Symptoms and signs of stomach and duodenal ulcers

An ulcer is a defect in the lining of the stomach and duodenum, extending beyond its mucosa, affecting the submucosal and muscular layers. There are actually several types of ulcers, but when talking about this pathology, people usually mean peptic ulcer disease, or a benign peptic ulcer, which occurs due to prolonged persistence (that is, the existence) of the bacterium Helicobacter pylori (Hp) in the stomach or duodenum. . The disease occurs with alternating periods of well-being (remission) and exacerbations, and is characterized by a tendency to complications in 1-4 out of 10 patients. What ulcers are like, the causes, risk factors and mechanisms of their occurrence, as well as the symptoms and signs of gastric and duodenal ulcers will be discussed in our article.

Symptoms

The disease progresses in waves. Exacerbations alternate with periods of well-being. Well-being worsens in spring or autumn under the influence of provoking factors: stress, alcohol, errors in diet.

Typical signs

In the classic course of peptic ulcer disease, patients present the following complaints:

• aching, cutting or boring pain under the xiphoid process on the right; they occur 1.5-2 hours after eating, on an empty stomach, at night and decrease after taking milk or food;
• nausea;
• heartburn;
• belching;
• tendency to constipation.

Atypical signs

Sometimes complaints arise that are not characteristic of a duodenal ulcer. This makes diagnosis very difficult.

• intense pain in other parts of the abdomen - such patients have to exclude acute surgical pathology;
• pain in the lumbar region - “radiculitis mask”;
• absence of complaints - “silent” ulcers that manifest themselves with sudden bleeding.

Diet for duodenal ulcers

Diet is one of the main methods of treating diseases of the stomach and intestines.

The attending physician should tell the patient with an ulcer about what can be consumed and what should be avoided.

The diet suggests the following:

• fractional meals;
• maintaining equal intervals between meals;
• complete abstinence from alcoholic beverages;
• thermal sparing of the stomach and duodenum;
• proper cooking;
• exclusion from the menu of prohibited foods, dishes and drinks.

Therapeutic nutrition for ulcers involves eating 4-6 times a day. Portions should be small.

You need to eat every 3-3.5 hours. The principle of thermal sparing must be observed.

This means not eating food that is too hot or cold. This can cause severe pain and even bleeding.

Errors in nutrition during the treatment of ulcers are the main cause of complications and frequent relapses.

You need to completely give up alcohol, as it provokes an exacerbation.

Nutrition for duodenal ulcers involves mechanical sparing of the mucous membrane.

You need to chew your food thoroughly and don’t eat it dry. Before eating, it is recommended to drink a glass of warm water.

The better the food is crushed and moistened with saliva, the less gastric juice is required to digest it.

The intestines are very sensitive to certain foods. The diet involves chemical sparing of the duodenal mucosa.

All patients need to give up spices, fried foods, smoked meats, chips, spicy foods, citrus fruits, tomatoes, canned food, fatty meats and foods that cause fermentation in the intestines (cabbage, legumes, radishes, milk).

You can't eat rye bread. Among drinks, preference is given to sweet juice, jelly, compote, and bicarbonate mineral water. Herbal teas have a good effect on the mucous membrane.

Chewing gum and seeds are prohibited, as they increase the secretion of gastric juice.

For peptic ulcers, you can eat boiled or stewed meat, fish, cereals, mucous and vegetable soups, dried bread, boiled and fresh vegetables, sweet fruits, cottage cheese, kefir.

The nutritional value of the diet should be about 2000 kcal. You can't eat fried foods.

Causes

Food soaked in gastric juice enters the duodenum. Hydrochloric acid and enzymes have a powerful irritating effect. Normally, substances are produced that protect the mucous membrane: mucus, prostaglandins, endorphins. Damaged cells are renewed every 3-5 days. When the balance between the factors of aggression and defense is disturbed, ulcerative defects are formed.

The disease develops due to a combination of several reasons:

• Heredity . Relatives of patients with duodenal ulcers get sick 5-10 times more often than other people.
• Helicobacter pylori infection. These bacteria are present in 100% of patients with duodenal ulcer. They secrete substances that damage the mucous membrane and reduce its protective properties.
• Medicines : Indomethacin, Aspirin, steroid hormones. After stopping these medications, the ulcers heal quickly.
• Nutritional Features . Rough, spicy, too hot and cold food increases the secretion of gastric juice and hydrochloric acid.
• Stressful situations . With psycho-emotional stress, the functioning of the autonomic nervous system is disrupted. Stress provokes exacerbations of the disease.
• Bad habits . Alcohol and nicotine irritate the mucous membrane, stimulate the production of hydrochloric acid, and inhibit protective factors. Nicotine causes vasospasm and impairs blood supply to the intestinal wall.
• Concomitant diseases . With chronic pathology of the heart and respiratory organs, the oxygen content in the blood decreases, and the nutrition of internal organs, including the intestines, deteriorates.

Causes of duodenal ulcer

In medicine, it is widely believed that duodenal ulcers are caused by the bacterium Helicobacter pylori. Less commonly, chronic obstructive pulmonary disease, long-term use of non-steroidal anti-inflammatory drugs, renal failure, celiac disease, Crohn's disease, liver cirrhosis and others lead to the development of the disease.

The following factors significantly increase the risk of developing duodenal ulcers:

• Hereditary predisposition to the disease (presence of pathology in older family members).
• Incorrect use of medications, in particular NSAIDs, antibiotics and painkillers.
• The patient has neuropsychiatric diseases, frequent stress and nervous tension.
• Poor nutrition, with a predominance of fatty, fried foods, fast food, processed foods and flour products in the diet.
• Having bad habits - smoking, alcoholism or drug addiction.

Diagnostics

The diagnosis and treatment of peptic ulcers is carried out by a therapist and gastroenterologist. In case of complications, consultation with a surgeon is indicated.

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History taking and examination

At the first stage, the doctor clarifies the nature of the pain, its duration, conditions of occurrence, and asks about other complaints. During the conversation, he finds out the possible causes of the disease.

The next stage is a general inspection. The doctor assesses the condition and color of the skin and mucous membranes, identifies swelling, measures height, weight, and blood pressure. Then he listens to the heart and lungs. With peptic ulcers, patients often experience disruptions in the functioning of the autonomic nervous system:

• cold damp palms;
• “marbling” of the skin;
• rare pulse;
• low blood pressure.

Next, the doctor begins to palpate (feel) the abdomen. The following symptoms are characteristic of a duodenal ulcer:

• soreness and tension in the abdominal muscles under the xiphoid process on the right;
• pain in this area when tapping with bent fingers.

Laboratory research

• Clinical blood test - no changes in uncomplicated ulcers; decrease in hemoglobin and red blood cells during bleeding.
• Fecal occult blood analysis is the simplest method for diagnosing occult intestinal bleeding;
• Urinalysis, blood biochemistry - without pathology;
• Examination for Helicobacter pylori - blood test (detection of specific antibodies), stool analysis, urease breath test, histology and cytology of the material obtained from the biopsy.
• Daily monitoring of intragastric pH – assesses the secretion of hydrochloric acid. With peptic ulcer disease it increases.

Instrumental methods

• FGDS is the main method for diagnosing the disease. During an endoscopic examination, an ulcer is found, its shape and size are assessed, the stage of the pathology is determined, and a biopsy is taken. In case of exacerbation, the edges of the defect are swollen, bright red, the bottom is covered with a coating of fibrin. With treatment, these signs gradually decrease and the ulcer heals. In the remission phase, scars are visible at the site of the defect.
• X-ray examination with a contrast agent - after taking barium porridge, several pictures are taken. The ulcer looks like a niche of various shapes; the duodenum can be deformed due to scars.
• Ultrasound of the abdominal organs - used if another pathology is suspected. The condition of the liver and pancreas is assessed, cysts, tumors, and infiltrates in the abdominal cavity are identified.

Symptoms

The symptoms of duodenal and gastric ulcers are very similar. The most basic symptom of these diseases is pain. It usually appears no earlier than an hour after eating. Hunger pains are felt at night or in the morning. Their nature depends on the characteristics of the organism and is expressed in different ways. The pain varies in duration and intensity. Most often localized to the right of the epigastric region. If the duodenal ulcer is located closer to the end of the organ, then the pain shifts to the left. They are caused by a violation of the integrity of the walls of the organ, the inflammatory process and the accumulation of metabolic products. Symptoms and treatment of different types of disease have some differences.

Almost every third case of duodenal ulcer is accompanied by heartburn. Vomiting and nausea are common symptoms of duodenal ulcer.

Indigestion becomes common. The stool becomes liquid. But sometimes an ulcer of the duodenal bulb can manifest as constipation that lasts for a week. Blood and mucus can be found in the stool. The patient suffers from increased appetite, however, due to poor absorption of food, a decrease in body weight is observed. Spasm of the bile ducts leads to stagnation of bile, as evidenced by the appearance of a yellowish coating on the surface of the tongue.

Changes in psycho-emotional state are another characteristic symptom of duodenal ulcer. A person constantly experiences irritation and nervous tension. In addition, patients with duodenal ulcers often suffer from insomnia.

The disease is closely related to pathological processes in other digestive organs - gastritis, cholecystitis. Therefore, the list of symptoms for duodenal ulcers in these cases is much wider.

Complications

Complications arise against the background of exacerbation of the disease:

• Ulcerative bleeding – develops in 10-15% of patients. Its intensity varies. Hidden bleeding does not manifest itself in any way and is detected only by laboratory methods. Massive - has characteristic symptoms: bloody vomiting, black stools, weakness, dizziness, decreased blood pressure.
• Perforation is the formation of a through defect in the wall at the site of the ulcer with the release of the contents of the duodenum into the abdominal cavity. This complication occurs in 6-20% of patients. When perforation occurs, severe abdominal pain suddenly appears.
• Penetration – penetration of an ulcer into neighboring organs: pancreas, bile ducts, liver. At the same time, the nature and location of pain changes.
• Stenosis of the duodenum is a narrowing of its lumen due to swelling of the mucous membrane and cicatricial changes. Combined with pyloric stenosis. Due to obstruction of intestinal patency, vomiting, rotten belching, and weight loss occur.

Treatment of duodenal ulcers with folk remedies

If there is a duodenal ulcer, treatment includes various folk remedies.

This is not an independent method of therapy, but only an addition.

The following folk remedies are the most effective:

1. potato juice;
2. decoction based on flax seeds;
3. sea ​​buckthorn oil;
4. herbal infusions and decoctions.

In case of heartburn, it is recommended to consume foods with an alkaline reaction. All patients benefit from eating oatmeal.

It has a mucous consistency, which helps reduce pain and speed up the healing of the ulcer.

An excellent remedy is flax seeds. They have anti-inflammatory, healing, bactericidal, enveloping and analgesic effects.

They can be consumed raw with a little water.

This remedy also helps in cases of constipation caused by ulcers. Decoctions and infusions are prepared based on the seeds.

It is recommended to take them half an hour before meals. Each time you need to prepare a new decoction, as the old mixture quickly loses its beneficial properties. Treatment with folk remedies must be approved by a doctor.

Thus, treatment of ulcers is predominantly medicinal.

If complications develop (perforation, penetration and bleeding), surgery may be required.

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Treatment

Treatment of uncomplicated peptic ulcer is carried out in a clinic. The main goals of therapy: elimination of symptoms, suppression of Helicobacter pylori, scarring of the ulcer. In case of severe pain, ineffectiveness of outpatient therapy, or development of complications, hospitalization is indicated.

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Diet

Proper nutrition is the basis for the treatment of duodenal ulcer.

General principles

• a complete diet containing all the necessary nutrients and calories;
• eating in a calm environment, in small portions 5-6 times a day;
• mechanical sparing of the stomach and intestines: products are boiled in water, steamed, crushed using a blender or sieve;
• chemical sparing: exclude dishes that stimulate the production of gastric juice;
• thermal sparing: exclude too hot and cold dishes and drinks. The optimal food temperature is 40 °C.

List of products and dishes

Medications

For peptic ulcers, anti-Helicobacter therapy is always prescribed: a combination of several drugs that suppress the activity of the microbe Helicobacter pylori, promoting the healing of the ulcer. The regimen and duration of medication intake are determined individually.

• Antibiotics (Amoxicillin, Metronidazole, Clarithromycin, Doxycycline). Two antibiotics are used simultaneously.
• Bismuth preparations (De-nol, Venter) - coat the intestinal walls, have a healing and antibacterial effect.
• Proton pump blockers (Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole) - reduce the production of hydrochloric acid, pepsin, and reduce heartburn.

4-6 weeks after completion of the course of treatment, a control test for Helicobacter is carried out.

Other drugs are also used in the treatment of peptic ulcers:

• Antacids (Rennie, Maalox, Almagel Neo) - contain magnesium and aluminum hydroxide and react chemically with hydrochloric acid. Antacids quickly eliminate heartburn and pain. They are prescribed in addition to the main therapy.
• H2 blockers (ranitidine, famotidine) – duodenal ulcer is combined with high acidity. The drugs suppress the production of hydrochloric acid.
• Antispasmodics (No-shpa, Papaverine, Dicetel, Buscopan) - relieve spasm of the smooth muscles of the intestinal wall, reduce pain.

To monitor the effectiveness of treatment, FGDS is performed once every 2 weeks.

Folk remedies

Use traditional medicine recipes in addition to the main treatment after consulting a doctor.

Potato juice

Potatoes without sprouts and green spots, rinse well, peel, chop in a blender or grate on a fine grater, squeeze out the juice using gauze. Take half a glass half an hour before meals for at least 10 days.

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Cabbage juice

Rinse the cabbage leaves well, chop them using a food processor or meat grinder, and squeeze out the juice. Take half a glass three times a day half an hour before meals for a week. Then take a break for 3 weeks and repeat the course.

Surgery

Surgery for peptic ulcer disease is performed routinely or urgently (according to health reasons).

Indications for surgery

Emergency surgery is performed when life-threatening complications develop.

Planned surgery - in the following situations:

• ineffectiveness of conservative treatment, frequent relapses;
• repeated bleeding;
• multiple ulcers;
• drug intolerance;
• narrowing of the duodenum.

Types of operations

• Suturing an ulcerative defect is performed when the ulcer is perforated, if the patient’s condition or the surgeon’s qualifications do not allow radical surgery to be performed.
• Gastric resection - the lower 2/3 of the stomach is removed, the remaining part is connected to the duodenum end to end (according to Billroth 1) or to the jejunum end to side (according to Billroth 2).
• Trunk vagotomy - the trunk of the vagus nerve is crossed, and pyloric plastic surgery is performed.
• Selective proximal vagotomy - the branches of the vagus nerve are crossed.

Recovery period

To prevent postoperative complications, patients are recommended early activation:

• move your arms and legs and do breathing exercises on the first day after surgery;
• get out of bed on day 2;
• drink no more than half a glass per day on day 2;
• gradually increase the volume of liquid drunk to a liter by day 4; allowed drinks: compote, vegetable broth, jelly;
• from day 5 – pureed semi-liquid food, then gradually expand the diet;
• remove the sutures on the 8th day.

The duration of treatment in hospital is 2 weeks.

Treatment regimen for duodenal ulcer

Treatment of duodenal bulb ulcer is carried out after diagnosis and exclusion of other diseases.

The main examination method is FEGDS. The acidity of the stomach must be measured.

A drug approach to treating patients is justified in the absence of complications.

The treatment regimen is selected taking into account the following factors:

• microbiological examination results;
• drug tolerance;
• contraindications;
• stomach acidity level.

In the absence of complications, they resort to drug therapy.

The following groups of medications help against duodenal ulcers:

1. antibiotics (macrolides, penicillins, nitroimidazoles);
2. antacids;
3. gastroprotectors;
4. proton pump blockers;
5. H2-histamine receptor blockers.

Pathogenetic therapy is of greatest importance. It is aimed at suppressing the production of hydrochloric acid and protecting the mucous membrane from damage.

It is possible to treat duodenal ulcers with folk remedies, but this is not always effective.

Such therapy is carried out with the permission of a gastroenterologist.

Eradication of Helicobacter bacteria

If a person has a duodenal ulcer and a positive test for antibodies to Helicobacter bacteria, antibacterial therapy is required.

These microorganisms can live in an acidic environment for years.

They play a large role in the development of gastric and duodenal ulcers.

These microbes promote increased synthesis of hydrochloric acid, which further aggravates the situation.

The most effective antibiotics are macrolides (Erythromycin-Lect, Ecositrin, Klabaks OD, Fromilid Uno, Fromilid), penicillins (Ampiox), nitroimidazoles (Metrogyl, Trichopol).

These medications for ulcers are taken in the form of tablets for oral administration.

The regimen and duration of treatment are determined by the doctor.

Macrolides are the most effective. Antibiotics for ulcers should not be taken for a long time, as they inhibit the natural intestinal microflora.

This can cause dysbiosis and chronic diseases. These medications are combined with proton pump blockers.

These are indispensable drugs for treating duodenal ulcers at home.

Reducing the acidity of the duodenum

Antibiotics alone are not enough to get rid of this disease.

Any experienced gastroenterologist knows how to cure a duodenal ulcer.

For increased acidity, proton pump blockers are prescribed.

These ulcer medications inhibit the production of stomach acid (hydrochloric acid). These drugs are used to treat and prevent relapses.

There is a large selection of proton pump blockers available on the market.

The main active ingredients in them are omeprazole, lansoprazole, pantoprazole, esomeprazole and rabeprazole. The most commonly prescribed medicine is Omez.

The drugs Nexium, Pariet, Nolpaza, Khairabezol, Sanpraz, Peptazol, Panum, Controloc, Epicur are in great demand.

Proton pump inhibitors have almost completely replaced histamine receptor blockers.

The disadvantage of the latter is that they can cause withdrawal symptoms.

Protection of the intestinal mucosa

Duodenal ulcer is an indication for the prescription of medications that protect the mucous membrane.

The most effective drugs are Venter and De-Nol.

These medications form a protective coating in the area of ​​the mucosal defect.

Venter is used to treat peptic ulcers in the acute stage. The De-Nol tablet helps with this pathology.

This drug contains bismuth salts. Analogues of this medicine are Novobismol, Escape and Ulcavis - all of these are antiulcer drugs.

De-Nol is available in the form of film-coated tablets. The main active ingredient is bismuth tripotassium dicitrate.

The medicine is contraindicated for use in severe renal failure, during pregnancy and lactation, in children under 4 years of age, as well as in case of individual intolerance.

For duodenal ulcers, treatment involves taking medications such as Vikair and Vikalin.

These medications not only protect the mucous membrane, but also inhibit Helicobacter bacteria. They do not affect the secretion of hydrochloric acid.

Use of symptomatic remedies

Treatment of duodenal ulcers includes the use of antacids.

This is a large group of medications that neutralizes hydrochloric acid.

These are symptomatic drugs that quickly eliminate pain and heartburn.

These medications have astringent and adsorbent effects.

Antacids are not recommended for use for more than 2 weeks due to possible side effects.

These medications are an addition to the main therapy.

Not every person knows how to treat a duodenal ulcer with antacids.

The most popular drugs are the following: Maalox, Rennie, Phosphalugel, Almagel, Gaviscon. They are available in the form of suspension and tablets.

Prevention

There are two groups of preventive measures: primary and secondary.

Primary activities

Primary preventive measures reduce the risk of peptic ulcer disease in people with a hereditary predisposition.

• quitting smoking and alcohol;
• stress management;
• proper nutrition;
• good sleep;
• examination for Helicobacter in chronic gastritis.

Secondary events

Secondary measures reduce the risk of exacerbations and complications if the diagnosis has already been established. Patients with peptic ulcer disease are monitored by a general practitioner and a gastroenterologist. Every year they undergo FGDS and examination for Helicobacter pylori.

In addition to primary measures, it is recommended:

• timely anti-Helicobacter therapy;
• prophylactic use of omeprazole when prescribing anticoagulants (drugs to prevent the formation of blood clots), acetylsalicylic acid, any non-steroidal drugs, hormones;
• physiotherapy, preventive course of medications in spring and autumn.

Classification of peptic ulcers

According to the causative factor, ulcers are divided into:

• HP-positive (when Helicobacter pylori is detected - accounts for about 90% of cases of peptic ulcer in residents of Eastern European countries);
• HP-negative (medicinal or symptomatic);
• mixed.

Depending on location:

• stomach ulcer;
• duodenal ulcer;
• combined ulcers – located in both organs.

Depending on the number of ulcerative defects:

• single;
• multiple.

Depending on the diameter of the defect:

• small – up to 5 mm;
• average – 5-10 mm;
• large – more than 1 cm;
• giant – more than 3 cm in the stomach or more than 2 cm in the duodenum;

Depending on the level of gastric secretion:

• with normal secretion;
• with increased secretion;
• with reduced secretion.

Depending on the stage of the disease:

• exacerbation;
• remission.

Depending on the type of complications:

• perforation (perforation);
• penetration (penetration of an ulcer into adjacent organs and tissues);
• bleeding;
• pyloric stenosis (narrowing of the gastric outlet);
• malignancy, or malignancy.

Forecast

The following factors influence the results of treatment:

• the nature of changes in the mucous membrane - the number, size of ulcers;
• management tactics - selection of the optimal drug therapy regimen, laboratory and FGDS - control; unreasonably low doses of drugs and a short period of treatment contribute to the exacerbation of the disease.
• individual characteristics of the body - in elderly patients with concomitant chronic diseases, ulcers take longer to heal;
• adherence to treatment - following a diet, eliminating risk factors, taking medications accelerates the healing of the ulcer.

When Helicobacter pylori is removed from the body, the risk of relapse does not exceed 7%.

Causes of peptic ulcer

The main cause of duodenal ulcers is the bacterium Helicobacter Pylori.
The main source of the disease is the bacterium Helicobacter Pylori, which produces substances that damage the mucous membrane and cause inflammation. Other factors predispose to the development of pathology. These include:

• Heredity. An increase in the number of cells that synthesize hydrochloric acid or a decrease in the secretion of components of gastric mucus that protects the walls of the organ is determined at the genetic level;
• Neuropsychic characteristics of personality. An ulcer often develops in excitable people under the influence of stress, negative emotions, and excessive mental stress;
• Poor nutrition. An abundance of spicy, sour, salty dishes, irregular meals lead to disruption of the production of gastric juice;
• Taking medications. Some non-steroidal anti-inflammatory and analgesic drugs have an irritating effect;
• Bad habits. Regular smoking and frequent consumption of alcoholic beverages lead to damage to the mucous membrane.

Over a long period of time, a duodenal ulcer may have minor symptoms such as discomfort in the upper abdomen or mild digestive disorders that quickly resolve. If you do not pay attention to them in time and do not take the necessary measures, the disease progresses and enters the acute stage.

Surgical intervention

If it is not possible to cure a stomach and duodenal ulcer with drugs and other methods, surgery is recommended. This happens very rarely. Surgery is also indicated for complications: bleeding, perforation, obstruction of the pyloric canal.

To prevent this from happening, it is necessary to treat diseases in a timely manner, and when the first signs of a stomach and duodenal ulcer appear, consult a doctor.

Forms of duodenal ulcer

According to the location of the ulcer:

• bulbar, or bulbous (anterior wall, posterior wall, “mirror”);
• post- or retrobulbar (proximal or distal), found in no more than 3% of cases.

Depending on the phase of the inflammatory process:

• exacerbation;
• fading exacerbation;
• remission;
• relapse of duodenal ulcer.

The disease is classified according to severity as follows:

• newly diagnosed duodenal ulcer;
• hidden course (asymptomatic);
• mild severity – the disease worsens no more than once every 1–3 years, responds well to conservative therapy, exacerbations last up to 1 week;
• moderate severity – 2 exacerbations during the year, during which patients are hospitalized, it takes up to 2 weeks to relieve the symptoms of an exacerbation, complications often develop;
• severe form - continuously recurrent, exacerbations occur more often than twice a year, patients during exacerbations are subject to hospital treatment, this form is characterized by complications, severe digestive disorders, intense, persistent pain.

Duodenal ulcer disease is registered more often in males, and is more common among young patients and mature patients (up to 50 years).

Depending on the size and depth of the ulcerative defect (according to the results of FGDS):

• small defect – no more than 5 mm in diameter;
• large ulcer – more than 7 mm;
• giant ulcerative defect – more than 15-20 mm;
• superficial ulcer – depth no more than 5 mm;
• deep ulcer – depth exceeds 5 mm.

Depending on the type of intestinal motility disorder, duodenal ulcer can occur in a hyper- or hypokinetic type.

Morphological types of ulcerative defect (ulcer):

• fresh defect;
• migrating ulcer;
• chronic ulcer (with no signs of scarring for more than 1 month);
• scarring ulcer;
• callous ulcer (long-term non-healing, formed by scar tissue);
• complicated ulcer.

Causes and risk factors

The main cause of duodenal ulcer (in almost 100% of cases) is infection with the microorganism Helicobacter pylori. The role of these bacteria in the development of inflammatory changes in the mucous membrane of the stomach and small intestine was identified in 1981 by Barry Marshall and Robin Warren, and in 2005 they were awarded the Nobel Prize for their discovery. Helicobacter are not only the main causative agents of gastritis and peptic ulcers, but are also considered representatives of class I carcinogens.

Helicobacter pylori is a rod-shaped, S-shaped, curved microorganism equipped at one of the poles with several (2 to 6) flagella. Moving quickly inside the gastrointestinal tract, it penetrates the mucus covering the intestinal walls, thanks to its flagella it corkscrews into the thickness of the intestinal wall, colonizes and damages it, causing duodenal ulcer. The optimal conditions for the existence of Helicobacter pylori are an ambient temperature of 37 to 42 ° C and an acidity level of 4–6 pH, which explains the vulnerability of the initial parts of the small intestine, where the pH varies from 5.6 to 7.9.

Most often, duodenal ulcers are caused by the bacterium Helicobacter pylori.

The source of infection is a sick person or a bacteria carrier - a person in whose body bacteria are present without causing symptoms of duodenal ulcer. Infection occurs through the fecal-oral or oral-oral route (Helicobacter pylori is excreted in saliva, dental plaque, feces) through direct contact, consumption of contaminated products, use of cutlery, toothbrushes, etc. contaminated with Helicobacter.

Despite the fact that Helicobacter pylori infection is the main cause of duodenal ulcer, there are a number of other factors that can trigger the disease:

• acute and chronic psycho-emotional stress;
• alcohol abuse, smoking;
• nutritional factor (systematic consumption of rough, spicy, excessively hot or cold food provokes gastric secretion and excess production of hydrochloric acid);
• taking gastrotropic drugs that have a damaging effect on the inner lining of the organ (non-steroidal anti-inflammatory drugs, salicylic acid derivatives, glucocorticosteroid hormones);
• chronic diseases of the gastrointestinal tract (cirrhosis, chronic pancreatitis);
• pressure on the mucous membrane of voluminous neoplasms localized in the submucosal layer;
• acute hypoxia (trauma, massive burns, coma);
• extensive surgical interventions (production of hydrochloric acid, one of the factors of aggression, increases up to 4 times within 10 days after surgery);
• severe diabetic ketoacidosis;
• occupational hazards (heavy metal salts, pesticides, vapors from paints and varnishes, aromatic hydrocarbons).

In developed countries, the incidence of duodenal ulcer varies from 4 to 15%.

Risk factors for developing duodenal ulcer:

• hereditary predisposition (approximately 3-4 out of 10 people suffering from this disease have a family history);
• the presence of blood type I increases the risk of developing an ulcer on the mucous membrane of the duodenum by almost 40%;
• stable high concentration of hydrogen chloride (HCl) in gastric juice;
• identification of histocompatibility antigens (Human Leukocyte Antigens) B15, B5, B35;
• congenital deficiency of gastroprotectors;
• diseases of the respiratory and cardiovascular systems, in which there is a decrease in the efficiency of external respiration (chronic obstructive bronchitis, bronchial asthma, heart failure, etc.), while generalized oxygen starvation develops, including the mucous membrane of the duodenum, leading to inhibition of local protective factors; and etc.

The pathogenesis of duodenal ulcer is an imbalance between aggressive influences (infection with Helicobacter, excessive production of HCl and aggressive digestive enzymes, impaired intestinal motility, autoimmune aggression, dysfunction of the parasympathetic component of the ANS and the sympathadrenal system, etc.) and protection (mucosal barrier , active regeneration of the intestinal epithelium, fully functioning local microvasculature, production of prostaglandins, enkephalins, etc.).

What to do during an attack

If symptoms of duodenal ulcer occur, you should consult a doctor. Threatening symptoms (continuous vomiting with blood, fever, loss of consciousness, abnormal blood pressure and pulse rate) are a reason to call an ambulance. If there are no dangerous symptoms, you can alleviate the condition at home. For this:

• you need to give up food;
• take a comfortable position in bed;
• drink an antispasmodic drug (No-Shpa, Buscopan, Duspatalin);
• an hour later, drink an antacid (Phosphalugel, Maalox, Gaviscon);
• during an attack, you can only drink clean water without gas;
• After your condition improves, you can eat boiled rice or oatmeal.

Improvement of the condition does not mean the disappearance of the problem. Most likely, the pain will appear again later, so it is worth making an appointment with a doctor as soon as possible. Before consulting a doctor, you are allowed to regularly eat porridge and light soups (without allowing breaks between meals of more than 3 hours).

Medical actions to treat and monitor the patient's condition

In the stage of exacerbation of gastric and duodenal ulcers, a gastroenterologist and therapist conduct a daily examination of the patient. In the hospital department, the patient is regularly cared for by middle and junior medical staff.

Medicines during exacerbation

By order of the Russian Ministry of Health, a list of medications for the treatment of stomach and duodenal ulcers was approved:

• muscarine receptor blockers (atropine, platyphylline, pirenzepine, amizil);
• histamine receptor blockers (ranitidine, famotidine, cimetidine, nizatidine, roxatidine);
• proton pump inhibitors (omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole);
• antacid drugs (Maalox, Gastal, Rennie, Almagel, Phosphalugel);
• mucus production stimulants (misoprostol, enprostil, carbenoxolone);
• for the formation of a protective film (colloidal bismuth subcitrates, sucralfate);
• astringents (De-nol, Vikair, Vikanol);
• antibiotics and antiprotozoals (amoxicillin, metronidazole, clarithromycin, levofloxacin, azithromycin, josamycin);
• regeneration stimulants (methyluracil, Solcoseryl, Actovegin);
• antispasmodics (No-shpa, papaverine);
• normalization of intestinal motor function (Cerucal, Motilium);
• sedatives and tranquilizers (Amitriptyline, Dalargin).

Antibiotic treatment regimens for Helicobacter pylori infection are carried out using a three-component method or quadruple therapy.

The triple regimen is carried out with two combinations of medications.

First method (duration from seven to ten days):

• pantoprazole 20 mg per day;
• clarithromycin 0.1 g twice a day;
• amoxicillin 1 g twice a day.

Second scheme (from one to two weeks):

• pantoprazole 40 mg or omeprazole 20 mg or lansoprazole 30 mg twice daily;
• clarithromycin one quarter of a gram twice a day;
• Metronidazole at a dosage of 0.4 g twice a day.

Four-component scheme (duration ten days):

• pantoprazole 40 mg per day;
• tetracycline 0.5 g four times a day;
• colloidal bismuth 100 grams four times a day;
• Metronidazole 0.4 g four times a day.

Auxiliary procedures

Physiotherapy for exacerbation of peptic ulcer of the duodenum and stomach is used in the absence of complications in the attenuation phase.

Physiotherapeutic treatment methods:

• applications with paraffin (white warm paraffin is applied to the abdominal area an hour before bedtime);
• ozokerite (warming compresses with anti-inflammatory, analgesic effects);
• mud therapy (application of silt sulfide mud to the epigastric region, enhances reparative regeneration, eliminates spasms);
• diathermy (heating tissues and organs using passing electric current);
• inductothermy (a disk-inductor with a current of 180 Ma is placed on the epigastric region for 10 minutes, procedures ten times every other day);
• UHF therapy;
• ultrasound therapy (1-2 after meals, procedures every other day 12-20 times);
• electrophoresis with 5% novocaine solution;
• aprofen-electrophoresis;
• pine, radon, pearl baths;
• acupuncture.

In the attenuation phase or during the period of remission, sanatorium treatment with drinking mineral waters is indicated.

Diet during exacerbation of peptic ulcer

For diseases of the digestive tract, stomach and duodenal ulcers, including during exacerbations, dietary therapy is indicated. Types of therapeutic nutrition: Table 1a, 1b, 1.

Diet Table 1a

The goal of the Pevzner Diet is to restore the functions of the mucous membrane and minimize the irritating effect on it. In the acute period of peptic ulcer disease, it is recommended to adhere to Table 1a for 6-8 days.

Diet features:

• restriction of carbohydrates, salt;
• exclusion of broths, roughage, all vegetables;
• exclusion of heavy foods (mushrooms, tough meat);
• food is served in ground form after preliminary boiling;
• dishes are served at medium heat;
• eating 6 times a day in strictly limited quantities;
• exclude fried, spicy, marinades, alcohol;
• emphasis on milk and milk porridges.

Diet Table 1b

At the end of Dietary Table 1a, move on to Table 1b. The goal is to relieve inflammation, nutritious nutrition, and scarring of lesions. The duration of dietary therapy on this table is up to two weeks.

Table Base 1b:

• food is served in mashed form;
• without broths, coarse foods, some vegetables, mushrooms, tough meat;
• Canned baby puree from vegetables and meat is allowed;
• introduce puree from boiled, steamed potatoes, carrots, beets;
• meals 6 times a day;
• Dairy products are recommended.

Diet Table 1

After Table 1b they move to Table 1. The period of dietary nutrition before moving to the general table ranges from two to six months.

Basic principles of Table 1:

• Broths, spicy, fried, raw vegetables, alcohol are prohibited;
• Before eating, food is boiled and wiped; if the condition improves, the condition is allowed without rubbing;
• salt is allowed in moderation;
• white crackers and fruit juices are introduced;
• milk is a priority;
• Vegetable oil and butter are added from fats;
• after 2-3 months, boiled vegetables and peaches are introduced.

The essence of pathology

All parts of the gastrointestinal tract are interconnected. Inflammatory processes in one of them provoke functional and organic changes in adjacent sections. The condition of the duodenum depends on the proper functioning of the stomach. Failures in the functioning of aggressive (acid-forming) and protective (alkalinizing) mechanisms, damage to the bile ducts, and improper functioning of the gastric sphincter cause acidic stomach contents to enter the duodenum.

In this case, irritation of the walls of the small intestine occurs, and the intestinal epithelium may degenerate into the gastric epithelium. The result of such changes is the extinction of the secretory and contractile functions of the duodenum, and the further progression of digestive disorders.

With the chronic course of these changes, the membranes of the duodenum become increasingly irritated, and foci of chronic inflammation arise. This process is accompanied by the gradual death of duodenal cells and the spread of inflammatory infiltration to the muscular and serous membranes. Necrotic changes provoke end-to-end damage to the small intestine, which is an ulcer.

FAQ

Question: Why should you not drink alcohol if you have a duodenal ulcer? Is it possible to drink non-strong drinks, such as wine?

Answer: Alcohol in any form is a source of ethyl alcohol. Ethanol is a poison that has a toxic effect on all living cells. In addition to the direct negative impact on the gastrointestinal tract (irritation, destruction of protective mucus, stimulation of acid production), alcohol provokes disturbances in the functioning of the pancreas and liver. Alcohol abuse accelerates the development of pancreatitis and hepatitis, and increases the risk of their progression to pancreatic necrosis and cirrhosis of the liver. Alcohol also disrupts the functioning of the endocrine and nervous systems, changing all types of regulation of the body and destabilizing all organoleptic systems.

If you have a duodenal ulcer, you should stop drinking alcohol of all types and strengths; it is undesirable to drink even in small doses. The reason for this is a possible decrease in the effectiveness of drug therapy. During remission of a peptic ulcer, it is the consumption of alcoholic beverages (often while eating a large meal) that causes a relapse.

Question: Is it possible to treat duodenal ulcers with sea buckthorn oil?

Answer: Sea buckthorn oil is rich in bioactive substances and vitamins. This remedy is available in all pharmacies and has long been used to heal ulcers and accelerate the regeneration of mucous membranes. The oil regulates the production of hydrochloric acid and accelerates the healing of erosive defects in the mucous membrane of the stomach and duodenum. Antioxidant properties help prevent chronic inflammation from developing into cancer. In folk medicine, the remedy is recommended for use for all gastrointestinal diseases. Traditional medicine practitioners rarely prescribe the oil, considering it too weak.

Sea buckthorn oil can be used as part of a complex treatment for duodenal ulcers in parallel with antibiotics and other medications prescribed by a doctor. Use a teaspoon of oil 3 times a day, half an hour before meals. If the patient has chronic disorders of the pancreas or liver, you should consult a doctor before use.

Question: Is it possible to consume fermented milk products?

Answer: Any products with a strong taste are prohibited from being consumed during an exacerbation of duodenal ulcer. Fermented milk products are no exception. In the first 10 days after the onset of an exacerbation, you cannot eat them (only low-fat cottage cheese is allowed). As you recover, the diet of the strict diet expands; it includes biscuits, crumbly cereals and fermented milk products (provided they are well tolerated).

Nutrition

If a sick person follows a diet and diet, then the risk of exacerbation of duodenal ulcers is reduced.

There are certain requirements for organizing nutrition for peptic ulcers of this organ:

1. Nutrition should be balanced, rich in vitamins and varied.
2. The calorie content of food should be 2000 Kcal.
3. The number of meals is 5 times, the portions are small so that they are easily digested.
4. Food temperature - room temperature (25-30 degrees), cooked by boiling or steaming.
5. Food should not be too salty, sour, fatty, or spicy; smoked - prohibited.
6. The consistency of the food should envelop the intestines (preferably grated).
7. Drinks - herbal teas (mint and lemon balm), non-carbonated mineral waters of Essentuki No. 4 and Borjomi, natural juices and rosehip decoctions.
8. Use only approved products: low-fat dairy products, lean fish and meat, rice, buckwheat, rolled oats, crackers, boiled and steamed fruits and vegetables (zucchini, potatoes, eggplant, carrots, beets), vegetable oils (corn, sunflower, olive, sea buckthorn ), vegetable puree soups.
9. Do not eat spicy, fried, smoked, pickled, salted, pickled, fatty (including meat and fish) and spicy foods, sour fruits and vegetables (tomatoes, citrus fruits, pineapples), fresh bread and baked goods, canned food.
10. You can add a small amount of butter to porridge.
11. Sugar should be replaced with honey.
12. Marshmallows, jam, and marmalade rich in pectin are allowed as dessert.

Diagnosis of duodenal ulcer

During the consultation, the doctor will carefully listen to the patient’s complaints. It is important to tell the specialist the time and duration of the discomfort in the abdomen, where it hurts the most, where the discomfort radiates, and what other symptoms are bothering you. You also need to remember what foods the patient consumed before the attack occurred. Since there is a genetic predisposition to peptic ulcer disease, the doctor will ask the patient about the presence of gastrointestinal problems in his close relatives.

Next, the doctor begins an examination - palpating the abdominal cavity to identify areas of increased sensitivity or pain. If a duodenal ulcer is suspected, a further examination is prescribed, which consists of laboratory and instrumental diagnostics:

• general blood test - reflects the presence of inflammation in the body;
• urine and stool analysis - reflect the presence of complications;
• fibrogastroduodenoscopy - endoscopic examination of the esophagus, stomach and duodenum (the most informative in terms of identifying their pathologies);
• pH-metry of gastric contents - to determine the degree of acidity of gastric juice;
• tissue biopsy in the area of ​​duodenal ulceration - for histological analysis and testing for helicobacteriosis;
• breath test or blood test for Helicobacter pylori.

Often, during the examination, concomitant pathologies are identified. In this case, the examination can be supplemented with other procedures and tests (blood biochemistry, ultrasound of internal organs, plain radiography of the abdominal cavity, CT or MRI, tests for infections).

Diagnosis of pathology

At your initial appointment with the doctor, it is important to talk in as much detail as possible about:

• previous or existing gastrointestinal diseases;
• drug therapy prescribed or used independently;
• family situations: does anyone suffer from digestive disorders;
• disturbing symptoms - how long they have been observed, the nature of the pain, time of occurrence, dependence on food intake; describe vomit and feces.

The following tests are prescribed:

• FGDS is an examination of the stomach and small intestine using a probe. The procedure allows you to detect bleeding, inflamed areas, determine their location and the extent of damage. A biopsy determines the presence of Helicobacter bacteria. The acidity of gastric juice is also measured;
• To identify complications (in particular, organ obstruction), radiography with a contrast agent is used;
• clinical blood and stool tests to detect bacteria and hidden bleeding.

Possible complications and dangerous consequences

If duodenal ulcer is left untreated, dangerous complications may occur, such as:

1. Development of bleeding. Most often, this complication occurs during periods of exacerbation, but can also develop during periods of remission, for example, after overeating, excessive physical exertion or stress;
2. Perforation of the walls of the duodenum, accompanied by loss of functionality of this section of the intestine;
3. Pyloric stenosis and disruption of food movement processes;
4. Development of suppuration. Prolonged inflammation of tissues leads to the formation of abscesses - purulent foci. This condition is very dangerous, since if the integrity of the abscess is violated, its contents, along with the bloodstream, spread throughout the body, causing toxic poisoning;
5. Degeneration of an ulcer into a malignant cancerous tumor. Despite the fact that this complication is extremely rare, such cases have been diagnosed. Oncological neoplasms pose a serious threat to human life, so diseases that can lead to their development require timely treatment.

The ulcer progresses: what new symptoms appear in the patient?

If a person does not consult a doctor and is not examined at the first warning signs of the disease, then the symptoms of stomach ulcers in adults continue to progress. At the following stages, the clinical picture of the disease looks like this:

• sharp and sudden attacks of abdominal pain. During them, the patient’s movements are sharply limited, he grabs his stomach and instinctively pulls his knees to his chest. He gets hot. He turns pale, his lips acquire a bluish tint;
• blood pressure drops;
• the heartbeat usually does not change or slows down slightly;
• when palpating the stomach area, the pain worsens;
• a person loses weight with a normal diet;
• constantly bothered by heartburn;
• blood appears in the stool.

An open ulcer looks like this:

• unbearable pain on the left or in the epigastric area;
• severe vomiting of bile (it may contain blood);
• increased heart rate.

If a perforation of the ulcer occurs, in which the walls of the stomach are completely corroded, then the person experiences the following symptoms:

• the pain continues to increase and covers the entire body;
• after a few hours it decreases or goes away completely;
• the temperature remains elevated;
• the patient suffers from dry mouth;
• stomach swells;
• pulse quickens;
• constipation and flatulence occur (gases accumulate to the right of the diaphragm);
• the pain syndrome resumes, accompanied by severe tachycardia, stool upset, and rapid deterioration of the condition. Without urgent hospitalization, death is possible.

Prevention of the disease

It is necessary to prevent the entry of Helicobacter pylori. Need to:

1. Use only a clean plate, spoon, and mug.
2. Do not use dishes that have been previously used by someone else and have not been washed. Peptic ulcer is an infectious disease. Transmitted through saliva. For this reason, you cannot taste food, drink from a mug, or use a family member’s cup. In cafeterias with friends you cannot try each other's food.
3. Erosive and ulcerative lesions of the duodenal mucosa were detected and treated in a timely manner.

It will be necessary to prevent a significant increase in the level of hydrochloric acid in gastric juice. The solution involves strict adherence to dietary recommendations - exclusion from food of fried, spicy foods, spices, overly salty products, canned food, and winter preparations. Patients with gastric and duodenal ulcers often neglect the diet that is the basis of treatment.

Interesting data have been obtained regarding the beneficial effects of sleep on digestion. Doctors came to the conclusion that after lunch the person needed a short nap. It is believed that during rest, more blood flows to the brain and heart. It has been proven that during sleep, these organs work in an “energy-saving” mode; most of the blood, compared to waking hours, enters the stomach and intestines, leading to a sufficient supply of nutrients, rapid regeneration of the mucous membrane of the duodenum, and a therapeutic effect.

Ulcer disease is considered not only as an independent disease. Often pathology is the cause of untreated erosions. Erosion – changes in the mucous membrane on the inner layer. With proper treatment, erosive and ulcerative lesions disappear without a trace; in advanced cases they turn into ulcers.

Nutrition adjustments

In order not to provoke relapses of the disease, it is necessary to follow a diet. The patient should avoid spicy, fatty, smoked and salty foods. Also, do not eat too hot or cold food, which irritates the walls of the stomach. You need to eat small meals every 4 hours. It is also worth giving up bad habits. It is recommended to dilute your diet with the following products:

• vegetables and fruits, baked or steamed;
• porridge;
• soups and diluted broths;
• eggs;
• yoghurts;
• dairy products.

All food should be enriched with vitamins and proteins so as not to provoke their deficiency.

Diet

Therapeutic diet Table No. 1 is a non-drug method of treating the disease, prescribed in combination with medications.

It is gentle in nature and is aimed at protecting the duodenal mucosa from thermal and mechanical damage and normalizing the secretion of gastric juice.

Weekly diet:

Only following a diet will help you get on the path to recovery!

Interesting article: Treatment and diet for duodenal bulbitis!

Is it possible to cure a duodenal ulcer?

If erosive defects of the duodenum are detected, treatment should be started as quickly as possible. Therapy should be comprehensive and include medication, diet, lifestyle adjustments, physiotherapeutic procedures, and spa treatment. Medicines and any other treatment methods should be selected by the doctor, focusing on the causes of the disease, the characteristics of the clinical and endoscopic picture, and the patient’s condition. In severe cases, surgical treatment is required. Surgeries to treat duodenal ulcers are rarely performed (compared to the number of interventions on the stomach) due to the high risk of complications and relapse.

Drug treatment

Complex drug therapy in the treatment of duodenal ulcers is aimed at destroying Helicobacter pylori, stimulating mucosal regeneration, eliminating pain and functional disorders in the gastrointestinal tract. The main place in treatment is eradication of Helicobacter pylori infection. For this purpose, antibiotics, antimicrobials, inhibitors of hydrochloric acid production, and enveloping agents are prescribed. Treatment lasts 7–14 days (depending on the resistance of the pathogen). The treatment regimen is described in the table below.

Table - Drugs for eradication of Helicobacter pylori

In order to eliminate painful sensations, antispasmodics are prescribed (No-Shpa, Buscopan, Duspatalin, Bellastesin, Bellalgin). Such drugs are used 1 tablet 3 times a day for a short course (up to 5 days) until the patient’s condition improves.

To eliminate nausea and normalize gastrointestinal motility, prokinetics are prescribed (Ganaton, Domperidone, Motilium). They are taken 1 tablet 3 times a day, half an hour after meals, for up to 7 days in a row.

To quickly reduce the acidity of gastric juice, as well as to relieve heartburn, fast-acting antacids in the form of a suspension or tablets can be prescribed. They are taken symptomatically, for pain or a burning sensation in the chest.

Surgery

Surgical intervention for duodenal ulcer is performed if the pathology is not amenable to drug therapy (no visible improvement within 2–3 months of treatment), and also if the patient has developed complications. The essence of the operation is to remove the damaged part of the duodenum and suturing the defect. Interventions on the duodenum are considered technically complex and difficult for the patient himself. They are accompanied by a high risk of complications.

Diet therapy for ulcers

The strict Pevzner diet No. 1a is prescribed for 8–10 days after an exacerbation of a duodenal ulcer. Therapeutic nutrition should exclude stimulation of the secretion of digestive juices through food products, chemical, thermal or mechanical irritation of the gastrointestinal tract. At the same time, the diet should contain enough proteins, carbohydrates, and a slightly reduced amount of fat. General recommendations:

• eat in small portions (small portions every 3 hours);
• drink enough water;
• consume all dishes and drinks warm;
• prepare foods by boiling or steaming;
• Grind products before use to a soft consistency.

All harmful foods are excluded from the diet: sausages, smoked meats, chips, crackers, selenium, marinades, canned food, animal fats, confectionery, coffee, chocolate, alcohol. You should not eat foods that can stimulate the secretion of hydrochloric acid and provoke heartburn (spices, rich broths from meat, fish, mushrooms, sour vegetables and fruits, chocolate, cakes). Vegetables that contain coarse dietary fiber (turnips, celery, legumes, leafy vegetables, radishes) and purine bases (tomatoes, sorrel, horseradish) are also prohibited. Below is a list of permitted products with the characteristics of their use or preparation.

• Flour and bakery products. It is allowed to eat crackers and yesterday's bread. Durum wheat noodles only in soup.
• Cereal products. Boiled porridges are prepared from buckwheat, semolina, rice, and oatmeal (or ground through a sieve). The consistency of the porridge should resemble soup. Prepared in water, seasoned with 5 g of butter per serving, salted immediately before use.
• Vegetables. Potatoes, Carrots, beets, zucchini, cauliflower, broccoli are steamed or boiled. Before use, be sure to puree it. Broths are prepared using vegetables. In soups they should be as boiled as possible.
• Meat and fish. They prepare cutlets, meatballs, meatballs (from minced meat) and soufflé from chicken, turkey, rabbit, veal, and lean white fish without bones. Before cooking, be sure to remove the skin, hymen, and fatty inclusions.
• Fruits. Eat baked apples and pears without skin. All other fruits can be used to make jelly. Also, pre-boiled fruits are consumed pureed (without skin and seeds).
• Dairy products and eggs. It is allowed to consume milk (in small quantities and only if tolerated well), curd soufflé, and low-fat soft cheeses of neutral taste. A steamed protein omelet is prepared from eggs.

Drinks allowed include weak black or herbal tea, compote, chicory, rosehip decoction, and jelly. Sweet desserts (including jam, honey, marshmallows and marshmallows) are excluded during a strict diet.

Phytotherapy

Herbs can be used as part of complex treatment for duodenal ulcers. However, you should not self-medicate using folk recipes. Doctors recommend medicinal plants with enveloping, anti-inflammatory and carminative properties to patients exclusively after an acute period of illness. The most commonly used:

• flax seeds - pour a spoonful of raw materials with cold water overnight, dilute with warm water in the morning, take half a glass, 1 hour before meals;
• chamomile - pour a teaspoon of flowers into a glass of boiling water, drink warm up to 3 times a day;
• anise, fennel, dill - mix a teaspoon of seeds, pour half a liter of boiling water, filter after 40 minutes, take half a glass 3 times a day, half an hour after meals.

It is strictly forbidden to be treated with alcoholic herbal tinctures. Alcohol negatively affects the condition of the stomach and duodenum and can provoke a relapse of the disease.

Other aspects of treatment

In the acute period, in order to increase the effectiveness of drug therapy, physiotherapy may be prescribed. Treatment with microcurrents, ultrasound, thermal procedures, as well as electrophoresis improves blood supply to the gastrointestinal tract and trophism of the mucous membranes. The procedures provide a quick analgesic effect, accelerate the regeneration of the membranes, which promotes the healing of erosive defects.

In complex therapy of duodenal ulcers, it is very important to stabilize the daily routine and normalize the patient’s lifestyle. It is necessary to get proper rest, eat regularly, and avoid overwork and stress. After the acute period subsides, patients are advised to do light exercises and walks in the fresh air.

Wellness therapy

Treatment of stomach and duodenal ulcers is carried out only after determining the causes. Symptoms and treatment of the disease are inextricably linked; health therapy is prescribed to combat individual symptoms.

Therefore, the basics of health therapy are the following:

• destruction of the bacterium Helicobacter pylori;
• decreased stomach acidity;
• symptomatic treatment: pain reduction, normalization of motor skills;
• diet.

Complex treatment with medications is usually carried out according to one scheme. The mainstay of treatment includes antibiotics, bismuth preparations, antacids, drugs that reduce the secretion of gastric juice, PPIs and drugs to reduce the severity of symptoms. What medications to take should be prescribed by a gastroenterologist; self-medication is harmful to a person and can provoke complications of the disease.

Degrees of development and characteristic features

Symptoms and manifestations of duodenal ulcers directly depend on the severity of the pathology. In a mild form, the patient does not experience severe discomfort; in a moderate form, severe pain and other manifestations of the disease may occur; in a severe form, complications that are dangerous to health often develop.