Peptic ulcer (peptic ulcer) is an open ulcer that forms on the mucosa of the lower part of the esophagus, stomach or duodenum.

The most common manifestation of peptic ulcer is abdominal pain.

The peptic ulcer that occurs on the gastric mucosa is called a stomach ulcer (peptic ulcer). Ulcers can occur in the lower part of the esophagus, and in the duodenum (duodenal ulcer).

Modern science believes that peptic ulcer is not caused by acute food, and not even by stress at work. Today, we can say with confidence that bacterial infection and the administration of certain drugs play a leading role in the development of peptic ulcer.

Causes of peptic ulcer.

A peptic ulcer occurs when certain damaging factors cause the erosion of the mucosa in the esophagus, stomach or duodenum. Our digestive tract is covered with a mucosa that protects it from the effects of acid. This shell is constantly restored and produces protective factors that help to resist an aggressive acidic environment.

The following causes can cause damage to the mucosa:.

Bacterial infection H. pylori.

The common cause of peptic ulcers is the bacterium Helicobacter pylori. pylori lives and multiplies in the gastric mucosa, at a very low pH. This microorganism is found in many people. Usually H. pylori does not cause problems, but sometimes it starts to erode the mucous membrane, forming an ulcer.

Helicobacter is transmitted by close contact, including with kisses. People also become infected with H. Pylori through food and water. Among people who live in crowded and unsanitary conditions, the percentage of infected H. Pylori is very high.

Regular intake of pain medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs or NSAIDs) are one of the main causes of peptic ulcer formation. Virtually all NSAIDs disrupt the work of the enzyme of cyclooxygenase type 1 (COX-1). This leads to a weakening of the protective factors of the mucosa and the formation of ulcers.

These drugs include Aspirin, ibuprofen (Nurofen), Naproxen (Nalgezin), Ketoprofen (Ketonal), Ketorolac (Ketanov, Ketorol), Diclofenac sodium (Voltaren, Olfen) and other drugs.

Peptic ulcers most often occur in elderly people who have been taking NSAIDs for a long time about arthritis. To avoid such problems, you should take NSAIDs after eating. If you have a peptic ulcer, be sure to inform the doctor when he will prescribe medications to you. Some pain relievers (paracetamol) do not cause a peptic ulcer.

Admission of other drugs.

Many other drugs are also associated with a high risk of peptic ulcer formation. Among them, preparations for the treatment of osteoporosis from the group of bisphosphonates (Fosamax).

Risk factors for peptic ulcers:.

• Smoking. Smoking dramatically increases the likelihood of ulcer development in people who are already infected with Helicobacter pylori.

• Alcohol. Alcoholic drinks irritate and contribute to the erosion of the gastrointestinal mucosa. Alcohol also increases the production of acid in the stomach.

• Stress. It is believed that stress is not a cause of peptic ulcer development, but it can be a predisposing factor. We are subjected to stress all the time - for example, during emotional overload, physical trauma, surgeries, diseases, etc..

Symptoms of peptic ulcer.

Pain is the most common symptom of peptic ulcer. With an ulcer, a stinging pain in the stomach. Pain occurs as a result of contact of the ulcerated stomach wall with aggressive gastric juice.

Pain with peptic ulcer can:.

• Appear anywhere, from the navel to the sternum.

• To get worse on an empty stomach.

• Disturb at night.

• Periodically disappear and worsen.

• Passing after taking an antacid or some products.

Other signs of peptic ulcer are:.

• Nausea and vomiting.

• Vomiting with blood (coffee grounds).

• Admixture of blood in the stool (tar color chair).

• Unexplained weight loss.

• Disturbance of appetite.

When should I see a doctor?.

Visit the doctor as soon as you notice the above symptoms. OTC antacids and acid blockers can alleviate your symptoms, but they will not solve the problem. Moreover, prolonged use of proton pump blockers or antacids can mask gastric cancer, which sometimes manifests itself with the same symptoms as peptic ulcer.

Complications of peptic ulcer.

• Gastrointestinal bleeding. This bleeding is very slow, manifested only by anemia and a minor admixture of blood in the stool. But bleeding can be severe, which requires immediate hospitalization and blood transfusion.

• Infection. The peptic ulcer is able to make a hole in the wall of the stomach or intestine, which leads to infection in the abdominal cavity (peritonitis).

• Scarring. An ulcer can form a scar tissue that disrupts the passage of food. This is manifested by a rapid sensation of overfilling after eating, vomiting and weight loss.

Diagnosis of peptic ulcer.

To detect an ulcer, the doctor can prescribe such tests and procedures:.

Test for H. pylori.

First of all, tests are recommended to determine the presence of H. pylori in the body. Tests can be different, depending on the situation. It can be a blood test, a stool test or a breath test.

For a breath test, the patient drinks a glass of water containing a substance with radioactive carbon. pylori cleaves this substance in the stomach. After this, the patient must blow into a special container. If a person is infected with H. pylori, then the sample will contain the same radioactive isotope.

Endospokia.

For endoscopy, the doctor enters into the patient through the mouth a flexible hollow tube provided with a video camera. This tube (endoscope) can pass through the esophagus and stomach, up to the duodenum. With the help of an endoscope, you can consider ulcers on the mucosa, as well as a biopsy - take a piece of tissue for analysis.

Biopsy helps identify H. pylori in the gastric mucosa. In addition, a biopsy is used to confirm cancer. For this reason, it is recommended to do endoscopy for elderly patients with signs of bleeding, as well as for those who have abdominal pain accompanied by weight loss and difficulty swallowing.

X-ray.

X-rays of the upper digestive tract can be used to detect ulcers. A series of X-ray images helps to find problems in the esophagus, stomach and duodenum. For X-rays, you need to drink a solution of contrast medium (barium salt), which envelops the walls of the digestive tract and improves the image quality in the pictures.

Treatment of peptic ulcer.

Treatment for peptic ulcers usually involves antibiotics to kill bacteria H. pylori. Other drugs are prescribed to reduce the acidity of gastric juice, relieve pain and speed up the reparative processes. Probably, antibiotics will have to be taken within a week or two, and acid-lowering drugs - for several months.

If the peptic ulcer is not associated with H. pylori, then you do not need antibiotics. Instead, the doctor will recommend another treatment, depending on the specific situation. Acid-lowering drugs will help to heal the ulcer more quickly, and analgesics will relieve the pain.

Treatment of peptic ulcers may include:.

Antibiotics against H. pylori.

If H. pylori is detected in the patient's stomach, antibiotics such as amoxicillin (Ospamox), clarithromycin (Clacid), metronidazole (Flagil), tetracycline and others are prescribed.. Duration of treatment can reach 10-20 days. In different countries there are different approved schemes for the therapy of Helicobacter pylori infection.

Preparations blocking the production of hydrochloric acid.

Proton pump inhibitors effectively block the basal and stimulated secretion of hydrochloric acid in the gastric lining cells. They have a strong and lasting effect. Among these medications, omeprazole (Omega), rabeprazole (Pariet), esomeprazole (Nexium), pantoprazole (Proxium), lansoprazole (Lansa). Long-term use of drugs in this group increases the risk of fractures of bones. In addition, taking proton pump inhibitors without examination by a doctor can mask the symptoms of stomach cancer, which will delay the diagnosis.

Another group, H2-histamine blockers, is often used to reduce acid production in the stomach. These drugs are well tolerated, in most countries are available without a doctor's prescription. These include: ranitidine (Ranigast, Histak), famotidine (Kwamatel), cimetidine (obsolete agent), and the drug Nizatidine (Axid).

Antacid agents.

Antacids are substances that chemically neutralize hydrochloric acid in the stomach. Modern antacids are considered the safest, although not the most effective, drugs for eliminating heartburn and treating peptic ulcers.

Antacids can be supplied in the form of suspensions, tablets for resorption. Modern forms provide a rapid onset of the effect (from 2-3 minutes). This group of drugs include the famous Rennie, Maalox, Almagel, Gastal, Gaviscon and others. Among the side effects of antacids, we can note constipation or diarrhea (depending on the composition of the drug).

Preparations protecting the mucosa of the digestive tract.

In some cases, the doctor prescribes cytoprotective drugs that help protect the mucosa from aggressive digestive juices. These include misoprostol (Cytotec), sucralfate (Venter), colloidal bismuth sub-citrate (De-Nol), and others.

Lack of treatment outcome.

Usually, drug treatment is successful, leading to a complete cicatrization of the ulcer. But if the symptoms continue to bother you, despite the treatment, the doctor can perform endoscopy to rule out more serious diseases. In some cases, the peptic ulcer simply does not respond to medication. There are many reasons for the resistance of the ulcer to treatment.

Among the most common:.

• Incorrect medication, skipping or underestimation of doses.

• Resistance of some strains of H. pylori to antibiotics.

• Regular use of NSAIDs and other ulcerogenic drugs.

• Smoking in the presence of peptic ulcer treatment.

Less often the reasons of inefficiency of therapy can be:.

• Stomach cancer.

• Hyperproduction of acid (Zollinger-Ellison syndrome).

• Infection caused by other bacteria (not Helicobacter pylori).

• Other diseases that cause ulceration of the gastrointestinal tract, such as Crohn's disease.

Advice for patients.

With peptic ulcers, simple and helpful advice can help you:.

Adhere to a healthy diet.

Patients with ulcers should not switch to a meager and monotonous diet. On your table should be cereals, vegetables, fruits, meat dishes. Nutrition, poor in proteins, vitamins and trace elements, does not contribute to the healing of ulcers. Some products can cause you unpleasant sensations - limit them. Talk to your doctor about a special diet for patients with ulcers.

Discuss the substitution of pain medication.

It often happens that an elderly person falls ill with an ulcer, for example, suffering from arthritis. Such a patient can be difficult without anesthetics. But with an ulcer, traditional NSAIDs are contraindicated. The doctor may recommend substituting ibuprofen or diclofenac for paracetamol, a safer drug. Do not continue to take regular NSAIDs, because treatment of the ulcer may be ineffective.

Control stress.

Stress can worsen symptoms of peptic ulcer. Reconsider your lifestyle and habits. Identify the main points that cause stress in you, and try to smooth them. Sometimes stress is inevitable, but you have to learn how to cope with it.

Quit smoking.

Smoking negatively affects the gastric mucosa, making it susceptible to damaging factors. Smoking also increases the acidity of gastric juice. If necessary, discuss with your doctor how to treat nicotine dependence.

Limit alcohol.

Alcohol irritates and damages the mucosa of the digestive tract. A patient with a stomach ulcer does not just have to limit alcohol, but generally refuse it.

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