимости от общего
condition and size of the defect.

Treatment regimens

Уничтожение  H.pylori способствует лучшему рубцеванию
ulcerative defect. This is the first step in the treatment of peptic ulcer.
There are two main schemes of antibiotic therapy.
They are assigned step by step, that is, first-line medications are not
worked, then try the second scheme.

1st line of eradication (during the week):

  • Proton pump inhibitors 20 mg twice a day.
  • Semisynthetic penicillins (Amoxicillin) по 1000 мг дважды
    per day or derivatives of nitroimidazole (metronidazole) 500 mg
    also twice a day.
  • Macrodides (Clarithromycin) 500 mg twice a day.

In case of failure, the 2nd line of eradication is proposed (1
a week):

  • Proton pump inhibitors 20 mg twice a day.
  • Nitroimidazole derivatives (Metronidazole) 500 mg each also
    three times a day.
  • Bismuth subcitrate (De-nol) 120 mg 4 times a day.
  • Tetracyclines (Tetracycline) 0.5 g each 4 times a day.

Currently, doctors are developing new treatments.
pathology. A vaccine against Helicobacter is already being tested.
For better healing of the defect of the mucous membrane is used
cytokine preparations, trefoil peptides and growth factors.

See details. Diet for stomach ulcers, menus, products.

Nutrition of patients

There are two basic requirements for food: it must be
full and spare the mucosa from the chemical and
physical damage. It is recommended to eat 5-6 times a day,
in small portions. Meals should be finely chopped or
liquid, not hot or cold, boiled or steamed (see
A detailed article on nutrition – what can you eat with an ulcer and

What can you eat?

What should be categorically excluded?

  • mucous soups from cereals (oatmeal, semolina, rice)
  • lean meats (turkey, chicken, veal) without skin and
    fascia, fish
  • liquid grated porridge
  • cream, cottage cheese
  • boiled eggs, steamed omelette
  • butter
  • jelly, mashed puree, mousses, fruit and berry compotes
  • honey
  • bread and bakery products
  • some vegetables and fruits – cabbage, legumes, tomatoes, radish,
    gooseberry, dates, citrus and so on
  • sauces, spices
  • canned food
  • tea, cocoa, coffee
  • meat broth
  • alcohol
  • fried, smoked, salted, spicy

Treatment of folk remedies

Heartburn will help remove fresh milk, soda, decoction of calamus root,
all kinds of nuts, pea powder and carrot juice (see medicines for
heartburn). To neutralize the hydrochloric acid contained in
gastric juice, use fresh potato juice. For this
you must grate the root vegetable and grate the resulting mass
through cheesecloth. Take potato juice half a glass an hour before
breakfast during the week.

Promote healing and herbal treatments. Healers recommend
infusions of fireweed, yarrow, marsh cornflower, strawberry leaves
and apple, flax seed, aspen buds, chaga birch fungus.

Healing properties also has a special herbal collection, in
which includes the rhizome of elecampane, chamomile flowers, yarrow,
celandine, dried marsh, flax seed, licorice root, fruits
rose hips. All herbs need to be well washed, dried and pour.
boiling water. Take preferably a tablespoon 10 minutes before
food intake. A positive result is not long in coming.

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