Duodenal ulcer
Duodenal ulcer – deep damage to the mucous membrane of the duodenum, a consequence of exacerbation of duodenal ulcer.
Sometimes “ulcer” is actually called peptic ulcer of the stomach and duodenum (duodenal ulcer).
Peptic ulcer disease is a chronic, recurrent disease characterized by the formation of stomach ulcers and duodenal ulcers in the exacerbation phase.
BRIEF PHYSIOLOGICAL DATA
The stomach is an organ of the digestive system, the main function is the digestion of proteins and partially fats.
The glands of the stomach produce gastric juice, which contains digestive enzymes necessary for the breakdown of large molecules of proteins and fats into smaller ones. The stomach maintains an acidic environment due to hydrochloric acid produced by the parietal cells of the stomach. The acidic environment serves to activate digestive enzymes, as well as to protect against bacteria ingested with food.
Gastric juice with a high level of acidity and digestive enzymes (“aggression factors”) is an aggressive environment not only for pathogenic microorganisms, but also for its own gastric mucosa and DPC – the next part of the digestive tract, where it gets from the stomach.
In the mucous membrane of the stomach and duodenum, there are mechanisms that protect their walls from “self-digestion”. These include a layer of mucus that covers the epithelium of the mucosa, HCO3 – ions that neutralize acid under the mucus layer; intensive blood supply and a high rate of mucosal regeneration. Regulate protective processes, in particular, local hormones – prostaglandins E and I2.
The separated duodenum contains HCO3 -ions, which neutralize HCl from gastric juice, which protects the underlying parts of the small intestine from the aggressive effects of acid.
CAUSES OF PEPTIC ULCER DISEASE
The disease develops when the action of damaging mechanisms begins to prevail over the action of protective ones. The reasons for the weakening of protective factors may be: stress, improper diet, genetic predisposition, smoking, alcohol consumption, taking NSAIDs and glucocorticoids.
Relatively recently, the participation of the bacterium Helicobacter pylori in the development of the disease was discovered. It secretes enzymes that damage the epithelium of the stomach, and promotes excessive acid production.
Some people are genetically resistant to the action of Helicobacter pylori.
FEATURES OF THE OCCURRENCE OF DUODENAL ULCER
An increase in acid production leads to an accelerated evacuation of stomach contents into the duodenum. An acidic environment forms in the lumen of the duodenum, which provokes the destruction of the mucosa. Acidification of the contents of the underlying parts of the intestine leads to a violation of their motility.
SYMPTOMS OF DUODENAL ULCER
The appearance of symptoms indicates a possible exacerbation of the disease.
The main symptom of exacerbation is pain in the upper half of the abdomen on an empty stomach, one and a half to 3 hours after eating or at night. The pain is relieved after eating, can radiate to various parts of the abdomen and back; often accompanied by vomiting and decrease after it.
If the ulcerative process has moved to the pancreas or to the gallbladder (penetration of the ulcer), pain can be determined in the left or right hypochondrium, respectively.
Early symptoms are heartburn and belching.
Constipation occurs due to impaired intestinal motility.
DIAGNOSIS OF DUODENAL ULCER
The diagnosis is made based on the patient’s complaints, an objective examination of the patient by a gastroenterologist, surgeon or therapist (pain during palpation, etc.) and additional research methods. These include radiography, fibrogastroduodenoscopy (the most informative method), clinical blood analysis.
When a patient is taken to a medical institution urgently with symptoms of an acute abdomen (for example, with perforation of an ulcer), the diagnosis is made during laparotomy or laparoscopy.
TREATMENT OF DUODENAL ULCER
Treatment depends on the phase of the disease.
In the acute phase, the patient is prescribed drugs that reduce the secretion of hydrochloric acid, antacids, gastroprotective drugs, antibacterial drugs, the spectrum of action of which includes action on H.pylori.
It is recommended to eliminate negative factors (smoking, alcohol, stress), a diet is prescribed that excludes irritation of the mucous membrane (table No. 1a). The same recommendations are given to patients in the remission phase.
During remission, if there is no risk of gastrointestinal bleeding, physiotherapy is prescribed.
If, despite ongoing conservative treatment, recurrent duodenal ulcers recur, the patient is shown surgical treatment.
COMPLICATIONS OF DUODENAL ULCER
Duodenal ulcer can cause such formidable complications as perforation (perforated duodenal ulcer, perforation is accompanied by the exit of the contents of the intestine into the abdominal cavity), penetration and bleeding. These complications lead to the development of peritonitis (and in case of bleeding – also to blood loss), therefore they are life-threatening and require emergency surgery.
*Thus, the phrase “exacerbation of duodenal ulcer” is incorrect. An ulcer is an exacerbation of duodenal ulcer.
