Pain in the stomach ulcer

A gastric ulcer according to medical supervision suffers 1/10 adult people. Disease in frequency is second only to coronary heart disease. The most common are men up to the age of fifty.

Pain in gastric ulcer is considered an important diagnostic sign. However, statistics warn that 25 to 28% of cases occur atypically. However, the pain is completely absent or reminiscent of other diseases. Pathology is revealed by chance.

If the course is favorable, then after exacerbations( at 3-8 weeks), a prolonged remission takes several years. During this period, patients should follow the recommendations for nutrition, regularly take preventive treatment courses. In case of trouble, serious complications are expected with the rupture of the wall of the stomach( perforation) and the development of peritonitis, perforation to neighboring organs, cancerous degeneration.

What criteria characterize peptic ulcers?

Pain syndrome is considered to be the most common manifestation of peptic ulcer of the stomach and duodenum. Symptom is caused by direct erosion not only of the mucous membrane of the inner shell, as in inflammation of the stomach, but also of the submucous, muscle layer, where there are many pain receptors.

Gastritis is a precursor of an ulcer. Ignoring timely treatment worsens the condition of the body and digestion in general. To fully characterize what pain in the stomach ulcer are the most typical, we should elaborate on the description of the symptom.

Localization of

75% of patients have abdominal pain in the epigastric zone and the upper part. Depending on the specific location of the ulcer in the stomach, the zone of maximum pain changes:

• if the lesion touches the cardiac and subcardial parts - under the xiphoid process of the sternum;
• in the body area - the left side of the epigastrium;
• in the pyloric and duodenum - on the right in the epigastrium.

Intensity of

In half of cases, patients consider pain tolerance tolerable, in 1/3 cases - strong. More pronounced at a young age and with complications. Removed - the intake of alkaline mineral water, drugs that suppress the secretion of gastric juice( Omez, Famotidine), antacids( Gastal, Almagel).

The pain intensifies - from acute and fried foods, physical activity, with a long break between meals, after drinking alcohol

What is associated with

There is a clear connection - with food intake, with the time of year( exacerbation in spring and autumn).Depending on the food, it is common to share pains:

• On early - begin half an hour after eating, increase gradually, last for up to two hours, decrease, then disappear when the food clot passes into the intestine. More characteristic for the localization of lesions in the body of the stomach. If the ulcerative process affects the cardial, subcardial and fundal parts, they appear immediately after swallowing the food.
• On late - patients are concerned about one and a half to two hours after a meal, unlike the "early ones" intensify as the content moves to the duodenum. Typical for ulcers located in the pyloric section and in the bulb of the duodenum.
• On night or "hungry" - arise after two to four hours after dinner, are removed by eating. Typical for localization in the duodenum, pyloric stomach.

In 75% of patients, the cause is considered to be Helicobacter pylori infection, so peptic ulcer disease can be attributed to infectious diseases with its own infection and transmission routes.

Other features of

In addition to the pain syndrome, among the signs of peptic ulcer is important to dyspeptic syndrome. Symptoms are more painful for patients, "dull" and intensify pain. These include:

• heartburn - worries about 80% of patients, appears after a half to three hours after meals, has a persistent nature, is caused by reflux digestion of acidic contents in the lower part of the esophagus;
• eructation - there are half of patients;
• nausea, vomiting - often manifest at the height of a pain attack, ease the condition, so patients are trained to induce vomiting on their own.

Violation of stool in the form of constipation - occurs against the background of an exacerbation in half of patients. Changes in appetite - little expressed, a decrease in food eaten due to fear of pain. Feeling of overflow or bloating.

Does the pain syndrome depend on the location of the ulcer?

The nature of the pain depends on the location and size of the damage to the stomach tissue.

Ulcers of the subcardial and cardiac divisions

Place immediately under the esophageal sphincter or not more than 5-6 cm towards the stomach. Features:

• pains "early", felt by patients high in the epigastrium, in the zone of the xiphoid process;
• are characterized by frequent irradiation to the heart area, always require differential diagnosis with angina( remember that angina attacks are associated with physical exertion, disappear at rest, relieve coronary-extending Nitroglycerin tablets, and "ulcerative" pain follow food intake);
• are weakly expressed in intensity;
• often contribute to the manifestations of gastroesophageal reflux with eructations, heartburn, vomiting, as a deficiency of the cardiac sphincter is formed;
• can be combined with reflux-esophagitis, hernia of the esophageal diaphragmatic foramen;
• rarely has a perforation, of complications, typically bleeding.

Appearance in the vomit masses of the "coffee grounds" indicates the onset of bleeding

Ulcers on the small curvature

Make up the largest proportion in the number. Features:

• is common in the elderly;
• pains are felt in the epigastrium on the left;
• refers to "late", less often to "hungry";
• often have a nagging, low intensity, but with exacerbation are very pronounced;
• is accompanied by heartburn, nausea, vomiting is rare;
• study of gastric secretion in most cases shows a normal level;
• bleeding occurs in 14% of patients, perforation is rare;
• up to 10% of cases is transformed into a cancerous tumor, this refers to ulcers located in the area of ​​the bend, the pain becomes permanent.

Ulcers on a large curvature

Characteristics: are rarely detected, the nature of pain and symptoms are not typical. It is important that half of cases occur with degeneration into a malignant tumor, therefore localization is considered potentially dangerous and requires enhanced monitoring( repeated biopsies of the edges and bottom).

Affection of the antrum

Ulcers are still referred to as "prepiloric", found in 10-16% of patients. Clinical features: mainly observed at a young age, the nature of the pain refers to the late "hungry" or "nocturnal", localized in the epigastric zone.

Similar to the course of duodenal ulcers. Often accompanied by heartburn. They differ in vomiting "sour", as the level of acidity is increased. They need differential diagnostics with stomach cancer, it is this localization of cancer that is most frequent. Up to 20% of cases in the clinical course cause gastric bleeding.

Ulcers in pyloric department

Localization accounts for 8% of cases. They differ in the persistent course of the disease, pronounced pain syndrome, paroxysmal nature of pain lasting for 30-40 minutes. In 30% of cases, the pain is late, "hungry", but can, generally speaking, not depend on food intake.

All patients have a feeling of overflow of the stomach, raspiraniya. Complication in the form of cicatricial changes and formation of stenosis of the pylorus. They are accompanied by vomiting "sour", constant heartburn. Patients report excessive sudden salivation.

Among other complications: frequent bleeding due to the location in the area of ​​an abundant number of vessels, perforation into the abdominal cavity, penetration of the pancreas, transformation into a cancerous tumor is observed in 8% of patients.

How can stomach and duodenal ulcer be distinguished by pain?

Symptoms of duodenal ulcer are important for differential diagnosis of stomach damage. If the bulb is injured on the front wall, the pains disturb the patients on the right side of the epigastrium, are "late", start at night or in the morning, are rarely accompanied by vomiting.

If the ulcer is localized on the back wall, spasm of Oddi sphincter develops more often, dyskinesia of the gallbladder is formed with a feeling of heaviness, blunt pains in the right hypochondrium, spreading to the back

The extra-fibrous location( postbulbarnye ulcers) is closer to the transition to the jejunum. Compose up to 7% of the total number of gastroduodenal ulcers. They are characterized by:

• later development;
• intense pain with localization to the right in the hypochondrium, irradiation under the scapula, in the back, seizures are similar to cholelithic and urolithiasis;
• complications in the form of inflammation of surrounding tissues( perivisceritis), narrowing of the bulb, mechanical jaundice when squeezing with scar tissue and infiltration of the bile duct.

Ulcer in the duodenum is more benign, does not go into cancer. With complication there is no bleeding, causes penetration into the hepatic-duodenal ligament or pancreas. Stimulates the development of pancreatitis.

How do multiple and multiple ulcers manifest themselves?

Combined ulcers is the simultaneous detection of ulceration in the stomach and duodenum( detected in 5-10% of cases), and multiple - nonunit ulcers in one organ. It is believed that the first is affected by the duodenum. Clinical signs express typical symptoms.

When the stomach ulcer joins, the patient's condition deteriorates noticeably:

• pain becomes almost constant, "late" pain is supplemented with "early" pain;
• spreads to the right and to the left;
• becomes a permanent heartburn and vomiting;
• is concerned about the feeling of a full stomach;
• complications occur according to the type of cicatricial stenosis of the pylorus, perforation, bleeding.

Multiple ulcers are more likely to relapse and complicate, pain persistent, it is difficult to select analgesics in treatment.

. As the stomach ulcer hurts depending on the size, let's clarify the signs of giant ulcers. These include the revealed defects in the wall of the stomach with a diameter of 20-30 mm. They are more often localized on a small curvature, less often - in the subcardial zone and on a large curvature.

The pain syndrome is intense, the sign of periodicity, dependence on food intake disappears. They become permanent, therefore, they must be distinguished from a cancerous tumor. Patients quickly lose weight.

In the clinical course, bleeding occurs more often, perforation in the pancreas, degeneration into a malignant neoplasm.

Syndrome in the elderly and young people

Peptic ulcer disease in old age can occur for the first time after 60 years or continue from youth. At the same time there is a decrease in the intensity of pain, against the background of an increase in the size and depth of the ulcer process, a tendency to bleed, the course of the disease along with the development of complications( cicatricial narrowing of the gatekeeper, adhesions), transformation into cancer.

In adolescence, pain manifestations can be masked, and the disease can be atypical. Complications are rare. More patients are concerned about the tendency to vegetovascular dystonia, sweating, irritability. Examination of adolescents by the commission of the military registration and enlistment office allows to identify and hospitalize young men in a specialized department.

Atypical cases are:

• "mute" ulcers, revealed only with a preventive examination;
• pains by type of appendicular, in the right ileal region;
• of the primary localization in the hypochondrium on the right, in the region of the heart, in the lower back.

Such forms of the disease for the first time manifest complications that have arisen after an ulcer: vague bleeding, perforation, detection of stenosis of the pylorus.

Treatment

Treatment of peptic ulcer combined and directed to counteract the mechanisms of ulcer formation, restoration of the gastric mucosa, the fight against complications. Anesthesia with a stomach ulcer is a necessary condition for effective therapy. For this, special medications are used. But the recommendations begin with strict requirements to the diet.

It is required to exclude from the menu fatty and fried dishes, spicy sauces, sour fruits and pickles, smoked meats, beans, chocolate and coffee.

During an exacerbation only liquid porridges on water are used, lean broths with white crackers, it is possible to drink broth of a dogrose. Meals are served in small portions 5-6 times a day. To find out which painkillers can be effectively applied in a particular case, the patient is examined the acidity of the gastric juice, the presence of Helicobacter in the contents.

The combination therapy includes:

• antacid agents that bind the acid( Almagel, Maalox), in Almagel A local anesthetic is added - anesthesin;
• preparations of bismuth( De-Nol, Bismofalk, Tribimol, Bismol) are used in the fight against Helicobacter pylori;
• cholinolytics( Gastroceptin, Atropine, Platifillin) - relieve impulse from the affected area, help with pain.

The dosage is determined by the doctor according to the age of the patient, the course of the illness. If the examination shows no signs of degeneration and bleeding, then physiotherapy( galvanization, magnetotherapy, mud applications) that effectively relieve pain is prescribed. With good tolerability and "nocturnal" pain, you can drink warm milk, a decoction of chamomile.

Beekeeping products are widely used in official and traditional medicine for pain relief for peptic ulcer

What folk remedies have analgesic effect?

Because acute pain is a sign of exacerbation, during this period doctors do not recommend taking folk remedies. You can not try to be cured on your own, prescribed medications and herbal decoctions can interact and worsen the effect.

In the period of remission, along with a diet to support the healing of ulcers, tincture of propolis, sea buckthorn oil, decoction from the medicinal collection( horsetail, chamomile flowers and marigold, rose petals, cotton grass, wormwood, hips, dill seeds) are used. Brew herbs in a thermos for the night or stand for 15 minutes in a water bath. Drink the broth to be warm.

Intensive pain syndrome in the presence of peptic ulcer indicates a problem, requires the selection of optimal medications. Violation of diet and diet negates all the best intentions of doctors and loved ones. Therefore, patients require a strong-willed decision and a serious attitude towards health.