Database of diseases - Pain treatment clinic

Ulcers usually locate in the duodenum and stomach, less often in the later part of the duodenum or esophagus. Their presence is accompanied by a team of ailments experienced by the patient.


DIAGNOSING OF GASTROOMESTRES

Symptoms of peptic ulcer disease

The main symptom of peptic ulcer disease is pain or discomfort in the epigastrium (or subcutaneous cavity), occurring 1 to 3 hours after meals. The pain often disappears after eating food or taking antacid medications. They often occur at night, waking the patient from sleep. The pain is usually blunt and nagging, it can last for days or weeks.


It should be remembered that it is not uncommon that peptic ulcer disease causes any discomfort. Its existence is then signaled only when the disease is complicated.

Other ailments (nausea, vomiting, bouncing, lack of appetite, heartburn, disgust in the mouth, weight loss) can also be associated with the presence of peptic ulcer disease, but are not specific to her alone. They are called dyspeptic symptoms (see dyspepsia).

Urease test

The specimen collected during gastroscopy is transferred to a special plate. The change in the color of the substrate from yellow to red indicates a chemical reaction taking place in the presence of bacteria. A positive test result means the presence of Helicobacter pylori. The result is known directly after the endoscopy.


Histological examination

A slice from the stomach, after using special coloring procedures, is examined under a microscope. Visible bacteria in the preparation. Usually 10 to 14 days are waiting for the result of this study.


Serological tests

Serological tests detect in the blood the presence of the body's immune response (antibodies) to a bacterial infection. The test consists in collecting blood in which the presence of antibodies is determined. They are less sensitive than the previously mentioned methods. Therefore, their practical value is only approximate. In most cases, you can recognize the infection on their basis. On the other hand, they are not suitable for assessing the effectiveness of treatment, because the presence of antibodies is still found after a few years after treatment. Thus, after successful treatment, the test is still positive, which does not mean that the treatment has failed.

Endoscopic examination of the upper gastrointestinal tract (gastroscopy)

Endoscopy is the best way to diagnose peptic ulcer disease. It consists in inserting a thin flexible tube through the mouth to the stomach and duodenum, through which the physician performing the examination can view the interior of these organs. The ulcer is seen as a severely defined defect in the mucous membrane. Its bottom may have a white color (due to the presence of a fibrin) or pink (caused by healing - granulation). Sometimes the sores have an irregular shape
After finding the ulcer (especially the stomach), the doctor usually takes samples for microscopic examination during examination. Also excisions are taken to detect Helicobacter pylori infection.


An urgent indication for gastroscopy is bleeding from the upper gastrointestinal tract.

This allows you to determine the cause of bleeding and, in some cases, stop it.


X-ray (radiological) examination of the upper gastrointestinal tract

Before the dissemination of endoscopic examination, it was the only study that could reveal the presence of ulceration. It is based on drinking the contrasting agent (baryta) and then tracking how it passes through the esophagus, stomach and duodenum. X-rays are taken during the examination. The ulcer is filled with contrast, which is reflected in the pictures as an allowance that is distinct from the regular curvature of the stomach or duodenum walls.


In the study, it is also possible to identify possible early distortions (scars) - that is, signs of a patient suffering from ulcerations in the past.

X-ray examination is less sensitive than the endoscopy for detecting an ulcer. About 30% of ulcers remain undetected by this study. In addition, it is not possible to assess any inflammatory changes and taking out excreta. Therefore, gastroscopy is in most cases a test preferred by physicians.


Helicobacter pylori detection tests

There are a number of methods to detect Helicobacter pylori. Only the most commonly used methods will be discussed here.
NON-PHARMACOLOGICAL TREATMENT OF PATH-FREE DISEASE

Avoidance of painkillers

All patients should avoid using non-steroidal anti-inflammatory drugs (ie aspirin and its derivatives) because they obstruct treatment and can cause peptic ulcers themselves. If you need to use painkillers, you can use paracetamol (preparations Acenol, Apap, Codipar, Calpol, Doliprane, Efferalgan, Lekadol, Panadol, Paracetamol, Scanol, Tazamol, Tylenol and a series of complex medicines) or new painkillers, so-called selective COX-2 inhibitors that do not adversely affect the gastrointestinal tract (celecoxib - Celebrex and rofecoxib - Vioxx).


No smoking

Smoking increases the risk of peptic ulcer disease, hinders ulcer healing and increases the risk of ulcer recurrence. The risk of complications of the disease, mainly bleeding from the ulcer, also increases.
The components of cigarette smoke increase gastric acid secretion, disturb blood circulation in the stomach wall and reduce the secretion of pancreatic antacids.






Nutritional recommendations

The importance of nutritional recommendations in the treatment of peptic ulcer is often overestimated. Significant restrictions are not necessary. You should regularly eat meals and limit only eating foods that are hard to digest, bloating, spices and carbonated drinks. They can exacerbate symptoms, although they probably do not affect the healing process of the ulcer. Coffee strongly stimulates the secretion of hydrochloric acid, hence its drinking should be discontinued during treatment. It is also advisable to avoid alcohol, which may damage the defense mechanisms of the mucous membrane. After healing the ulcer, no special dietary restrictions are needed.




DRUGS AGAINST PATHIC DISEASE (1)

Antacid drugs

It is the most commonly used group of medicines, available in pharmacies without a prescription. They act protectively by neutralizing the acid reaction of gastric juice. Effectively combat pain and other symptoms associated with peptic ulcer disease. On the other hand, they are not used as medicines to heal ulcers, because preparations with a much stronger effect are known. In general, 4 or 5 doses per day (1 dose = 1 tablet or one measure of suspension) are administered between meals and at bedtime. Neutralizing drugs can cause side effects: diarrhea (clay and magnesium) or constipation (calcium and bismuth). They inhibit the absorption of many other medicines used simultaneously. In patients with renal insufficiency, magnesium and aluminum accumulation in the system may lead to toxic symptoms.






H 2 -amine antagonists (H 2 blockers)

These drugs inhibit the secretion of hydrochloric acid in the stomach. Three drugs are available in Poland: cimetidine, ranitidine and famotidine known under many company names:

a / cimetidine - Altramet, Cimetidine, Histodil

b / ranitidine - Apo-Ranitidine, Gastroren, Histac, Novo-Ranitidine, Raniberl, Ranigasan, Ranigast, Ranisan, Ranital, Ranitin, Ranitidine, Rantagon, Zantac

c) famotidine - Fagastin, Famogast, Famotidine, Novo-famotidine, Quamatel, Ulfamid.

It is estimated that their use causes healing of about 60 - 80% of ulcers within 4 weeks. H 2 blockers do not reduce the rate of relapse (unless they are used chronically). Newer medicines from this group (ranitidine and famotidine) have few side effects. However, some people may experience headaches or dizziness, feelings of breakage, muscle pain. The treating physician must assess whether the H 2 blocker can be used simultaneously with other medications.


Inhibitors (blockers) of the proton pump

Drugs that inhibit the proton pump very strongly and for a long time inhibit the secretion of hydrochloric acid in the stomach, favoring the healing of ulcers.During the 4 weeks of treatment, about 90% of duodenal ulcers and 70% of stomach ulcers are healed.

This group includes omeprazole, pantoprazole, lansoprazole and rabeprazole, available in pharmacies under many company names:

omeprazole - Exter, Gasec, Losec, Ortanol, Polprazol, Prazol, Helicid, Omar and several other preparations

pantoprazole - Controloc

lansoprazol- Lanzul

rabeprazole


The use of proton pump blockers is safe:

Diarrhea, nausea, headaches and dizziness are rare. Some of them affect the metabolism of other medicines. Always ask your doctor if they can be used together with other medicines.

However, the results of treatment are exacerbated by cigarette smoking (this applies not only to drugs in this group, but also to H2 blockers).

The proton pump blockers not only heal the ulcer, but are also used as one of the components of Helicobacter pylori infection treatment.


prostaglandins

Prostaglandins inhibit gastric acid secretion and, at the same time, protect the mucous membrane by increasing mucus secretion and improving blood flow in the stomach wall. Two drugs are used in this group: misoprostol and enprostil.
Within 4 weeks of using misoprostol (Cytotec), 60-80% of gastric and duodenal ulcers are healed. The main side effect is diarrhea, and moreover, you may experience spasmomic pains, nausea and headaches. They are contraindicated for pregnant women because they cause uterine contractions.
These drugs are used much less frequently than drugs that reduce the secretion of hydrochloric acid, especially in people who have an history of peptic ulcer disease, and for various reasons must take chronic non-steroidal anti-inflammatory drugs.


Drugs with a protective effect on the mucous membrane

This group includes sucralfate, bismuth compounds and previously discussed prostaglandins.
Sucralfate (Anerusal, Sucralfate, Ulcogant, Ulgastron, Venter) reaches the stomach and binds to proteins on the bottom of the ulcer niche. In addition, it inhibits the activity of stomach enzymes and binds irritating salts of bile acids.
During 4 weeks of treatment, sucralfate heals 60 to 90% of ulcers. The drug should be used on an empty stomach. Side effects are quite rare, and include diarrhea, nausea and dryness in the mouth. Caution should be exercised with coexisting kidney disease.
Potassium-bismuth citrate, or colloidal bismuth (Cytribin, De-Nol, Ventrisol) also binds to tissue proteins at the bottom of the ulcer to form a protective layer. It binds bile salts and pepsin and stimulates the secretion of a protective mucus. It acts directly destroying Helicobacter pylori.
During the 4 weeks of treatment, 50 - 90% of ulcers are healed.
Bismuth compounds stain black and stool black. Other side effects are rare. The drug is used on an empty stomach.



DRUGS AGAINST PATHIC DISEASE (2)

Treatment of Helicobacter pylori infection

According to contemporary findings, any peptic ulcer with the presence of Helicobacter pylori infection should be treated with antibacterial effects. Because Helicobacter pylori infection is present in more than 90% of patients with duodenal ulcer disease, there is no need to perform additional tests to determine the infection. It is assumed that every patient with duodenal ulcer is infected and each should be subjected to antibacterial treatment. In the case of gastric ulcer, the possibility of drug-induced ulcer (mainly associated with the use of analgesics and anti-inflammatory drugs) should be ruled out.







Helicobacter pylori infection is treated with medicines belonging to different groups.

Most often, doctors use one of the proton pump blockers simultaneously with two antibiotics. Such treatment gives a chance to cure infection (eradication) in 85-95% of cases. The use of a single antibiotic taken for other indications (eg respiratory tract infections), certainly will not cure Helicobacter pylori infection.


Treatment usually lasts for 7 days and is generally well tolerated.

Often, this short treatment is sufficient to heal the ulcer. Often, doctors after anti-bacterial treatment use traditional anti-ulcer drugs for several weeks.


The treatment of Helicobacter pylori infection has become a breakthrough in the treatment of peptic ulcer disease.

It causes not only a rapid resolution of the disease and healing of the ulcer, but also in the majority of cases prevents the recurrence of the disease. He is, therefore, definitive treatment.


Methods to prevent ulcers caused by non-steroidal anti-inflammatory drugs and their treatment

Not all people taking non-steroidal anti-inflammatory drugs are equally exposed to peptic ulceration. The risk increases if these drugs are taken by an elderly person (over 65), the drugs are used in a high dose or several medicines are used simultaneously and if in the past the person has had an ulcer disease or complication of using anti-inflammatory drugs. The risk of complications is greatest in the first few weeks of treatment. It also depends on