Peptic ulcer - an open wound, or wet areas, with a tendency to develop in one of two places:
- In the mucous membrane of the stomach (gastric ulcer);
- In the upper part of the small intestine - the duodenum (duodenal ulcers).
duodenal ulcer occurs three times more often than gastric ulcer.
Ulcers develop when the stomach, intestine, digestive glands appear digestive juices, and damaged gastric mucosa or duodenal ulcer.
Ulcers can be an average of from 0.62 cm to 1.25 cm in diameter. Helicobacter Pylori bacteria - the main cause of peptic ulcer disease. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) - the second most common cause.
Peptic ulcer disease affects all age groups, but rarely in children. In men, the risk of ulcer twice higher than in women. The risk of duodenal ulcer disease is on the rise, since 25 years and continues to 75 years. The risk of most of its peaks - from 55 to 65 years.
ulcer formation mechanism
Two important component of digestive juices - hydrochloric acid and pepsin enzyme. Both substances are crucial to the destruction and digestion of starches, proteins and fats in the food. They play different roles in the sores.
- Hydrochloric acid. Distributed by the mistaken assumption that an excess of hydrochloric acid, which is released in the stomach, is solely responsible for the production of ulcers. Patients with duodenal ulcer, tend to have higher than normal levels of hydrochloric acid, but the majority of patients with stomach ulcer have an acid level of normal or below normal. The presence of gastric acid, in fact, it is important to protect against H. Pylori - bacteria, which in most cases causes a peptic ulcer. Exceptions are ulcers that occur on the Zollinger-Ellison syndrome - a rare genetic condition in which tumors in the pancreas or duodenum identifies very high levels of gastrin - a hormone that stimulates the secretion of hydrochloric acid.
- Pepsin. This enzyme cleaves proteins in the food. It is also an important factor in the formation of ulcers. Since the stomach and duodenum are composed of proteins that are sensitive to the action of pepsin. However, the body has a defense system to protect the stomach and intestines against these two potent substances:
- A layer of mucus that covers the stomach and duodenum (the first line of defense);
- Bicarbonate, releasing mucus layer, which neutralizes the digestive acids;
- Hormone-like substances prostaglandins help dilate blood vessels in the stomach to assure good blood flow and to protect against injury. Prostaglandins can also stimulate action of bicarbonate and mucus.
The destruction of the protective mechanisms of the mucous membrane makes the stomach and intestine susceptible to the action of acid and pepsin, increasing the risk of ulcers.
Causes of gastric and duodenal ulcers
In 1982, two Australian scientists have identified Helicobacter pylori (Helicobacter Pylori, or H. Pylori) as the main cause of stomach ulcers. They showed that the inflammation of the stomach and stomach ulcers result from gastric infection caused by the bacteria H. Pylori.
Helicobacter pyloriBakterii apparently cause ulcers thus: Helicobacter Pylori corkscrew shape allows them to penetrate into the mucous layer of the stomach or duodenum, so that they can be attached to the lining. The surfaces of cells lining the stomach, contain protein. Acceleration factor of the breakdown of proteins acts as a receptor for the bacteria.
H. Pylori survive the strongly acid medium. H. Pylori and stimulates an increase in the release of gastrin. Higher levels of gastrin sodeystvovuyut increase acid secretion. Increasing the acid damages the intestinal mucosa, that certain individuals leads to ulcers. H. Pylori also modifies certain immune factors that allow these bacteria to avoid detection by the immune system and lead to frequent inflammation, even without invasion of the mucosa. Even if not develop ulcers are believed bacterium Helicobacter pylori is the main cause of chronic inflammation of the active in the stomach - gastritis, and in the upper small intestine - duodenitis. H. Pylori also closely related to gastric cancer and possibly other extraintestinal problems. Bacteria H. Pylori, likely transmitted directly from person to person. However, little is known how these bacteria are transmitted.
About 50% of the world's population are infected with H. Pylori. The bacteria are almost always acquired in childhood and persist throughout life if the person is not treated. The prevalence of this bacterium in children is about 0.5% in industrialized countries. But even there, in regions with critical unhygienic conditions, infection conditions are equal to those in developing countries.
It is not entirely clear how these bacteria are transmitted. Possibly, the transfer means include:
- Intimate contact, including contact with the liquid through the mouth;
- Diseases of the gastrointestinal tract (especially with vomiting);
- Contact with the feces (fecal matter);
- Contaminated wastewater.
Although Helicobacter pylori are fairly common, ulcers in children are very rare - only 5-10% of the H. Pylori-infected adults. Several factors may explain why some patients get infected ulcers:
- Smoking;
- Use of alcohol;
- The presence of family members in dealing with peptic ulcer disease;
- male;
- Infecting bacterial strain which contains a cytotoxin associated gene.
When the bacteria Helicobacter Pylori were first identified as a major cause of peptic ulcer disease, it was detected in 90% of people with the duodenum and about 80% of people with stomach ulcers. As more and more people are now tested and treated for the bacteria, the rate of H. Pylori-induced ulcers decreased. Currently H. Pylori are about 50% of people with peptic ulcer disease;
Factors that cause ulcers in carriers H. Pylori
Causes of stomach ulcers and duodenal kishkiOpredelennye factors may increase the risk of ulcers in NSAID:
- Age 65 years and older;
- History of peptic ulcer or gastrointestinal-bleeding;
- Other serious diseases - such as congestive heart failure;
- The use of drugs such as: anti-coagulant Warfarin (Coumadin), corticosteroids, osteoporosis drug alendronate (Fosamax), etc .;
- Alcohol abuse;
- Helicobacter pylori infection;
- Other risk factors for ulcer from H. Pylori or NSAIDs;
- Stress and psychological factors;
- Bacterial or viral infection;
- Bodily injury;
- radiation therapy;
- Smoking. Smoking increases the secretion of acid, bicarbonate and prostaglandin decreases and reduces the flow of blood. However, the actual results of smoking research ulcers different.
In only 10-15% of people infected with Helicobacter Pylori, developing peptic ulcer. Infections H. Pylori, especially in the elderly, may not always lead to peptic ulcer disease. Also to be present, and other factors in order to actually cause ulcers:
- Genetic factors. Some people have strains of H. Pylori genes that make bacteria more dangerous and increases the risk of ulcers;
- Immune disorders. Some people have a violation of the intestinal immune response, which allows bacteria to injure the intestinal mucosa;
- Lifestyle factors. Although lifestyle factors such as chronic stress, coffee and smoking has long been considered the main causes of ulcers, it is now considered that they only increase susceptibility to ulcers, some carriers H. Pylori - and no more;
- Stress. Although stress is no longer believed to cause ulcers, some studies show that stress can predispose a person to ulcers or prevent healing of existing ulcers;
- Shift work and interrupted sleep. People who work night shifts have a significantly higher incidence of ulcers than day workers. Researchers suspect that the frequent interruptions of sleep can weaken the immune system's ability to protect against harmful bacteria.
- Non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use of NSAIDs such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Alevi, Naprosyn) - the second most common cause of ulcers. NSAIDs also increase the risk of gastrointestinal bleeding. The risk of bleeding continues for as long as the patient is taking the drugs, and it can last for about 1 year after the break. Short courses of NSAIDs for the temporary relief of pain should not cause serious problems, because the stomach has time to recover and fix any occurring damage.
Patients with ulcers from NSAIDs, stop taking these drugs. However, patients who need these drugs for the long term, can reduce the risk of ulcer drug administration group PPI - proton pump inhibitor - such as omeprazole (Prilosec), famotidine (Pepsid - H2 blockers), and others.
In 15-25% of patients taking NSAIDs regularly are evidence of one or more ulcers, but in most cases, these ulcers are very small. Long-term use of NSAIDs can damage, perhaps the small intestine. Even low doses of aspirin (81 mg) may be a risk, although the risk is lower than at higher doses. The greatest risk from the use of very high doses of NSAIDs for a long period of time, particularly in patients with rheumatoid arthritis.
Zollinger-Ellisona- Medications. Ulcers can exacerbate some other drugs, in addition to NSAIDs. These include: Warfarin (Coumadin) - anticoagulant, which increases the risk of bleeding, oral corticosteroids, some chemotherapy drugs - spironolactone and Niacin. Bevacizumab - for the treatment of colorectal cancer, may increase the risk of gastrointestinal perforation (perforation or perforation of ulcers - a breakthrough ulcer outside of the stomach or duodenum with the release of their contents). While the benefits of bevacizumab outweigh the risks, gastrointestinal perforation are very serious. If they occur, patients should stop taking the drug.
- Zollinger-Ellison syndrome (ZES) syndrome .. Another cause of peptic ulcer disease, although much smaller than H. Pylori, or NSAIDs, is Zollinger-Ellison syndrome. A large amount of acid produced in response to an overproduction of hormone gastrin, which in turn causes tumor pancreas or duodenum. These tumors generally cancerous and should be removed. acid production must also be suppressed to prevent new ulcers.
ZES should be suspected in patients with ulcers that are not infected with H. Pylori and have no history of NSAID. Diarrhea may occur before the ulcer symptoms. Ulcers occurring in the second, third or fourth parts of the duodenum or jejunum (the middle part of the small intestine) - signs of ZES. Gastroesophageal reflux disease (GERD) is a common and often more severe in patients with ZES. Complications of GERD include ulcers and narrowing (stricture) of the esophagus.
Ulcers associated with ZES usually resistant and difficult to treat. The treatment is to remove the tumor and acid suppression with special drugs. In the past, removal of the stomach was the only treatment option.
Experts do not know what factors actually increase the risk of ulcers.
Symptoms of gastric ulcer and duodenal ulcer
- Dyspepsia. The most common symptoms of peptic ulcer disease are collectively known as "indigestion". However, peptic ulcer dyspepsia may occur without, or any other gastrointestinal symptoms, particularly if they are caused by NSAIDs.
The main symptoms of dyspepsia:
- Bloating;
- Feeling of fullness;
- Hunger and the feeling of emptiness in the stomach, often after 1-3 hours after eating;
- Burping.
- Heartburn and belching. The most common symptoms of peptic ulcer are abdominal pain, heartburn, belching, perhaps a feeling of acid in the throat.
Many patients with these symptoms do not have a peptic ulcer. Most of them have what is called "functional dyspepsia." Elderly patients are less likely to have symptoms than younger. No symptoms may delay diagnosis, which may lead to an elderly patient at greater risk of serious complications.
- Recurrent abdominal pain. Recurrent abdominal pain and other gastrointestinal symptoms, often found in children. It is becoming the norm for pediatricians with Helicobacter pylori infection in children identify with these symptoms. However, the researchers were unable to confirm a clear connection between regular abdominal pain and H. pylori infection in children.
- Pain in the ulcer. Ulcers pain can be localized to one place, or may be throughout the abdominal cavity. Pain can be a burning or aching in the upper abdomen, or as stitching, penetrating through the intestines.
Symptoms can vary depending on the location of the ulcer:
- In the duodenum often ache after a few hours after eating, and then patients can relieve pain meal. Many also happens heartburn;
- Dull, aching pain in the stomach, often immediately after a meal. Eating does not relieve pain, and may even enhance it. The pain may also come in the night;
- Ulcer pain can be especially confusing when it gives on the back or on the chest, behind the breastbone. In such cases, it can be confused with other diseases - such as heart attack;
- Due to the fact that the ulcer can cause hidden bleeding, patients may experience symptoms of anemia, including fatigue and shortness of breath.
- It is dangerous symptoms. Severe symptoms that begin suddenly may indicate a blockage in the intestines, bleeding or perforation, and all that - emergencies. Symptoms may include:
- Black or bloody stools;
- Severe vomiting, which may include a substance in the blood, like coffee grounds (sign of serious hemorrhages), or all of the stomach contents (character ileus);
- Severe abdominal pain with vomiting or without, with blood.
The ulcer can lead to emergency situations. Severe abdominal pain, sometimes with signs of bleeding, may indicate that the perforated ulcer of the stomach or duodenum. Vomiting substances that resemble coffee grounds, or the presence of black tarry stools may indicate a severe bleeding in the digestive tract.
Diagnosis of gastric and duodenal ulcers
Always ulcer is suspected in patients with persistent dyspepsia. Symptoms of dyspepsia occur in 20-25% of people who live in industrialized countries, but only about 15-25% of patients with dyspepsia in fact have an ulcer. It should take a few steps to accurately diagnose ulcers:
- Medical and family history. The doctor will ask questions about the dyspepsia for expanded patient's response, as well as check:
- Other important symptoms - such as weight loss or fatigue;
- The adoption of the present and past medications (especially long-term use of NSAIDs);
- Family members with ulcers;
- Habits of drinking and smoking;
- Exclusion of other diseases and disorders. Dyspepsia cause many other diseases. Symptoms of ulcer - in particular abdominal pain, and chest, can be similar to symptoms of other diseases, including:
- Gastroesophageal reflux disease. About half of patients with dyspepsia are GERD also. In GERD or other esophageal problems are the main symptoms of heartburn, burning pain to the throat. It usually develops after meals and extends from antacid. The patient may have difficulty swallowing, you may experience heartburn or regurgitation. Less likely that elderly patients with GERD have these symptoms, but instead may include: loss of appetite, weight loss, anemia, vomiting or dysphagia (difficulty or painful swallowing);
- Heart problems. Heart pain, such as angina or heart attack is likely to occur from exercise and may be transmitted to the neck, jaw, etc. Moreover, patients usually have risk factors for cardiovascular disease;
biaxin xl dosage
- Gallstones. The main symptom - persistent corrosive attack or pain on the right side below the rib cage. This pain can be severe and may be given in the upper back. Some patients experience pain in the chest. Pain often occurs after a heavy or fatty foods, but gallstones almost never cause indigestion;
- Irritable bowel syndrome - can cause indigestion, abdominal pain, nausea, vomiting, abdominal distension. In women it is more common than in men;
biaxin xl dosage
- Side effects of medications. Dyspepsia may also derive from gastritis or stomach cancer as a side effect of certain drugs, including NSAIDs, antibiotics, iron, corticosteroids (theophylline) and calcium blockers;
- Non-invasive tests to identify gastrointestinal bleeding.