Stomach ulcer – the disease of a stomach of chronic recidivous character which is followed by formation of defect of a mucous membrane of a stomach and the fabrics located under it. As the main symptom serves pain in an epigastriya on an empty stomach or after food, quite often giving to a back and a thorax. Vomiting, an eructation, heartburn, nausea is often noted. The most dangerous complications - bleeding, a stomach wall perforation, a stenosis of privratnikovy department, malignant regeneration of an ulcer. It is diagnosed according to gastroscopy and a X-ray analysis of a stomach, analyses on a helikobakterny infection. Uncomplicated stomach ulcer is treated conservatively, in the complicated cases resort to a surgical grant.
Stomach ulcer of a stomach is the chronic disease of long recidivous character which is expressed in an ulceration (emergence of ulcer defect) of a mucous wall of a stomach. It is necessary to distinguish from stomach ulcer the symptomatic stomach ulcers (arising as a result of other yazvoprovotsiruyushchy factors) which, as a rule, have acuity and safely recover after removal of the trigger which caused them. The factors causing symptomatic stomach ulcers: a stress (a stressful ulcer), reception of gastrotoksichny medicines (a yatrogenny ulcer), diseases of endocrine glands, disorders of exchange (an endocrine ulcer), other diseases of internals and systems (a secondary ulcer), increase in secretion as a result of development of a gastrinprodutsiruyushchy tumor - gastrinoma (Zolingera-Ellison's syndrome). A major factor of development of stomach ulcer of a stomach is infection with Helicobacter Pylori bacterium.
Stomach ulcer reasons
Stressful ulcers arise after severe injuries, perenese6niya sharp diseases of various bodies, heavy operations, transferring of terminal states (shock, a collapse), a sharp renal or liver failure, a heavy hypoxia of fabrics. At influence of several stressful factors the probability of developing of stressful stomach ulcer considerably increases. The mechanism of development are a violation of balance of influences of the factors damaging mucous and the factors protecting it. In a situation when all bodies and systems work in emergency mode, there is a considerable emission in blood of the corticosteroids and catecholamines promoting increase in sekretorny activity of glands mucous and, at the same time, reducing its protective properties. Also it is broken a traffic of tissues of stomach, wall hemorrhages are formed that in turn promotes an ulceration of mucous. Stressful ulcers mainly in walls of a body and a bottom of a stomach are localized. Very seldom they are formed in a duodenum.
Types of stressful ulcers:
- at severe damage of a body burns and development of a burn disease the arising stressful ulcer is called the Curling ulcer;
- Cushing's ulcer arises as a result of severe damage of the central nervous system (a craniocereberal trauma, brain operations, strokes);
- also distinguish ulcers after a myocardial infarction and traumatic ulcers.
Damages mucous a stomach as erosion and ulcers arises in half of cases of these states, but the stressful ulcer is not diagnosed for most of patients as after improvement of a state and treatment of the main pathology which served as a stressful factor, the ulcer is independently healed. However at long action of the damaging situation of an ulceration of mucous can be deep and lead to perforation of a wall of a stomach with development of peritonitis.
Medicamentous or medicinal ulcers arise as a result of administration of drugs, possessing gastrotoksichesky side effect. Ultserogenny (causing an ulcer) the majority of anti-inflammatory medicines (kortikosteroidny hormones, nonsteroid resolvents), sulfanylamides, potassium chloride, caffeine, glucocorticoids, foxglove medicines, anticoagulants, nitrofurans have effect.
The mechanism of damage mucous at different medicines also differs, it can be also the direct damaging action (potassium chloride) and mediated: decrease in protective properties of production of gastroprotektivny prostaglandins, mucous at suppression (not selective anti-inflammatory medicines of a hormonal and non-hormonal row), increase in secretion of gastric juice (glucocorticosteroids, , caffeine), suppression normal traffic of a gastric wall. The majority of medicines combine direct damage mucous with the mediated action.
As a rule, after cancellation of medicinal therapy by ultserogenny medicines of an ulceration and an erosion mucous safely heal. However danger of ulcers that they can be complicated by bleeding and perforation of a wall of a stomach.
At gastritis and stomach ulcer of a stomach or a duodenum purpose of ultserogenny medicines can provoke development of an exacerbation of a disease, on it such patient medicines with gastrotoksichesky side effect are appointed only at emergency and with care, accompanying therapy with reception of gastroprotektivny means.
The excess producing parathyroid glands of a paratgormon is called giperparatireozy. These hormones are responsible for regulation of exchange of calcium in an organism, however one of effects of action of a paratgormon is increase in production of hydrochloric acid glands mucous a stomach. Surplus of ions of calcium also stimulates secretion of acid and a gastrin in blood. At an ulcer giperparatireoza arise on a mucous membrane of a duodenum more often. In a stomach antralny localization is characteristic of them. The course of a giperparatireozny ulcer quite heavy, with frequent pains, will badly respond to conservative treatment, is inclined to a recurrence and often is complicated by bleedings and a perforation of a wall of a stomach. Often mucous a stomach the disease of bodies of a gastrointestinal tract can be complicated by an ulceration: cirrhosis, pancreatitis. Ulcers can arise also as a result of chronic diseases of respiratory and secretory systems, at diabetes.
Stomach ulcer of a stomach has the same mechanisms of development, as stomach ulcer of a duodenum and also is classified.
Stomach ulcer symptoms
Unlike a duodenum ulcer the pain arising and amplifying right after meal is characteristic of stomach ulcer. Vomiting at stomach ulcer gives relief. A frequent symptom is heartburn, and also weight in a stomach (it is connected with violation of its depletion), a meteorizm. Appetite is, as a rule, reduced. However sometimes and the ulcer which is localized in antralny departments of a stomach can be shown by hungry and night pains.
Also as well as the duodenum ulcer, stomach ulcer is dangerous by such complications as bleeding, perforation of a stomach. At localization of an ulcer in the field of the gatekeeper development of a stenosis of piloroduodenalny department is possible. The ulcers localized in a stomach also have high risk of an ozlokachestvleniye, unlike ulcers of a 12-perstny gut.
Diagnosis of stomach ulcer
The main information for exact diagnosing of stomach ulcer is given by gastroscopy – an endoscopic research of a stomach. Also expressed ulceration can be found at a contrast X-ray analysis of a stomach. At a research of gastric contents make for identification of helikobakteriya. With the same purpose apply the respiratory test, identification a helikobakter by PTsR and IFA method. The general and biochemical blood test can show symptoms of anemia if bleeding from an izjyazvlenny wall takes place, specific symptoms of an ulcer at laboratory researches cannot be revealed. Kal it is also possible to investigate regarding detection of the latent bleeding (the analysis a calla on the hidden blood).
Treatment of stomach ulcer
In treatment of stomach ulcer of a stomach strict observance of a diet – refusal of the products irritating a wall of a stomach and promoting strengthening of production of gastric juice is of great importance. The patients having stomach ulcer should exclude the spicy, salty, sour, fried and smoked food, products rich with rough cellulose from a diet. It is recommended to eat food boiled or steamed.
Medicinal therapy includes inhibitors of a proton pomp (, , and analogs) or blockers of H2-histamine receptors for suppression of gastric secretion (medicines of group of ranitidine); gastroprotektivny (bismuth, ) and antatsidny means; antibacterial medicines for suppression of a helikobakterny infection (metronidazole). The medicinal therapy directed to an eradikation of H. Pylori, as a rule, is carried out within 10-14 days. Then continue by the medicines lowering the acidity supporting therapy.
Uncomplicated stomach ulcer of expeditious treatment does not demand. Surgical removal of a part of a stomach (resection) is appointed only in case of development of heavy complications: perforation, impassability, an ulcer ozlokachestvleniye with development of cancer of stomach. Seldom resort to surgical treatment at the persistent often recurrent disease resistant to conservative therapy.
Treatment of symptomatic stomach ulcers demands, first of all, removal of the factor which provoked an ulcer. As a rule, it is enough for positive effect. As additional therapy apply the means reducing secretion of hydrochloric acid (inhibitors of a proton pomp, H2-gastroprotektory). Decrease in sekretorny activity at stomach ulcer can be reached in the surgical way - by carrying out a vagotomiya.
Prevention and the forecast at stomach ulcer
Prevention of stomach ulcer of a stomach, also as well as stomach ulcer of DPK, timely identification and treatment of a helikobakterny infection of digestive tract, avoiding of stressful situations, uncontrolled reception of medicines and the regular balanced food is. Uncomplicated stomach ulcers at timely identification and adequate therapy safely recover. The adverse forecast at development of complications.