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Stomach ulcer

Peptic ulcer is a chronic recurrent disease characterized by the development of peptic ulcer of the mucous membrane of the stomach or duodenum.

The prevalence of peptic ulcer in the structure of gastroenterological pathology is from 3.6 to 14.8%. Boys and girls get sick equally often, only after 14 years the number of patients among young men is greater.

Distinguish peptic ulcer of the stomach and duodenum. Duodenal ulcer occurs 3 times more often than gastric ulcer.

One of the causes of peptic ulcer is congenital inferiority of the cells of the gastric mucosa, an increase in the mass of the parietal and main cells, a hereditary deficiency in the production of IgA The aggravating factors are:

1) heredity;

2) H. pylori;

3) violation of the evacuation of food from the stomach;

4) acute and chronic psycho-emotional stressful situations;

5) nutritional factor;

6) the effect of drugs;

7) endocrine disorders.

In recent years, the main etiological factor is considered infection with H. ru1op. Microorganism often enters the body at an early age, mainly in the first three years of life, most often from the mother in the period after the termination of breastfeeding, since breast milk contains antibodies. The child may have loose stools and vomiting. Since an accurate diagnosis is not established during this period, the infection has no clinical signs. During the period of exacerbation, defects in the mucous membrane associated with the destruction of cells are formed.

The development of peptic ulcer is the result of an imbalance between the factors of protection and aggression of the mucous membrane. Aggressive factors include:

1) a high level of hydrochloric acid and pepsin;

2) the presence of Helicobacter;

3) violation of the function of the gastrointestinal tract, contributing to the casting of bile acids into the stomach. Duodenal ulcer is a consequence of increased factors of aggression. With gastric ulcer, there is a decrease in the protective properties of the mucous membrane, which are manifested by the release of a layer of mucus, the production of integumentary epithelium of alkaline secretion and prostaglandins that regulate these processes.

Usually, a ulcerative defect occurs at the site of ischemia, which reduces the protective function of the mucous membrane. This process occurs as a result of hemorrhage or thrombosis at the site of active inflammation of the mucous membrane.

In terms of size, small ulcers are distinguished - with a diameter of up to 0.5 cm, medium - up to 1 cm, large - up to 2 cm, giant - over 2 cm.

There are four stages of the ulcerative process:

1) fresh ulcer;

2) the beginning of ulcer defect epithelization;

3) healing of a mucosal defect;

4) stage of remission.

The main clinical manifestation of peptic ulcer is pain: in accordance with the stage of the disease, the nature of the pain is different. In the first stage, it is initially uncertain, appears suddenly, sharply, is localized in the epigastric region. The difference in pain with gastric ulcer is its appearance shortly after eating. With localization of the ulcer in the duodenum, pain appears 2 hours after eating (late pain), often starving and nightly pains appear. Peptic ulcer disease is characterized by seasonal exacerbation. The pains are usually paroxysmal, often radiating to the sternum, lumbar spine or right lumbar region. The rhythm of pain is noted: hunger — pain — temporary relief after eating.

Pain can accompany heartburn; belching; relief vomiting.

In addition, irritability, tearfulness, sleep disturbance, headache, sweating appear.

In the second stage of pain, they acquire a pulling, aching character. Eating brings relief, there are no night pains.

In the third stage, the intensity of the pain decreases. After eating, they disappear.

In the fourth stage, there are no symptoms of the disease.

Palpation with peptic ulcer causes pain in the epigastric region.

Often, peptic ulcer disease in childhood is asymptomatic, with less severe pain, lack of seasonality of the disease.

A complication of the disease can be:

1) bleeding;

2) stenosis of the duodenal bulb;

3) penetration;

4) perforation.

With a mild course of the disease, the ulcer heals in a month, remission can last up to a year or more. In the case of moderate severity, the healing period may be more than a month, remission - less than a year. In severe cases, complications can occur, exacerbations occur more often than twice a year, the healing period of ulcers is long.

Diagnostics. Decisive is endoscopic and radiological studies.

At the first stage, a mucosal defect to the muscle layer is detected, it is surrounded by a hyperemic fiber, the bottom of the ulcer is usually covered with plaque, bleeding vessels, multiple erosions are visible. In addition to endoscopy, abdominal ultrasound is performed, according to indications, an X-ray examination with barium. Fractional gastric sounding, intraventricular Ph-metry, rheogastrography are performed.

With a biopsy of the mucosa, histological, bacteriological, biochemical studies of the gastric mucosa are performed.

In addition, antibodies to Helicobacter are serologically determined, the polymer chain reaction method (a study based on the recognition of DNA of microorganisms) is used, etc.

Currently, at least two studies are prescribed:

1) determination of the presence of ammonia of the stomach (urease tests);

2) immunological studies.

All this makes it possible to determine the presence of helicobacteria. Treatment

There are two types of treatment for peptic ulcer. The conservative method is used in uncomplicated form, surgical treatment is used in the presence of complications.

Conservative therapy consists of basic and individual treatment. Basic therapy includes limitation of motor activity, diet, prescription of medication.

Individual treatment depends on the characteristics of the course of the disease.

Since the complete repair of the gastric mucosa lags behind in terms of the disappearance of the clinical manifestations of the disease, complete clinical and endoscopic remission occurs in 1-2 years, depending on the severity of the disease.
During this period, children must follow a diet. She must:

1) to be full in quantitative and qualitative terms;

2) cause minimal irritation and excitement of the stomach;

3) to be with a fractional meal: up to 5-7 times a day, in small portions, with thorough chewing.

The diet of table 1a is prescribed for 7 days with an exacerbation of peptic ulcer, then table 1b is prescribed for 14 days, then table No. 1 for a year.

Diet No. 1. Indications: peptic ulcer of the stomach and duodenum during exacerbation, chronic gastritis with impaired secretory function during exacerbation.

General characteristic: diet with physiological content of proteins, fats and carbohydrates, restriction of salt, moderate restriction of mechanical and chemical irritants of the mucous membrane and receptor apparatus of the gastrointestinal tract, stimulants of gastric secretion.

Culinary processing: all dishes are cooked boiled or steamed. Some baked dishes are allowed. Diet - 5-6 times a day.

Drug therapy. Combined therapy of peptic ulcer is based on localization, age of the patient, features of secretion, the presence or absence of Helicobacter pylori infection, concomitant diseases. The basic principles of the treatment of peptic ulcer:

1) agents that suppress H. ru1ogts

2) the use of drugs that reduce the intensity of exposure to aggressive acid-peptic factor;

3) improving the regenerative ability of the gastric mucosa;

4) if there is evidence of sedative therapy. Anti-Helicobacter pylori therapy is prescribed for a recurrent course and long-term non-healing ulcers. It includes at least two drugs: amoxicycline (amoxiclav, flemoxin, etc.) and macrolides (rovamycin) or semi-synthetic tetracycline (doxycycline, monocycline, etc.). With Helicobacter pylori infection and its prevention, amoxicillin, clarithromycin, tetracycline are the most effective.

Antacid therapy. Magnesium oxide, almagel, and vicalin are used as antacid therapy. The courses of treatment are prescribed individually.

Antispastic therapy is prescribed to reduce tone and reduce contractile activity of the smooth muscles of the stomach and duodenum. For this purpose, papaverine, no-spa is prescribed in age-related dosages.

Tserukal or Motilium are prescribed for nausea and vomiting.

Gastroprotectors. Blockers of H2 receptors of the II — IV generation (zantac, famotidine) are used. These drugs suppress the secretion of hydrochloric acid, contribute to ulcer epithelization. They are used in an age dose 2 times a day before meals, 1 time at night for 4-6 weeks.

Currently, proton pump blockers have appeared, such as omeprazole, lansoprazole.

Stimulating therapy. It is carried out using methyluracil, pentoxin, potassium orotate, riboxin.

Of the sedatives, if indicated, valerian, bromine, motherwort, which have a calming effect, are prescribed; drugs that normalize sleep.

In the complex treatment of peptic ulcer, physiotherapy is also used: paraffin baths, ultrasound, diathermy, calcium electrophoresis. Physiotherapy exercises are also used. Group and individual training methods are used. In addition to general developmental exercises for the abdominal press are gradually introduced. They are performed without tension with a small number of repetitions, without unpleasant sensations. Respiratory exercises are prescribed various, with a deepening of diaphragmatic breathing. Applied exercises in relaxation. After the disappearance of pain and dyspeptic disorders, classes continue 2-4 times a week with a gradual increase in load to an average level. Walking and light running are included.

Treatment of complications. When bleeding etamsylate is administered intravenously or intramuscularly at an age-specific dosage, epsilon-aminocaproic acid, plasma-replacing solutions and blood products are transfused. The patient is provided with complete rest, a rubber bladder with ice is placed on the stomach area. The child is transferred to the surgical department. If ulcer perforation is suspected, the child is immediately treated in the surgical department.

Spa treatment. Indication for referral to the resort is a peptic ulcer in remission, contraindications are incomplete remission, pyloric stenosis.

The healing factors of the resorts are used.

1. Sanatorium-resort regime.

2. Therapeutic nutrition (table No. 1 with 4-5 meals a day, chemically and mechanically sparing, quantitatively and qualitatively complete, fortified) - 1 month.

3. Mineral waters of the Smirnovskaya type No. 1, 2, Essentuki No. 4 are used. With normal evacuation and motor function of the stomach, mineral water is prescribed at the rate of 3 ml / kg of mass. Water is taken on an empty stomach.

4. Balneotherapy is provided by the appointment of sodium chloride or radon baths lasting 5-12 minutes, 10-12 procedures are prescribed.

5. Mud and ozokerite applications on the area of ​​the duodenum, 6-12 procedures.

Prevention

Distinguish between primary and secondary prevention. Primary includes rational nutrition from an early childhood, the organization of a regimen in accordance with age, the creation of a favorable microclimate in the family, physical education and sports.

Secondary prevention consists of maintenance therapy with half-dose antisecretory drugs for several months daily in the evening.

In other cases, therapy is performed on demand when symptoms of an exacerbation of the disease appear.

Clinical observation is carried out for five years after the exacerbation, then the patient is deregistered after the examination.

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