Peptic ulcer and 12 duodenal ulcer is a chronic disease, the main expression of which is recurrent gastric or duodenal ulcer arising on the background gastritis.
According to classical ideas, an ulcer is formed as a result of an imbalance between the aggressive and protective mechanisms of the gastrointestinal mucosa.
By aggressive factors include
- hydrochloric acid
- digestive enzymes
- bile acids;
to protective –
- mucus secretion
- cell renewal of the epithelium,
- adequate blood supply to the mucosa.
The causal value of H. pylori for chronic gastritis determines the most important place of the microorganism in the development of gastric ulcer and 12 duodenal ulcer. It turned out that H. pylori is closely associated with factors of aggression in peptic ulcer. The most important result of his destruction – reducing the frequency of relapses of the disease.
When duodenal ulcer pain occurs after an hour and a half after eating, there are nocturnal, hungry (that is, arising on an empty stomach) pain in the pancreas area or in the right hypochondrium, which pass after eating, taking antacid drugs, ranitidine, omeprazole .
Vomiting of acidic stomach contents may occur at a height of pain, after vomiting, the patient is relieved (some patients independently induce vomiting to reduce pain).
Pain occurring after 30 minutes – 1 hour after eating is more characteristic of the localization of an ulcer in the stomach.
Manifestations of peptic ulcer also include nausea, heartburn, belching.
Naturally, there are cases with atypical symptoms: the lack of a characteristic connection between pain syndrome and food intake, the lack of seasonality of exacerbations does not exclude this diagnosis. The so-called silent exacerbations of the disease are difficult to suspect and correctly recognize.
The symptomatology of the disease is sufficiently bright, and the diagnosis is not difficult in a typical case. Be sure to conduct esophagogastroduodenoscopy.
A complete diagnosis of peptic ulcer disease should include objective information about the presence of H. pylori infection. Many laboratories perform a urea breath test with urea.
For analysis, only 2 samples of exhaled air are needed, the method allows you to monitor the success of the treatment.
A polymerase chain reaction (PCR) technique has been developed for determining H. pylori in feces. The method has sufficient sensitivity and specificity.
Principles of treatment of peptic ulcer:
- the same approach to the treatment of gastric and duodenal ulcers;
- compulsory basic therapy that reduces acidity;
- selection of an acidic lowering drug that supports intragastric acidity 3 about 18 hours per day;
- the appointment of reducing the acidity of the drug in a strictly defined dose;
- endoscopic control at 2-week intervals;
- duration of therapy depending on the time of ulcer healing;
- anti-helicobacter therapy according to indications;
- mandatory monitoring of the effectiveness of therapy after 4-6 weeks;
- repeated courses of therapy for its ineffectiveness;
- supportive anti-relapse therapy.
The protocol for the treatment of peptic ulcer disease involves primarily conducting basic therapy, the purpose of which is to eliminate pain syndrome and digestive disorders, as well as to achieve scarring of the ulcer defect as soon as possible.
Drug treatment involves the appointment of a drug that reduces the acidity of gastric juice, in a strictly defined dose. The duration of treatment depends on the results of endoscopic control, which is carried out at a two-week interval (i.e. after 4, 6, 8 weeks).
In each patient, a gastric ulcer or duodenal ulcer, in which N. Pylori is detected in the gastric mucosa, is carried out by one method or another (quick urease test, morphological method, using DNA determination by polymerase chain reaction, etc.). antimicrobial therapy. This therapy involves a combination of several antimicrobial agents.
Eradication therapy 2 lines
- Proton pump blockers 2 times a day;
- Bismuth colloid subcitrate 120 mg x 4 times;
- Tetracycline 500 mg x 4 times;
- Metronidazole 250 mg x 4 times;
- The duration of treatment is 7 days.
As an alternative scheme, a combination of pyloride ( ranitidine ) at a dose of 400 mg 2 times a day with one of the antibiotics, clarithromycin (250 mg 4 times or 500 mg 2 times a day) or amoxicillin (at a dose of 500 mg 4 times a day) was proposed.
The protocol of eradication therapy involves mandatory monitoring of its effectiveness, which is carried out 4-6 weeks after its completion (during this period, the patient does not take antimicrobial drugs) using the respiratory test or polymerase chain reaction. While N. Pylori is preserved in the gastric mucosa, a second course of eradication therapy is carried out with the use of second-line therapy with subsequent monitoring of its effectiveness also after 4-6 weeks.
The ineffectiveness of the conservative treatment of patients with gastric or duodenal ulcer can manifest itself in two versions: a frequent recurrent ulcer (i.e., with an exacerbation frequency 2 times a year and above) and the formation of refractory gastroduodenal ulcers (ulcers that do not cicatrize for 12 weeks continuous treatment).
Factors determining the frequency of relapsing peptic ulcer are:
- seeding of the mucous membrane of the stomach N. Pylori;
- taking nonsteroidal anti-inflammatory drugs (diclofenac, ortofen, ibuprofen, etc.);
- the presence of ulcerative bleeding and ulcer perforation in the past;
- low compliance, i.e. lack of willingness of the patient to cooperate with the doctor, manifested in the refusal of patients to stop smoking and drinking alcohol, irregular medication.