ulcer of the stomach. - A disease of the stomach chronic recurrent nature, accompanied by the formation of gastric mucosa defects and located underneath tissue. The main symptom is pain in the epigastric empty stomach or after eating, often radiating to the back and chest. Often there is vomiting, belching, heartburn, nausea. The most dangerous complications - bleeding, perforation of the stomach wall, pyloric stenosis department, malignant degeneration of ulcers. Diagnosed according to a gastroscopy and gastric X-rays, tests for H. pylori infection. Uncomplicated gastric ulcer treated conservatively, in complicated cases, surgical manual.
ulcer of the stomach.
Peptic ulcer - a chronic disease of long-term recurrent nature, expressed in the ulceration (ulcer occurrence) of the mucous lining of the stomach. It should be distinguished from a peptic ulcer, symptomatic ulcer (arising as a consequence of other factors yazvoprovotsiruyuschih), which tend to have acute and safely cured after removal of the trigger which caused them. Factors causing symptomatic stomach ulcers: stress (stress ulcers), reception gastrotoxicity drugs (iatrogenic ulcer), diseases of the endocrine glands, metabolism disorders (endocrine plague) and other diseases of internal organs and systems (secondary ulcer), increased secretion as a consequence of gastrinprodutsiruyuschey tumor - gastrinoma (Zollinger-Ellison syndrome). The main factor in the development of gastric ulcer is an infection with the bacterium Helicobacter Pylori.
renal or liver failure, severe tissue hypoxia. When exposed to several stress factors the likelihood of stress ulcer increases markedly. The mechanism of development - is an imbalance in the influence of factors, damaging the mucous membrane and the factors that protect it. In a situation where all the organs and systems work in emergency mode, there is a significant release into the blood corticosteroids and catecholamines that enhance the secretory activity of mucous glands and, at the same time reducing its protective properties. Also disrupted trophic gastric tissue wall formed hemorrhage, which in turn contributes to ulceration of the mucous. Localized stress ulcers predominantly in the walls of the body and fundus. Very rarely, they are formed in the duodenum.
Types of stress ulcer:
gastric mucosal damage by type of erosions and ulcers occur in half of the cases of these conditions, but in most patients, stress ulcer is not diagnosed, because after improvement and cure the underlying pathology, which served as a stress factor, the ulcer heals alone. However, when prolonged action ulceration damaging situation may be deep and cause gastric wall perforation with peritonitis.
Medication or drug ulcers occur as a result of taking the drugs, have side effects gastrotoksicheskim. Ulzerogennosti (causing ulcers) have the effect of most anti-inflammatory drugs (corticosteroids, non-steroidal anti-inflammatory drugs), sulfonamides, potassium chloride, caffeine, corticosteroids, digitalis drugs, anticoagulants, nitrofurans.
The mechanism of mucosal damage in different drugs also differ, it could be a direct damaging effect (potassium chloride) and indirect: decrease protective properties of mucous while suppressing generation gastroprotective prostaglandins (nonselective antiinflammatory drugs hormonal and non-hormonal series), increased secretion of gastric juice (glucocorticosteroids reserpine, caffeine), suppression of normal trophism of the gastric wall. Most drugs combine direct mucosal damage to the indirect action.
As a rule, after the cancellation of drug therapy ulcerogenic drugs ulceration and erosion of the mucosa heal safely. However, the risk of ulcers that may be complicated by bleeding and perforation of the stomach wall.
When gastritis and gastric ulcer or duodenal ulcer ulcerogenic appointment of drugs can provoke the development of disease exacerbation, this such patients, drugs with side effect gastrotoksicheskim appointed only if absolutely necessary and with caution, accompanying therapy receiving gastroprotective agents.
Excessive production of PTH parathyroid glands is called hyperparathyroidism. These hormones are responsible for the regulation of calcium metabolism in an organism, however one of the effects of parathyroid hormone action is to increase the production of hydrochloric acid gastric mucosal glands. The excess calcium ions in the blood and stimulates acid secretion and gastrin. When hyperparathyroidism ulcers tend to occur in the mucosa of the duodenum. In the stomach, they are characterized by antral localization. Current giperparatireoznoy ulcers rather severe, with frequent pain, responds poorly to conservative treatment, tends to recur and is often complicated by bleeding and perforation of the stomach wall. Often, ulceration of the stomach lining may be complicated by a disease of the digestive system: liver cirrhosis, pancreatitis. ulcers can also occur as a consequence of chronic diseases of the respiratory and excretory systems, diabetes.
Peptic ulcer is the same development mechanisms as duodenal ulcer, and is also classified.
bleeding, perforation of the stomach. With the localization of ulcers in the pyloric stenosis may develop pyloroduodenal department. Localized ulcers in the stomach also have a high risk of malignancy, unlike ulcers duodenum 12.
Gastroscopy - endoscopic examination of the stomach. Also pronounced pitting can be detected by X-ray contrast stomach. In a study of gastric contents produced bakposev to detect helicobacter. With the same purpose, use a breath test, detection of Helicobacter using PCR and ELISA. General and biochemical blood tests may show signs of anemia, if there is bleeding from the ulcerated walls, specific signs of an ulcer can not be detected in laboratory studies. Kal is also possible to investigate in order to identify the hidden bleeding (fecal occult blood).
surgery is not required. Surgical removal of the stomach (resection) is prescribed only in case of serious complications: perforation, obstruction, malignancy ulcers with the development of gastric cancer. Occasionally resorting to surgery if persistent disease is often recurrent, recalcitrant to conservative therapy.
Treatment of symptomatic gastric ulcers requires, first of all, the removal of provoking ulcer factor. Usually, it is enough for a positive effect. The use as adjunctive therapy agent decreasing acid secretion (proton pump inhibitors, H2-gastroprotectives). Reducing the secretory activity of gastric ulcer can be achieved surgically - by performing vagotomy.
Prevention and prognosis of gastric ulcer
Prevention of gastric ulcers, as well as duodenal ulcer, is early detection and treatment of H. pylori infection of the gastrointestinal tract, avoiding stressful situations, uncontrolled medication and regular balanced meals. Uncomplicated gastric ulcers with timely detection and appropriate therapy are cured successfully. Prognosis in the development of complications.