Stomach ulcer. Possible complications of a stomach ulcer

A gastric ulcer is a deep defect in the gastric mucosa, resulting from an inflammatory process caused by a damaging factor. A disease in which an ulcer forms in the stomach is called gastric ulcer. This is a common disease that affects about 10% of the population, with men several times more likely than women.

Causes of peptic ulcer

Several factors are involved in the formation of gastric ulcers, the main one being Helicobacter pylory infection. For a long time it was believed that bacteria do not survive in the very acidic environment of gastric contents, until at the end of the twentieth century it was convincingly proven that the microorganism Helicobacter pylory not only survives there, but is also the main link in the mechanism of inflammatory diseases of the stomach and duodenum.

Other factors contributing to the development of gastric ulcers are:

• Frequent use of non-steroidal anti-inflammatory drugs (aspirin, naklofen, ibuprofen, indomethacin, nemesil, etc.)
• Hereditary predisposition;
• Gross errors in nutrition;
• Psychogenic factors (stress);
• Alcoholism;
• Permanent burn of the gastric mucosa by hot food.

The main symptom of a stomach ulcer is severe pain in the epigastric (epigastric) region. Gastric ulcers are characterized by hunger pains that occur several hours after eating, and often at night. The pain subsides after eating or taking antacid (acidity-reducing) medications.

Other symptoms of a stomach ulcer include dyspeptic symptoms, indicating a disorder of the digestive process: heartburn, belching, nausea, sometimes vomiting of acidic gastric contents, which occurs with severe pain and brings some relief, and therefore sometimes patients with a stomach ulcer themselves induce vomiting during pain attack. A person suffering from a stomach ulcer loses weight, his skin looks pale, his appetite and vitality decrease.

Sometimes blood appears in the stomach contents, and sometimes in the stool. This occurs when a vessel is involved in the ulcerative process. Blood clots can be red, but they can also be dark, almost black, which is sometimes misleading. Discharge of blood in vomit or feces can be not only a symptom of a stomach ulcer, but also a sign of a malignant tumor, and therefore requires urgent medical attention.

Diagnosis of stomach ulcers

Currently, the diagnosis of gastric ulcers is based on endoscopic examination. The method is called fibrogastroscopy (FGS), during which a thin flexible instrument equipped with a light source and a camera is inserted through the esophagus into the stomach. This allows you to see the ulcerative defect of the gastric mucosa, determine its location and size. The previously widely used method of contrast fluoroscopy is still used today, but has only an auxiliary value.

Laboratory tests of gastric and intestinal contents are carried out for the presence of Helicobacter pylori and occult blood, and general blood and urine tests are prescribed to assess the general condition of the body.

Treatment of gastric ulcer

For tens, if not hundreds of years, gastric ulcer was considered an incurable disease, for which only surgery could help, and even then not always effectively. After the discovery of the main cause of the disease, namely infection with Helicobacter pylori, treatment of gastric ulcers began to be carried out with therapeutic agents, primarily antibiotics. Currently, the gold standard for the treatment of gastric ulcers is three-component therapy, which includes: a drug that is a proton pump inhibitor (omeprazole and the like), a bismuth drug, and the simultaneous use of two antibacterial drugs.

At the same time, antacids are prescribed - drugs that reduce the acidity of gastric contents. This treatment allows in most cases to cure stomach ulcers within two weeks.

One of the most important moments The treatment for stomach ulcers is to follow a diet and diet. This also serves as the main preventive measure aimed at preventing relapses. The diet for stomach ulcers should be balanced, containing a sufficient amount nutrients, while excluding products that irritate the gastric mucosa (alcohol, coffee, strong tea, spicy seasonings, smoked foods, pickles, etc.). Food is served in thermally processed (stewing, boiling, baking or steaming, frying in oil is excluded) and ground form. Meals should be fractional - in small portions 4-5 times a day, at a certain time. A diet for stomach ulcers should become a way of life, if not for life, then for several years even after achieving remission, although during this period some mitigation is permissible, otherwise a re-development of gastric ulcer is possible, since there remains a predisposition to it and the possibility re-infection with Helicobacter.

Surgical treatment of gastric ulcer is used for persistent ulcers that cannot be treated, as well as for high risk of complications (perforation of the stomach wall, bleeding). In this case, the area of ​​the stomach containing the ulcer is excised, and in parallel, drug treatment for the stomach ulcer is prescribed to prevent relapses of the disease.

During the rehabilitation period, treatment of gastric ulcer is carried out using physiotherapy, as well as balneological methods. General strengthening procedures are carried out; it is highly recommended to change your lifestyle to a healthier one and refuse bad habits(smoking, drinking alcohol, eating fast food and other unhealthy foods).

Video from YouTube on the topic of the article:

A stomach ulcer is an internal violation of the integrity of the walls, in which the mucous membrane is corroded by digestive juice. The result of such processes is severe forms of the disease, leading to exacerbations of the disease. The risk group includes the adult population. What types of complications are there, the methods used for treating peptic ulcers and preventive methods - read the article.

Examination of a stomach ulcer is carried out using the endoscopic method, during which material is taken from several points of the ulcers, followed by analysis. During and after treatment of ulcerative gastroduodenoscopic control is carried out. Diagnostics allows us to identify the symptomatic picture of peptic ulcer and duodenal ulcer, which in medicine is divided into indirect and direct. Particular attention is paid to changes in the structure of the walls of the stomach and accompanying disorders of the esophagus.

In case of illness, failures in the production of gastric juice have opposite manifestations with the duodenum. Often, with ulcerative gastrointestinal tract, the rate of secretion of hydrochloric acid and pepsin is at an acceptable level or is underestimated. Complications of stomach ulcers most often occur in spring or autumn and are sluggish in nature. With a duodenal ulcer, the acidity level is always elevated, and exacerbation of the disease can occur throughout the year.

Common forms of complications

Complications of gastric and duodenal ulcers are divided into two types:

• A sharp exacerbation that threatens the patient's life. These include bleeding and perforation.
• Sluggish. These include penetration, stenosis, spillover into cancerous tumors and others.

In medical practice, there have been cases where complications are combined, for example, perforation or penetration are accompanied by bleeding. Statistics indicate that the percentage of exacerbation of the disease manifests itself as follows:

• 12-15% – opening of bleeding;
• 7-10% – penetration;
• 5-22% – perforation;
• 5-7% - develop into the form of cancer.

Complications of the ulcer are preceded by severe pain, which is often difficult to diagnose due to its extensive localization. To determine the source of pain, an examination is carried out using special instruments. Any manifestation of the disease requires careful diagnosis, constant monitoring with the use of therapeutic methods. Let us consider in more detail the frequently occurring forms of complications.

1. Bleeding.

Occurs when the disease grows, which leads to disruption of the mucous wall of blood vessels, as a result of which they are corroded by intestinal juice. Symptoms depend on the amount of blood loss.

Signs:

• sudden loss of strength;
• fainting;
• a sharp decrease in blood pressure;
• vomiting blood;
• liquid black stool.

Treatment of opened bleeding is carried out only in the hospital surgical department. Therefore, when diagnosing the above symptoms, you should immediately call an ambulance. Gastroscopy is performed to detect the source of bleeding. During the procedure, the bleeding is stopped using medicinal solutions and special clips. Intravenous administration of drugs designed to reduce the volume of hydrochloric acid is prescribed.

If the bleeding has stopped, the patient is discharged on the fifth day. If this could not be done, then a surgical operation is used, the type of which is prescribed by the doctor depending on the characteristics of the ulcer and the patient’s body.

2. Perforation.

Perforation is through holes in the walls of the stomach and duodenum. Through them, various substances penetrate into the abdominal cavity, which causes the development of peritonitis. A particular precursor to this type of complication is the use of alcohol-containing products, overeating, and stress.

Symptoms:

• increased body temperature;
• nausea, vomiting;
• chills;
• sudden acute pain syndrome;
• abdominal muscle tension;
• gases;
• pale skin;
• bradycardia.

The patient’s well-being deteriorates after 7 hours. With complications of a perforated ulcer and lack of medical care, peritonitis develops. The pulse changes to rapidity, fever and constipation appear, although at the beginning of complications of the disease, stool may be normal. However, after 8-10 hours, stool and urination become difficult and a slow accumulation of gases begins. Most often, to normalize the patient’s condition, laparoscopy is indicated as a diagnostic method. But if the examination raises doubts among specialists, then the biomass is taken and air is pumped into the stomach with a probe.

3. Penetration.

Penetration is a severe form of complication of a stomach ulcer, in which the disease spreads to nearby organs. At the same time, the pain syndrome does not allow us to accurately determine the source of increased discomfort.

Signs:

• changes in biological processes;
• high body temperature;
• spread of pain to the back, chest, shoulders, lower back;
• vomiting, which brings relief.

It is noted that during fasting, pain decreases, but does not respond to drug treatment. In this regard, surgical intervention is performed, otherwise the patient faces death. Peptic ulcer with penetration does not heal even with long-term therapy. The operation is carried out in the form of removal of part of the stomach along with the disease.

Ulcer treatment

In case of peptic ulcer without complications, prompt wound healing is observed, pain is reduced, and the patient’s general well-being returns to normal.

Drug treatment includes:

• taking targeted antibiotics;
• drugs that restore stomach tissue;
• medications that reduce the production of hydrochloric acid.

When complications of gastrointestinal tract develop, surgery is usually performed due to the high risk of death. Taking medications and general therapy do not help, but only prolong and worsen the patient’s condition.

There are also conservative treatment methods. However, they are used to keep the patient in a normal condition, which reduces the risk of complications.

• Exclusion of meat, fish, canned and gas-containing products, caffeine, strong tea.
• Diet food - include light broths, cereal porridges, vegetables, fruits and more in your diet.
• Eat small meals 4-5 times a day.
• Avoid strenuous physical activity.
• Complete abstinence from the use of alcoholic beverages and tobacco.

Most often, the inclusion of a particular product in the diet occurs in agreement with the doctor.

How to prevent the disease?

Prevention of ulcerative disease can have a beneficial effect on the body. With the right daily routine, diet and moderate physical activity the risk of disease is practically reduced to zero.

1. full sleep up to 8 hours;

2. refusal to eat high-fat and smoked foods;

3. eating in small portions with thorough chewing;

4. give preference to steamed food;

5. do not consume nicotine and alcohol;

6. avoidance of a stressful lifestyle and irritability;

7. If pain or discomfort occurs, consult a doctor;

8. maintain oral health;

9. annual examination for chronic diseases;

10. do exercises;

11. drink still water, at least 6 glasses a day;

12. stabilization of the daily routine.

To prevent recurrence of ulcers, a set of measures is prescribed to reduce pain and the risk of recurrent exacerbation of the disease.

• Physiotherapy, herbal medicine, taking medications and drinking mineral still water.
• In autumn and spring, it is recommended to relax in special-purpose sanatoriums.
• Stick to your diet strictly.
• Regular examinations both in laboratories and using medical instruments.

Preventive methods can significantly reduce the risk of developing peptic ulcers. Timely measures prevent the onset of the disease, and if diagnosed, reduce the risk of complications. Treatment of gastrointestinal tract leads to positive results if you follow the advice of doctors and take care of your health.

(peptic ulcer) - is one of the most common diseases of the gastrointestinal tract, characterized by the formation of a defect small sizes(up to 1 cm, rarely more) on the mucous membrane (sometimes submucosal) of the stomach, as a result of the aggressive effect of certain factors on the mucous membrane (hydrochloric acid, bile, pepsin). It is a chronic disease, therefore it alternates between periods of exacerbations (most often in spring and/or autumn) and remissions (symptoms subside). A gastric ulcer is an irreversible disease, since a scar is formed in the area of ​​the gastric mucosa affected by the ulcer, and it does not have the functional ability (secretion of gastric juice), even after treatment.

Gastric ulcer affects approximately 10-12% of the adult population, about 400-500 cases of the disease per 100 thousand population. In the CIS countries there are about 12 cases per 10 thousand population. More often, the disease occurs among the urban population, perhaps this is due to psycho-emotional factors and nutrition. Men suffer from peptic ulcers more often than women. Women more often get sick in middle age (during menopause), due to hormonal changes in the body.

Anatomy and physiology of the stomach

The stomach is an organ of the digestive system in which food accumulates and, under the action of gastric juice, undergoes primary digestion with the formation of a mushy mixture. The stomach is located, for the most part, in the upper left region of the abdominal cavity. The stomach does not have a specific shape and size, since they depend on the degree of its filling, the state of its muscle wall (contracted or relaxed) and age. On average, the length of the stomach is about 21-25 cm, and its capacity is about 3 liters. The stomach consists of several parts that are important in localizing the ulcer:

• Cardiac part of the stomach, is a continuation of the esophagus. The border between the esophagus and the cardiac part of the stomach is the cardiac sphincter, which prevents the reflux of food in the opposite direction (into the esophagus);
• Fundus of the stomach- this is the convex part of the stomach, dome-shaped, which is located to the left of its cardiac part;
• Body of stomach- this is the most most of, has no clear boundaries, is a continuation of the bottom, and gradually passes into its next part;
• Pyloric part of the stomach, is a continuation of its body, is located at an angle relative to the body of the stomach, and communicates with the lumen of the duodenum. At the junction of the pyloric part of the stomach into the duodenum, a circular muscular thickening is formed, which is called the pyloric sphincter. When it closes, it acts as a barrier to the passage of food mass into the duodenum, preventing food from returning to the stomach.

The structure of the stomach wall
The stomach wall consists of 3 layers (tunics):

• Outer layer represented by the serous membrane, is the inner layer of the peritoneum;
• Middle layer is represented by the muscular membrane, which consists of muscle fibers located longitudinally, radially (in a circle) and obliquely. The circular layer forms the cardiac sphincter, which prevents the backflow of food into the esophagus, and the pyloric sphincter, which prevents the backflow of food into the stomach. At the border between the middle layer (muscular membrane) and the inner layer (mucosa), there is a poorly developed submucosa.
• Inner layer - mucous membrane , is a continuation of the esophageal mucosa, has a thickness of about 2 mm, and forms many folds. In the thickness of the gastric mucosa there are several groups of gastric glands that secrete components of gastric juice.

Gastric glands participate in the formation of gastric juice, under the influence of which digestion occurs. They are divided into the following groups:

1. Cardiac glands, located in the cardiac part of the stomach, secrete mucus;
2. Fundic glands, located in the fundus of the stomach, are represented by several groups of cells, each of which secretes its own components of gastric juice:

• the main cells secrete the digestive enzyme pepsinogen, from which pepsin is formed, which is involved in the breakdown of proteins from food into peptides;
• parietal cells secrete hydrochloric acid and Castle factor;
• accessory cells secrete mucus;
• undifferentiated cells are precursors for the maturation of the above cells.

Functions of the stomach

• Secretory function stomach, consists in the secretion of gastric juice, which contains the necessary components (primarily hydrochloric acid) for initial stages digestion and formation of chyme (food bolus). About 2 liters of gastric juice are secreted per day. It contains: hydrochloric acid, pepsin, gastrin and some mineral salts. The acidity of gastric juice is determined by the content of hydrochloric acid in it, its amount can vary depending on the composition of the food and diet, on the person’s age, and on activity nervous system and others. When the secretory function of the stomach is disrupted, a person’s acidity increases, i.e. the release of hydrochloric acid increases, or decreases and is accompanied by a decrease in the release of hydrochloric acid.
• Motor function of the stomach, occurs as a result of contraction of its muscle layer, resulting in the mixing of food with gastric juice, primary digestion and its movement into the duodenum. Impaired gastric motility, which develops as a result of impaired tone of the muscular wall, leads to impaired digestion and evacuation of gastric contents into the intestine, which are manifested by various dyspeptic disorders (nausea, vomiting, bloating, heartburn and others).

Mechanism of gastric ulcer formation

A gastric ulcer is a defect in the gastric mucosa, rarely ˃1 cm (sometimes submucosal), surrounded by an inflammatory zone. Such a defect is formed as a result of the action of certain factors that lead to an imbalance between protective factors (gastric mucus, gastrin, secretin, bicarbonates, muco-epithelial barrier of the stomach and others) of the gastric mucosa and aggressive factors (Helicobacter Pylori, hydrochloric acid and pepsin). As a result of certain reasons, there is a weakening of the effect and/or a decrease in the production of protective factors and an increase in the production of aggressive factors, as a result of which the non-resistant area of ​​the gastric mucosa undergoes an inflammatory process, with the subsequent formation of a defect. Under the influence of treatment, the defect is overgrown with connective tissue (a scar is formed). The area where the scar has formed does not have functional capacity (secretory function).

Causes of stomach ulcers

Stomach ulcers develop for 2 main reasons:

• BacteriumHelicobacter Pylori in certain (favorable) conditions for it, it has a destructive effect on the cells of the gastric mucosa, destroys local protective factors of the gastric mucosa, as a result of which, in the absence of treatment, a defect in the form of an ulcer is formed. Infection occurs through the saliva of an infected person (lack of hygiene, using unwashed dishes after an infected person). There are about 60% of infected people on the globe, but not everyone gets stomach ulcers, perhaps this is due to predisposing factors. To prevent Helicobacter Pylori infection, you must wash your hands and use clean utensils before eating.
• Increased acidity, develops as a result of increased secretion of hydrochloric acid, which has a corrosive effect on the gastric mucosa, with subsequent formation of a defect.

Factors leading to the formation of stomach ulcers

• Nervous and emotional stress leads to increased secretion of gastric juice (hydrochloric acid);
• Genetic predisposition to the formation of stomach ulcers, including hereditary increased acidity;
• Smoking, drinking alcoholic beverages, coffee, nicotine and ethyl alcohol stimulate the formation of gastric juice, thereby increasing acidity;
• The presence of a pre-ulcerative condition (chronic gastritis), chronic inflammation of the gastric mucosa, leads to the formation of defects in the form of ulcers;
• Disturbed diet: fast food, long breaks between meals, lead to disruption of the secretion of gastric juice;
• Abuse of sour, spicy and rough foods leads to stimulation of the secretion of gastric juice, and the possible formation of inflammation and defects in the gastric mucosa;
• Long-term use of medications that have a destructive effect on the gastric mucosa. Such medications include: non-steroidal anti-inflammatory drugs (Aspirin, Ibuprofen and others), glucocorticoids (Prednisolone) and others.

Symptoms of a stomach ulcer during an exacerbation

1. Dull, cutting, stabbing pain in the upper abdomen, most often in the middle (in the epigastric region), it can radiate to the left hypochondrium. The appearance of pain is associated with eating, approximately 0.5-1 hour after eating, stops after approximately 2 hours, this is associated with emptying of the stomach. Pain appears as a result of irritation of the ulcer surface with food, and it is relieved with antacids (Almagel). The pain is also characterized by seasonality, i.e. exacerbation occurs in spring and autumn.
2. Dyspeptic disorders:

• heartburn appears as a result of the reflux of acidic gastric contents into the lower parts of the esophagus. It appears simultaneously with the onset of pain;
• Nausea and vomiting also occur at the same time that pain occurs. Vomiting is accompanied by relief for the patient;
• sour belching, constipation, develop due to increased gastric acidity;

1. Weight loss, occurs due to the fear of eating food, which contributes to the appearance of pain.

Complications of gastric ulcer, perforated gastric ulcer (ulcer perforation)

• Perforation (perforation) of the ulcer, develops as a result of the destruction of all layers of the stomach wall and its end-to-end perforation. It is an acute process and therefore requires urgent medical (surgical) care, since as a result of perforation, gastric contents are released through a through hole in the stomach wall, resulting in the development of peritonitis.
• Ulcerative bleeding occurs as a result of corrosion of a vessel in the stomach wall at the level of the ulcer. The main symptom is vomiting blood and general weakness. Bleeding leads to loss of circulating blood volume and the possible development of shock. Requires urgent surgical intervention to stop bleeding.
• Ulcer penetration- this is the penetration of an ulcer through the wall of the stomach into nearby organs, most often the pancreas. In this case, acute pancreatitis also occurs.
• Stenosis of the pyloric part of the stomach, such a complication develops if the ulcer is localized in this area. As a result of ulcerative stenosis of the pyloric part of the stomach, food is not able to pass from the stomach to the intestines. This complication requires surgical treatment to restore the passage of food into the duodenum.
• Perigastritis, develops as a result of reaching the zone of inflammation around the ulcer, the serous membrane of the stomach. As a result of this complication, adhesions form with neighboring organs (for example: liver or pancreas), which leads to deformation of the stomach.
• Ulcer malignancy, those. formation of a malignant tumor from an ulcer. This is a fairly rare complication, but the most life-threatening for the patient.

Diagnosis of gastric ulcer

To diagnose a gastric ulcer, it is very important to carefully collect anamnesis (patient complaints, pain associated with eating, hereditary predisposition, seasonality).

During an objective examination of the patient - palpation of the abdomen, tension is observed abdominal wall in the epigastric region and in the left hypochondrium.

To accurately confirm gastric ulcer, the following instrumental research methods are used:

1. Blood test for the content of Helicobacter Pylori antibodies.
2. Determination of the acidity of gastric juice (PH - metry), Using a probe inserted into the stomach, a portion of gastric juice is taken and its acidity, which depends on the content of hydrochloric acid, is examined.
3. X-ray examination of the stomach, reveals the following signs characteristic of a stomach ulcer:

• niche symptom – retention of contrast agent in the area of ​​the gastric mucosal defect;
• ulcer shaft - characterizes the area of ​​inflammation around the ulcer;
• cicatricial-ulcerative deformation of the gastric wall, characterized by the direction of the folds of the mucous membrane around the ulcer, in the form of a star;
• symptom index finger, characterized by retraction of the gastric mucosa on the opposite side to the ulcer;
• pylorospasm, spasmed pyloric sphincter does not allow contrast agent to pass through;
• accelerated and delayed evacuation of contrast agent from the stomach;
• Detects the presence of possible complications (ulcer perforation, penetration, ulcerative stenosis).

1. Endoscopic examination (fibrogastroduodenoscopy), This method consists of examining the gastric mucosa using a fibrogastroduodenoscope. This research method determines the location of the ulcer, its exact size, and possible complications (including bleeding from the ulcer).
2. Microscopic examination biopsy of the gastric mucosa taken during fibrogastroduodenoscopy for the presence of Helicobacter Pylori.

Treatment of stomach ulcers

Drug treatment stomach ulcers are carried out in conjunction with diet therapy. The attending physician individually selects the necessary groups of drugs for each patient. Drug treatment of gastric ulcer has the following goals:

1. Eradication (destruction)Helicobacter Pylori, is carried out using antibiotic therapy.

Groups of antibiotics used for Helicobacter pylori infection:

• Macrolides (Erythromycin, Clarithromycin). Clarithromycin tablets are used 500 mg, morning and evening;
• Penicillins: Amoxicillin is prescribed 500 mg 4 times a day, after meals;
• Nitroimidazoles: Metronidazole, taken 500 mg 3 times a day, after meals.

1. Reducing the acidity of gastric juice, relief of pain and heartburn, is carried out using the following groups of drugs:

• Proton pump inhibitors: Omeprazole, prescribed 20 mg 2 times a day, before meals;

• H2 receptor inhibitors: Ranitidine, prescribed 150 mg 2 times a day, before meals.

• Antacids (Almagel, Maalox). Almagel is prescribed to drink 1 tablespoon 30 minutes before meals;
• Bismuth preparations (De-nol) have both an astringent mechanism for the gastric mucosa and a bactericidal effect against Helicobacter Pylori. De-nol, prescribed 120 mg 4 times a day, 30 minutes before meals.

Depending on the severity of the disease and the results of the study, 3-component or 4-component therapy is prescribed, which includes 3 or 4 drugs from the above groups. In cases of severe dyspeptic syndrome, which makes it difficult to take medications in tablet form, patients are prescribed the same injection medications. The duration of treatment lasts about 14 days.

Diet for stomach ulcers

When treating stomach ulcers, diet therapy should be a mandatory component. First of all, you need to avoid drinking alcohol and strong coffee. Food should be gentle on the gastric mucosa (thermal and mechanical), and not cause increased secretion of gastric juice. Therefore, it is necessary to exclude rough foods, cold or hot, spicy, bitter, and fried foods from the diet. Fatty and salty foods, canned food, and sausages are prohibited. Foods (garlic, onions, radishes and others) that increase appetite also lead to increased secretion of gastric juice, so they also need to be excluded.

Food for a patient with a stomach ulcer should be warm, liquid or pureed, boiled or steamed. The patient must follow a diet, eat small portions 5 times a day, and reduce the total daily caloric intake to 2000 kcal/day. Milk has a very good astringent effect, so it is recommended to drink a glass of milk every morning and at night. Hydrocarbonate mineral waters, which contribute to the alkalization of gastric contents, also have a good effect, these include Borjomi, Essentuki No. 4, Arshan, Burkut and others.

It is also recommended that the patient drink soothing teas (from lemon balm, mint). Food should be rich in vitamins, minerals and proteins, so the diet must include dishes made from vegetables. Dairy products: cottage cheese, kefir, cream, low-fat sour cream, regulate recovery processes in the body. Fish and meat dishes can be consumed from low-fat varieties (chicken, rabbit, perch, pike perch). For faster healing of the ulcer surface, fats are included in the diet plant origin(For example: olive oil, sea buckthorn). It is very good to include milk porridge (oatmeal, rice, buckwheat) in your diet every morning. White or gray bread, it is better to eat not fresh (yesterday's), as well as crackers.

Prevention of stomach ulcers

Prevention of gastric ulcer is: exclusion stressful situations, premature treatment of pre-ulcerative conditions (chronic gastritis), elimination of bad habits (alcohol, smoking), timely nutrition, absence of long breaks between meals, avoidance of foods that increase the acidity of the stomach and have an irritating effect on its mucous membrane. Prevention also includes preventing infection with Helicobacter pylori infection; for this it is necessary to wash your hands with soap and use clean utensils before eating.

– a chronic polyetiological pathology that occurs with the formation of ulcerative lesions in the stomach, a tendency to progression and the formation of complications. The main clinical signs of peptic ulcer disease include pain in the stomach and dyspeptic symptoms. The diagnostic standard is an endoscopic examination with a biopsy of pathological areas, radiography of the stomach, and detection of H. pylori. Treatment is complex: diet and physiotherapy, eradication of Helicobacter pylori infection, surgical correction of complications of the disease.

General information

Gastric ulcer (GUD) is a cyclically relapsing chronic disease, the characteristic feature of which is ulceration of the stomach wall. PUD is the most common pathology of the gastrointestinal tract: according to various sources, from 5 to 15% of the world's population suffer from this disease, and among urban residents the pathology is five times more common. Many specialists in the field of gastroenterology combine the concepts of gastric ulcer and duodenal ulcer, which is not entirely correct - ulcerations in the duodenum are diagnosed 10-15 times more often than ulcers in the stomach. However, PU requires careful study and development of modern diagnostic and treatment methods, since this disease can lead to the development of fatal complications.

About 80% of cases of primary detection of gastric ulcers occur in working age (up to 40 years). In children and adolescents, gastric ulcers are diagnosed extremely rarely. Among the adult population, there is a predominance of men (women suffer from peptic ulcers 3-10 times less often); But in old age, sex differences in incidence are smoothed out. In women, the disease is milder, in most cases asymptomatic, and is rarely complicated by bleeding and perforation.

Gastric ulcer ranks second among the causes of disability in the population (after cardiovascular pathology). Despite the long period of study of this nosology (more than a century), therapeutic methods of influence that can stop the progression of the disease and completely cure the patient have not yet been found. The incidence of gastrointestinal ulcers throughout the world is continuously growing, requiring the attention of therapists, gastroenterologists, and surgeons.

Classification

Until today, scientists and clinicians around the world have not been able to reach agreement on the classification of gastric ulcers. Domestic experts systematize this pathology according to the following criteria:

• causative factor– ulcers associated or not associated with H. pylori, symptomatic ulcers;
• localization– ulcer of the cardia, antrum or body of the stomach, pylorus; greater or lesser curvature, anterior, posterior wall of the stomach;
• number of defects– single ulcer or multiple ulcerations;
• defect size– small ulcer (up to 5 mm), medium (up to 20 mm), large (up to 30 mm), giant (more than 30 mm);
• stage of the disease– exacerbation, remission, scarring (red or white scar), cicatricial deformation of the stomach;
• course of the disease– acute (the diagnosis of gastric ulcer is established for the first time), chronic (periodic exacerbations and remissions are noted);
• complications– gastric bleeding, perforated gastric ulcer, penetration, cicatricial ulcerative gastric stenosis.

Causes and pathogenesis of gastric ulcer

The main etiological factor in the formation of gastric ulcer is infection with H. pylori - more than 80% of patients have positive tests for Helicobacter pylori infection. In 40% of patients with gastric ulcer infected with the Helicobacter bacterium, anamnestic data indicate a family predisposition to this disease. The second most important cause of gastric ulcer formation is considered to be the use of non-steroidal anti-inflammatory drugs. Rarer etiological factors of this pathology include Zollinger-Ellison syndrome, HIV infection, connective tissue diseases, liver cirrhosis, heart and lung diseases, kidney damage, exposure to stress factors that lead to the formation of symptomatic ulcers.

The main significance for the formation of gastric ulcer is an imbalance between defense mechanisms mucous membrane and exposure to aggressive endogenous factors (concentrated hydrochloric acid, pepsin, bile acids) against the background of a disorder of the evacuation function of the gastrointestinal tract (gastric inactivity, duodenogastric reflux, etc.). Inhibition of protection and slower recovery of the mucous membrane is possible against the background of atrophic gastritis, with chronic Helicobacter pylori infection, ischemia of stomach tissue against the background of collagenosis, long-term use of NSAIDs (the synthesis of prostaglandins slows down, which leads to a decrease in mucus production).

The morphological picture of gastric ulcer undergoes a number of changes. The primary substrate for the occurrence of ulcers is erosion - superficial damage to the gastric epithelium, which forms against the background of necrosis of the mucous membrane. Erosions are usually detected on the lesser curvature and in the pylorus of the stomach; these defects are rarely isolated. The size of erosions can range from 2 millimeters to several centimeters. Visually, erosion is a mucosal defect that does not differ in appearance from the surrounding tissues, the bottom of which is covered with fibrin. Complete epithelization of erosion with a favorable course of erosive gastritis occurs within 3 days without the formation of scar tissue. If the outcome is unfavorable, erosions transform into acute gastric ulcers.

An acute ulcer is formed when the pathological process spreads deep into the mucous membrane (beyond its muscular plate). The ulcers are usually single, take on a rounded shape, and look like a pyramid when cut. In appearance, the edges of the ulcer also do not differ from the surrounding tissues; the bottom is covered with fibrin deposits. Black coloration of the bottom of the ulcer is possible when the vessel is damaged and hematin is formed (a chemical substance formed during the oxidation of hemoglobin from destroyed red blood cells). A favorable outcome of an acute ulcer consists of scarring within two weeks; an unfavorable outcome is marked by the transition of the process to a chronic form.

The progression and intensification of inflammatory processes in the area of ​​the ulcer leads to increased formation of scar tissue. Because of this, the bottom and edges of a chronic ulcer become dense and differ in color from the surrounding healthy tissue. A chronic ulcer tends to enlarge and deepen during an exacerbation; during remission it decreases in size.

Symptoms of stomach ulcer

The clinical course of gastric ulcer is characterized by periods of remission and exacerbation. Exacerbation of peptic ulcer is characterized by the appearance and increase of pain in the epigastric region and under the xiphoid process of the sternum. With an ulcer of the body of the stomach, the pain is localized to the left of the center line of the body; in the presence of ulceration of the pyloric region - on the right. Pain may radiate to the left half of the chest, shoulder blade, lower back, and spine. Gastric ulcer is characterized by the onset of pain immediately after eating with increasing intensity within 30-60 minutes after eating; pylorus ulcer can lead to the development of night, hunger and late pain (3-4 hours after eating). The pain syndrome is relieved by applying a heating pad to the stomach area, taking antacids, antispasmodics, proton pump inhibitors, and H2-histamine receptor blockers.

In addition to the pain syndrome, gastrointestinal tract is characterized by a coated tongue, bad breath, and dyspeptic symptoms - nausea, vomiting, heartburn, increased flatulence, and stool instability. Vomiting mainly occurs at the height of stomach pain and brings relief. Some patients tend to induce vomiting to improve their condition, which leads to progression of the disease and complications.

Atypical forms of gastric ulcer can manifest as pain in the right iliac region (appendicular type), in the heart (cardiac type), and in the lower back (radiculitis pain). In exceptional cases, pain syndrome with gastric ulcer may be completely absent, then the first sign of the disease is bleeding, perforation or cicatricial stenosis of the stomach, for which reason the patient seeks medical help.

Diagnostics

The gold standard for diagnosing gastric ulcers is esophagogastroduodenoscopy. Endoscopy allows you to visualize the ulcerative defect in 95% of patients and determine the stage of the disease (acute or chronic ulcer). Endoscopic examination makes it possible to timely identify complications of gastric ulcer (bleeding, cicatricial stenosis), conduct endoscopic biopsy, and surgical hemostasis.

Treatment of gastric ulcer

The main goals of therapy for peptic ulcer include repair of the ulcer, prevention of disease complications, and achievement of long-term remission. Treatment of gastric ulcer includes non-drug and drug treatments, surgical methods. Non-drug treatment of peptic ulcer involves following a diet, prescribing physiotherapeutic procedures (heat, paraffin therapy, ozokerite, electrophoresis and microwave exposure), it is also recommended to avoid stress and lead a healthy lifestyle.

Drug treatment should be comprehensive and affect all parts of the pathogenesis of ulcerative gastrointestinal tract. Anti-Helicobacter therapy requires the use of several drugs to eradicate H. pylori, since the use of monoschemes has shown to be ineffective. Attending physician in individually selects a combination of the following drugs: proton pump inhibitors, antibiotics (clarithromycin, metronidazole, amoxicillin, tetracycline, furazolidone, levofloxacin, etc.), bismuth preparations.

If you seek medical help in a timely manner and carry out a complete anti-Helicobacter treatment regimen, the risk of complications of gastric ulcer is minimized. Emergency surgical treatment of gastric ulcer (hemostasis by clipping or suturing a bleeding vessel, suturing the ulcer) is usually required only for patients with a complicated pathology: perforation or penetration of the ulcer, bleeding from the ulcer, malignancy, and the formation of scar changes in the stomach. In elderly patients, if there is a history of complications of ulcerative gastritis in the past, experts recommend reducing the duration of conservative treatment to one to one and a half months.

Absolute indications for surgical intervention: perforation and malignancy of the ulcer, massive bleeding, cicatricial changes in the stomach with disruption of its function, gastrojejunostomy ulcer. Conditionally absolute indications include penetration of ulcers, giant callous ulcers, recurrent gastric bleeding during conservative therapy, and lack of ulcer repair after suturing. A relative indication is the absence of a clear effect from drug therapy for 2-3 years.

For decades, surgeons have been discussing the effectiveness and safety of various types of surgical interventions for gastric ulcers. Today, gastrectomy, gastroenterostomy, different kinds vagotomy. Excision and suturing of a gastric ulcer is used only in extreme cases.

Prognosis and prevention

The prognosis for gastric ulcer largely depends on the timeliness of seeking medical help and the effectiveness of anti-Helicobacter therapy. Peptic ulcer is complicated by gastric bleeding in every fifth patient, from 5 to 15% of patients suffer perforation or penetration of the ulcer, and 2% develop cicatricial stenosis of the stomach. In children, the incidence of complications of gastric ulcer is lower - no more than 4%. The likelihood of developing stomach cancer in patients with peptic ulcer is 3-6 times higher than among people who do not suffer from this pathology.

Primary prevention of gastric ulcer includes preventing infection with Helicobacter pylori infection, eliminating risk factors for the development of this pathology (smoking, cramped living conditions, low standard of living). Secondary prevention is aimed at preventing relapses and includes following a diet, avoiding stress, and prescribing an anti-Helicobacter drug regimen when the first symptoms of peptic ulcer appear. Patients with gastric ulcer require lifelong monitoring, endoscopic examination with mandatory testing for H. pylori once every six months.

is a relapsing disease that is chronic in nature. In this case, an ulcerative defect appears in the stomach and/or duodenum. As a result, there is a significant imbalance between the protective properties of the gastroduodenal zone and aggression factors.

This disease is considered to be the most common lesion of the gastrointestinal tract. Statistics show that approximately 10% of the total population suffers from peptic ulcer disease. As a rule, the disease affects both young and middle-aged people. More often, peptic ulcer disease is diagnosed in men. Today, doctors note a characteristic “rejuvenation” of the disease, as well as a more frequent manifestation of a severe form of the disease and a decrease in the effectiveness of treatment.

Causes of peptic ulcer

As a rule, the disease develops as a consequence of the influence of several predisposing factors on the human body. The causes of the development of this disease are determined by errors in the activity of hormonal and nervous mechanisms that regulate the activity of the stomach and duodenum, as well as the lack of proper balance between the effects on these organs of hydrochloric acid , pepsins etc. and protective factors, which include bicarbonates , slime , cell regeneration . In particular, peptic ulcer disease develops in people who have a hereditary predisposition to its manifestation, as well as in those who regularly experience emotional stress and do not adhere to the rules healthy eating.

The causes of peptic ulcer disease are usually divided into predisposing and implementing. Predisposing causes include genetic factors. Some people have a genetically determined increased number of stomach cells that produce hydrochloric acid. As a result, a person suffers from increased acidity. In addition, there are other genetic characteristics that influence the development of peptic ulcers. There are also studies that suggest that peptic ulcers are more common in people who have first blood group .

An important factor is certain features of the neuropsychic state. Those who suffer from impaired functioning are more susceptible to illness autonomic nervous system .

The nutritional factor is also taken into account. The development of peptic ulcers can be facilitated by constant consumption of spicy foods, irregular meals, and the lack of nutritious hot meals in the diet. But until today there is no clear evidence direct impact this factor does not exist for the manifestation of peptic ulcer disease.

Stomach ulcers can also be caused by long-term treatment with certain medications. These drugs include: non-steroidal drugs with anti-inflammatory effects , synthetic adrenal cortex . Taking these drugs can negatively affect the condition of the mucous membrane of the stomach and duodenum. In addition, they activate the aggression of gastric juice and at the same time reduce protective function. If a person suffers from a chronic ulcer, then these drugs can provoke an exacerbation of the disease.

The presence of bad habits can also lead to manifestations of peptic ulcer disease. Strong alcoholic drinks can damage the mucous membrane, and alcohol also increases secretion in the stomach. If alcohol is consumed regularly and for a long period, a person may develop chronic .

Smoking is no less dangerous, since nicotine, like alcohol, increases gastric secretion. At the same time, the blood supply to the stomach deteriorates. But, like the food factor, this reason is still not considered proven.

The underlying cause of gastric and duodenal ulcers is determined by the presence of Helicobacter pylori infection . Infection can occur from eating dirty food or from using poorly sterilized medical instruments.
Helicobacter pylori produces cytotoxins - substances that damage mucosal cells, which can ultimately cause the development of erosion and gastric ulcers. Even if these substances are not produced by Helicobacter, a person develops chronic gastritis.

Symptoms of peptic ulcer

Basically, peptic ulcer of the duodenum and stomach is manifested primarily by pain in the upper abdomen (that is, “in the pit of the stomach”). Most often, the pain becomes intense when a person feels hungry, it mainly manifests itself between meals. Sometimes attacks of pain bother the patient at night. During such attacks, a person has to get up to take medicine or food. In such a situation, help is provided by those drugs that reduce the secretion of hydrochloric acid in the stomach or completely neutralize it. As a rule, about half an hour after eating or the indicated medicines the pain becomes less intense and gradually subsides. In addition, symptoms of a peptic ulcer may include periodic nausea, a feeling of severe fullness in the stomach and a feeling of severe heaviness in it immediately after eating. In more rare cases, the patient suffers from bouts of vomiting, after which a feeling of relief appears. Sometimes a person experiences a noticeable decrease in body weight due to loss of appetite.

In general, the manifestation of symptoms of the disease and its overall clinical picture directly depend on where exactly the pathological process is localized and what stage of the disease occurs.

The first stage is considered to be a condition in which a fresh ulcer of the duodenum or stomach forms. In this case, the main symptom is the manifestation of pain in the epigastric region, which becomes more severe if the person is hungry, and can also appear several hours after the person has eaten. It is at this stage that night pain and severe symptoms appear. dyspeptic syndrome (belching , constipation , nausea ). The patient notes pain on palpation of the abdomen.

The second stage of the disease is the period of initial epithelization of the ulcerative defect. Pain in the epigastric region at this stage occurs mainly during the day. After eating, a person feels noticeable relief. During this period, dyspeptic manifestations are much less pronounced.

The third stage is the period of ulcer healing. At this time, the patient may feel pain exclusively during the manifestation of a feeling of hunger, while no dyspeptic manifestations are observed.

At the fourth stage of the disease, which is remission, the person feels relatively normal and does not express complaints. There is no pain on palpation of the abdomen.

Diagnosis of peptic ulcer

To establish the correct diagnosis, the doctor must familiarize himself with the medical history in order to study the evolution of the disease. When collecting anamnesis, it is important to take into account information about whether the patient has a digestive disorder. Sometimes an ulcer occurs without any visible symptoms, in which case signs of the disease are detected only when a complication of the disease appears.

During the diagnosis process, the patient is also examined. This takes into account whether the person’s body weight is reduced or whether there is pain in the epigastric region.

After this, a variety of paraclinical research methods are used. The simplest test is an x-ray, which can also help detect certain complications of the disease.

But if the patient has signs of complications of a peptic ulcer, then he undergoes a radiographic examination without contrast, fibrogastroduodenoscopy. To rule out cancer, histological analysis is performed on samples that are collected.

Sometimes it is advisable to perform diagnostic laparoscopy, which sometimes turns into laparotomy. As a result, an operation can be performed to eliminate the causes of ulcer complications.

During the diagnostic process, it is also important to determine the presence of Helicobacter pylori infection in the body. For this purpose, a special study of the patient’s blood is performed. When making a diagnosis, it is necessary to differentiate an ulcer from other ailments.

Treatment of peptic ulcer

It is important that the treatment of gastric and duodenal ulcers is carried out comprehensively and in certain stages. At the stage of exacerbation of the disease, its therapy is necessarily carried out in a hospital. Treatment begins immediately after diagnosis. Initially, the patient must adhere to bed rest for several days and strictly adhere to the principles. Complex therapy includes treatment with non-absorbable antacids , antisecretory drugsAnd . In addition, with the help of certain drugs (used, metoclopramide , hydrochloride , ) hypermotor dyskinesia in the gastroduodenal zone is eliminated. If Helicobacter pylori is detected in a patient, a special three-component therapy method is used, which lasts several weeks.

At the second stage, periodic anti-relapse therapy is carried out, a diet is followed, and treatment is performed. vitamin complexes .

At the third stage, it is advisable to conduct a course sanatorium treatment, which is prescribed to the patient approximately four months after hospital therapy.

When treating peptic ulcers, it is important to adhere to certain general principles which are extremely important for recovery. First of all, it is important for the patient to completely quit smoking. This step will contribute to more active scarring of ulcers and reduce the number of exacerbations. You should also reduce your consumption of alcoholic beverages to a minimum. If possible, it is recommended to avoid the use of non-steroidal anti-inflammatory drugs and steroids. If this is not possible, then the dose of the drug should be reduced as much as possible.

It is necessary to adhere to the principles of dietary nutrition. can significantly reduce the frequency of attacks of the disease. It is most important not to eat those foods that make the symptoms of peptic ulcers more intense.

In the treatment of peptic ulcers, herbal medicine has a fairly effective effect. Some herbal decoctions and infusions provide reliable protection mucous membrane, providing an astringent and enveloping effect. In addition, they eliminate pain, promote faster tissue healing, and have an anti-inflammatory effect.

When compiling a collection of herbs for the treatment of peptic ulcers, you should definitely take into account the acidity level of a particular patient. In the treatment of ulcers, infusions of chamomile, calamus roots, licorice, bergenia, marshmallow, fennel fruit, and plantain leaves are used. Treatment with a decoction of St. John's wort, valerian root, chicory, etc. is also effective. A decoction of flax seeds has an effective enveloping effect on the mucous membrane of the stomach and duodenum. Herbal decoctions must be taken several times every day. The general course of treatment lasts at least two months.

The doctors

Medicines

Diet, nutrition for peptic ulcers

To this day, doctors claim that proper nutrition for peptic ulcer disease contributes to a more active cure. It is important that patients, especially those whose ulcers last a long time, take this point into account and adhere to the rules of a healthy diet during peptic ulcer disease. Due to the fact that the main damage, both in the stomach and in the duodenum, appears under the influence of hydrochloric acid, it is imperative to reduce the amount of foods in the diet that stimulate the secretion of gastric juice. If possible, it is better not to use them at all. Dietary food must necessarily contain a sufficient amount of proteins, fats, and vitamins. It is advisable to eat foods that weakly stimulate gastric secretion. These are milk and vegetable soups, boiled fish, and well-cooked meat. It is also recommended to include dairy products, eggs, day-old white bread, porridge with milk, and weak tea in the menu. At the same time, alcoholic and carbonated drinks, canned food, all spicy foods, strong tea and coffee, rich broths from meat, fish, and mushrooms greatly stimulate secretion in the stomach. Therefore, nutrition for peptic ulcer disease should not include these dishes and drinks. In addition, those products that irritate the mucous membrane mechanically are also undesirable to consume. We are talking about radishes, turnips, asparagus, legumes, as well as unripe fruits and fruits with too hard skins. You should also not eat dishes made from products that contain coarse connective tissue - too stringy meat, skin, cartilage.

Prevention of peptic ulcers

Most often, the manifestation of peptic ulcer in humans is observed in autumn or spring. In order to avoid exacerbations, as well as completely prevent the manifestation of peptic ulcer disease, you should definitely ensure proper sleep - at least 6-8 hours a day, and do not eat fried, smoked and fatty foods too often. At the first symptoms of a gastrointestinal disease, you should undergo a full examination by visiting a specialist. It is equally important to carefully monitor the health of your teeth and avoid nervous strain. The disease can be triggered by drinking alcohol and smoking, so it is important to get rid of such bad habits in time. In general, a healthy and active lifestyle and the right attitude towards one’s own health are important for the prevention of peptic ulcer disease.

Complications of peptic ulcer

There is evidence from experts that complications of gastric and duodenal ulcers are more common in males. The most common complication of the disease is considered. Bleeding develops much more often in people with duodenal ulcers.

If the ulcer gradually enlarges, it may eventually expose the vessel wall, which is subsequently destroyed by the acid. After this, internal bleeding appears. Depending on the amount of blood loss, the patient exhibits certain symptoms. But the main signs of bleeding are a feeling of sudden severe weakness, fainting, vomiting, in which scarlet or coagulated blood is released, a sharp decrease in blood pressure. When a patient bleeds, the stool will be liquid and tarry.

It is important to note that bleeding can only be treated in the surgical department of a hospital. To determine exactly where the source of bleeding is located, the patient undergoes a gastroscopic examination. At the time of gastroscopy, the blood is stopped using specially prepared solutions. Also, a vessel that is bleeding can be stitched with paper clips specially used for this purpose. The patient is given intravenous medications that reduce the production of hydrochloric acid.

Even after the bleeding has stopped, the patient is advised to remain in the hospital for several more days under the close supervision of a doctor. If stopping the bleeding is impossible without surgery, the patient undergoes surgery, the type of which is determined by a specialist individually.

When a stomach ulcer develops, there is a risk of ulcer perforation . For this condition, which is also called perforation of the ulcer , characterized by the appearance of a through hole in the wall of the organ affected by the ulcer. Due to the formation of such an opening, part of the contents of the duodenum or stomach ends up in the abdominal cavity. As a result, development occurs peritonitis .

With this complication of the disease, the patient feels acute pain in the epigastric region. These sensations can be compared in intensity to a knife blow to the stomach. The pain is so severe that it threatens to develop a state of shock. Then the pain gradually spreads to one of the lateral sections of the abdomen. In this case, due to such strong pain, a person turns pale, becomes covered in sweat, and his consciousness may become clouded. During such an acute attack, he is forced to remain in a motionless lying position - the so-called “embryo” position. His body temperature rises and his tongue becomes dry.

This condition manifests itself in the patient in three stages: shock initially sets in, followed by a period of imaginary well-being, after which progressive peritonitis develops. Another distinctive symptom of this state is the tense state of the muscles of the anterior abdominal wall.

Ulcer perforation occurs as a consequence of the progression of peptic ulcer disease. More often, perforation is diagnosed in men of working age. It is very important to promptly hospitalize a patient with such a complication, since without surgery the patient is at risk of death. It is impossible to cure the perforation without surgery.

There are also cases of covered perforated ulcer, in which after perforation, after about one hour, the hole is covered by an organ located nearby. But, as a rule, the hole is not tightly covered, so peritonitis still develops.

Its one complication of peptic ulcer is ulcer penetration . With this condition, a hole also appears in the wall of the duodenum or stomach. But at the same time, such a hole will not open into the abdominal cavity, but into those organs that are located nearby. Symptoms of such a complication appear in the patient depending on which organ in question.

However, there are also characteristic general symptoms. In particular, this is severe pain, which only becomes more intense over time and appears constantly. Such pain cannot be relieved with drugs - antacids . An increase in body temperature is characteristic. This pathology can only be treated surgically.

At stenosis of the pylorus and duodenum (this condition is also called obstruction of the pyloric part of the stomach ) food from the stomach enters the intestines with significant difficulties, which arise as a consequence of scarring of the ulcer, which developed either in the initial part of the duodenum or in the final part of the stomach. If such a narrowing is insignificant, then it can be expressed by a feeling of heaviness for some time after consuming food. Periodically, the patient may experience vomiting, after which he notices relief. If stenosis develops further, then some of the food is already retained in the stomach, which, in turn, stretches. The person notes a putrid odor from the mouth, a constant urge to vomit, and severe pain in the abdomen. After some time, the disturbance in the digestive process progresses, and the person becomes noticeably exhausted, his body becomes dehydrated.

List of sources

• V.T.Ivashkin. Recommendations for the diagnosis and treatment of peptic ulcer. Methodological manual for doctors. - M.: 2002;
• I.I. Dyagtereva. Clinical gastroenterology: a guide for doctors. - M.: MIA, 2004;
• Ivashkin V.T., Lapina T.L. Gastroenterology: national guidelines. Moscow: GEOTAR-Media, 2008;
• Isakov V. A., Domaradsky I. V. Helicobacteriosis. M.; 2003;
• Grigoriev P.Ya., Yakovenko E.P. Diagnosis and treatment of diseases of the digestive system. - M.: Medicine, 1996.