Peptic ulcer and 12 duodenal ulcer - a chronic disease, the main expression of which is recurrent gastric or duodenal ulcer, occurs in the background gastritis.
According to classical concepts, ulcers formed by imbalance between aggressive and defensive mechanisms of the gastrointestinal mucosa.
For aggressive factors include
- hydrochloric acid,
- digestive enzymes,
- bile acids;
to protective -
- mucus secretion,
- epithelium cell renewal,
- adequate blood flow to the mucous membrane.
Causal value H. Pylori for chronic gastritis It defines 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 linked c aggression factors for peptic ulcer. The most important result of its destruction - reducing the frequency of relapses.
Manifestations of peptic ulcer
Ulcer pain duodenum appear within half an hour after a meal there at night, hungry (that is, arising on an empty stomach) pain in pancreatic area or right upper quadrant, which extend after meals, antacids reception, ranitidine, omeprazole.
Vomiting acidic stomach contents can occur at the height of pain, vomiting after the patient experiences relief (some patients self-induce vomiting to reduce pain).
Pain that occurs after 30 minutes - 1 hour after a meal are more typical for the localization of ulcer in the stomach.
Manifestations of peptic ulcer also include nausea, heartburn, belching.
Naturally, there are cases with atypical symptoms: lack of communication characteristic of pain with food intake, lack of seasonality of exacerbations do not rule out this diagnosis. So-called dumb exacerbation of the disease is difficult to suspect and recognize correctly.
Diagnostics
Symptomatology of the disease sufficiently bright, and the diagnosis is not difficult in a typical case. Be sure to spend esophagogastroduodenoscopy.
Full diagnosis of peptic ulcer disease should include objective information about the presence of H. Pylori. Many laboratories performing urea breath test with urea.
For analysis requires only two samples of exhaled air, the method allows to monitor the success of the treatment.
The technique of polymerase chain reaction (PCR) to determine H. Pylori in stool. The method has a sufficient sensitivity and specificity.
Treatment of gastric ulcers and 12 duodenal ulcer
The principles of treatment of peptic ulcer:
- the same approach to the treatment of gastric and duodenal ulcers;
- mandatory basic therapy, reduces the acidity;
- choice of reducing the acidity of the product, supporting the intragastric acidity> 3 about 18 hours a day;
- appointment of reducing the acidity of the drug in a strictly defined dose
- endoscopic examinations with 2-week intervals;
- duration of treatment depending on the terms of ulcer healing;
- H. pylori therapy if indicated;
- mandatory monitoring of treatment efficacy in 4-6 weeks;
- repeated courses of therapy for its inefficiency;
- supporting preventive treatment.
The protocol involves the treatment of peptic ulcer disease primarily conducting basic therapy, the purpose of which is to eliminate pain and digestive disorders, as well as the achievement of scarring of the ulcer in the shortest time.
Drug treatment comprises administering drugs that reduce gastric acidity, in strictly defined dose. The duration of treatment depends on the endoscopic inspection results, which performed with a two week interval (t. e. after 4, 6, 8 weeks).
Each patient with gastric ulcer and 12 duodenal ulcer, which in the gastric mucosa revealed N. Pylori by some method (rapid urease test, morphological method by determination of DNA by polymerase chain reaction and the like. D.) Is carried antimicrobial therapy. This therapy involves the combination of several antimicrobials.
Eradication therapy 2 lines
- Blockers, proton pump 2 times a day;
- Colloidal bismuth subcitrate 120 mg x 4 times;
- Tetracycline 500 mg x 4 times;
- Metronidazole 250 mg x 4 times;
- Duration of treatment 7 days.
At a dose of 400 mg 2 times a day as an alternative schemes proposed combination pilorida (ranitidine) with one of antibiotics - clarithromycin (250 mg four times or 500 mg 2 times a day) or amoxicillin (500 mg 4 times day).
Eradication therapy protocol requires mandatory monitoring of its effectiveness, which takes place 4-6 weeks after her closure (during this period the patient does not accept antimicrobials) using a breath test or polymerase chain reaction. While maintaining N. Pylori in the gastric mucosa, a second course of eradication therapy with therapy 2nd line with the subsequent control of its effectiveness as 4-6 weeks.
Inefficiency of medical treatment of patients with gastric ulcer or duodenum 12 can manifest itself in two ways: chastoretsidiviruyuschem during peptic ulcer disease (t. e. with a frequency of exacerbations 2 times per year and above) and forming refractory gastroduodenal ulceration (ulcers without scarring within 12 weeks of continuous treatment).
Determinants chastoretsidiviruyuschee for peptic ulcer are:
- colonization of the gastric mucosa H. pylori;
- nonsteroidal anti-inflammatories (diclofenac, Ortophenum, ibuprofen and others.);
- existence of previous ulcer bleeding and perforation of the ulcer;
- low "compliance", i.e. lack of willingness of the patient to cooperate with the doctor, which manifests itself in failure patients to stop smoking and drinking alcohol, taking drugs irregular drugs.