Pain due to stomach and duodenal ulcers

December 11, 2019
Gastroenterology
Konstantin Kim

An ulcer or gastric ulcer (GUD) is a chronic pathology of the stomach in which the mucous membrane is damaged with the development of a local ulcerative defect in it. The course is recurrent, with exacerbations and remissions. The peak of exacerbations is often seasonal – spring-autumn. The pathology is caused by trophic disorders under the influence of aggressive factors when their effect prevails over protection.

The frequency of pathology is 10-15% of the population. The disease is most common between the ages of 25 and 50, and less common in women. This is the most active period of life, when frequent stress, dry food, alcoholism, all kinds of extreme diets, etc. occur.

According to statistics, ulcers occur in 70% of patients between 25 and 50 years of age, and in every fifth person after 50 years of age. An ulcer does not occur suddenly; it is preceded by diseases of the stomach and intestines.

Morphology of the ulcer

The gastric mucosa is very durable, it can withstand the action of hydrochloric acid, the causticity of pancreatic enzymes, and hunger strike. Gastric juice kills 99% of pathogens, so a healthy person, even when eating stale food, most often has no consequences.

When a healthy person skips a meal, he or she may experience unpleasant sucking sensations in the epigastrium, but no more. Then he can take food again, and this will not affect his health. It's a completely different matter with an ulcer.

Here the mucous membrane is thinned, and pockets of inflammation may occur in it. These are gastritis, and neglecting the timeliness of meals is already painful. The mucous membrane is easily corroded by gastric juice, acidity increases. Eating any food at any time is no longer an option.

First, erosions form - more superficial damage to the mucosa. When moving into deeper layers (submucosal and muscular), ulcers appear. A healed ulcer is a scar.

Localization

In what area does it hurt with a peptic ulcer? A typical pain syndrome is observed in the epigastric region. They have the character of attacks that intensify after eating, especially during exacerbation of the disease. Depending on the specific location of the ulcer, the pain will change location. The pain can be localized in different areas. For example:

First, let's look at the pain associated with a duodenal ulcer. In this case, the pain symptom will be localized in the upper right part of the peritoneum. As a rule, it has the character of attacks that are quite intense, multi-temporal and can be repeated several times a day. However, there have been cases when the pain has an increasing character and is quite long-lasting.
If the ulcer is located right in the center of the stomach, then the pain symptom is felt in the epigastrium, sometimes in the left side of the abdomen.
An ulcer located at the top of the stomach makes itself felt by pain in the form of burning and pressure behind the sternal process. It is also worth paying attention to the fact that they are often confused with the symptoms of an angina attack, the characteristic feature of which is pain in the area of the left shoulder blade, heart or arm. As a rule, symptoms appear after eating, but they can also be noticed after intense physical activity.

Mechanism of ulcer development

There is always mucus on the surface of the mucosa. It is produced by special cells of the stomach, its role is protective. Under stress, predominant vagal tone, or under the influence of hormonal disorders, mucus is produced in a smaller volume, and some area of the mucous membrane appears to be particularly weakened. The further mechanism is as follows: inflammation of the epithelium appears, which is expressed in some discomfort in the stomach area. If measures are not taken, the inflammation process goes deeper, the painful sensations intensify and are replaced by degenerative changes in the mucosa. Next comes erosion, the mucous membrane in some areas is deeply destroyed. This is where an ulcer forms, this is the mechanism of the so-called stress ulcer. With the integrity of the stomach wall, its functionality is also impaired.

When H. Pylori penetrates the stomach wall, the bacterium uses its flagella. They attach it and remain in place for a number of years. It has the property of producing the enzyme urease, which breaks down urea into ammonia. And it already neutralizes hydrochloric acid, alkalization of the stomach environment occurs.

Nothing prevents bacteria from developing and multiplying, forming an infectious focus. Epithelial cells begin to die, the mucous membrane is destroyed and an ulcer appears.

Stomach diseases

The cause of the development of diseases of the digestive system in adults is most often poor nutrition, bad habits, stress, and hereditary factors. All diseases have certain characteristic symptoms, which greatly simplifies diagnosis; each of them is assigned a code in the international classification.

Gastritis

Gastritis is an inflammation of the gastric mucosa; this disease is the leader among pathologies of the gastrointestinal tract and occurs in acute or chronic form. There are autoimmune and Helicobacter types; inflammation can be accompanied by an increase or decrease in the acidity of the juice.

Acute gastritis is a one-time inflammation that can be triggered by medications, junk food, chemicals and bacteria. The chronic form is characterized by a long course, remission is replaced by exacerbation. The disease code according to ICD-10 is K29.

Causes of gastritis:

damage to the stomach by pathogenic microorganisms, the main pathogen is the bacteria Helicobacter pylori;
poor nutrition, fasting, overeating;
alcoholism;
long-term use of non-steroidal anti-inflammatory drugs, glucocorticoids;
duodenal reflux;
autoimmune pathologies;
hormonal imbalance, vitamin deficiency;
helminthiasis, stress.

The bacterium Helicobacter pylori is the causative agent of gastritis

With gastritis with high acidity, the patient complains of discomfort in the solar plexus area or near the navel; the discomfort decreases after eating. The main symptoms are heartburn, belching with the taste and smell of rotten eggs, diarrhea, metallic taste, stomach pain, and morning sickness.

Gastritis with low acidity is accompanied by deterioration of peristalsis, frequent constipation, bad breath, rapid satiety, heaviness in the abdomen, and increased gas formation.

A dangerous consequence of the chronic form of the disease is atrophic gastritis, which gradually begins to destroy the glands that are responsible for the synthesis of gastric juice.

Peptic ulcer

An ulcer is a consequence of chronic gastritis; deep wounds form in the gastric mucosa; the disease is chronic. With an ulcer, destructive processes affect the deep layers of the mucous membrane, and scars appear after healing. The ICD-10 code is K25.

The reasons for the development of peptic ulcer disease are similar to gastritis, but sometimes an ulcer develops against the background of diabetes, tuberculosis, hepatitis and cirrhosis, lung cancer, and syphilis.

Main features:

pain in the upper abdomen - a symptom manifests itself in 75% of patients;
constipation;
heartburn, nausea, sometimes vomiting;
lack of appetite, weight loss;
bitter or sour belching, flatulence;
coating on the tongue, constantly sweaty palms;
feces with mucus.

The ulcer is often hereditary; the risk of developing the disease is high in men and women with blood group I.

Frequent coating on the tongue may indicate a stomach ulcer

Gastroparesis

The disease is characterized by slow motility - the stomach muscles weaken, food does not move well through the gastrointestinal tract. The symptoms of the disease are in many ways similar to other gastric pathologies - nausea, vomiting after eating, pain and cramping in the abdomen, rapid satiety. The ICD-10 code is K31.

Causes of the disease:

diabetes;
inflammatory processes in the pancreas;
diseases of the nervous system;
micronutrient deficiency;
surgical interventions on the stomach, removal of a bladder for cholelithiasis, during which the vagus nerve was affected;
chemotherapy, radiation exposure.

Against the background of gastroparesis, there is a failure in metabolic processes, vitamin deficiency, and sudden weight loss.

People with diabetes are more likely to experience gastroparesis

Gastroptosis

Stomach prolapse due to weakened muscle tone; the pathology is often congenital. The acquired form develops due to sudden weight loss, constant lifting of heavy objects, childbirth, the disease has an initial, moderate and severe stage. The ICD-10 code is 31.8.

Disease syndromes:

a strong feeling of heaviness, especially after overeating;
unstable appetite, craving for spicy foods, dairy products can cause disgust;
nausea for no apparent reason;
frequent belching, increased gas formation;
constipation;
acute pain in the lower abdomen, which intensifies with changes in body position;
the stomach sags.

Against the background of gastroptosis, prolapse of the kidneys and liver often occurs.

Adenocarcinoma

Stomach and esophageal cancer are the most dangerous, often fatal diseases of the digestive system; malignant neoplasms are formed from the epithelial tissues of the gastric mucosa. The disease is common among people aged 50–70 years; the pathology is diagnosed in men more often than in women. The ICD-10 code is C16.

Causes of the disease:

excessive consumption of salt, food additives category E, smoked, pickled, canned, fried foods;
alcohol, smoking, unsystematic use of Aspirin and hormonal drugs;
deficiency of ascorbic acid, vitamin E;
the destructive effects of Helicobacter pylori, streptococci, staphylococci, Candida fungi, Epstein-Bar virus;
chronic gastritis, peptic ulcer, polyps, surgery or gastric resection;
hereditary factor - cancer develops more often in people who have inherited blood group II;
lack of immunoglobulin Ig in the tissues of the gastric epithelium.

Chronic gastritis can develop into stomach cancer

The main danger of cancer is that the disease can occur for a long time without any special symptoms. At the initial stage, there is a decrease in performance, a general deterioration in well-being, heaviness and discomfort in the abdomen. As the tumor grows, the abdomen increases in size, weight decreases sharply, the person suffers from frequent constipation, severe thirst, abdominal pain intensifies, radiates to the back, blood appears in the stool, and pain in the anus is bothersome.

Helicobacter pylori is transmitted through saliva, contaminated food and water, poorly disinfected medical instruments and dirty dishes, from mother to fetus.

Pneumatosis

The disease is characterized by increased gas formation; excess gas leaves the body along with loud belching. Neurological pneumatosis develops in hysterics and neurasthenics, who often involuntarily swallow large portions of air. The ICD-10 code is K31.

Causes of organic pneumatosis:

hernias, increased intra-abdominal pressure;
respiratory diseases, which are accompanied by difficulty breathing, dry mouth;
talking while eating, snacking on the go, babies swallow a lot of air during feeding;
some pathologists of the heart and blood vessels;
smoking, chewing gum.

In addition to belching, a person is worried about bloating, rapid heartbeat, heart pain after eating, hiccups, and difficulty breathing.

Smoking can cause gastric pneumatosis

Gastric volvulus

A rare and serious disease in which the stomach rotates around its anatomical axis. The ICD-10 code is K56.6.

Causes of the disease:

anatomical malformations, elongation of ligaments, sudden weight loss;
diaphragmatic hernia;
lifting weights;
abuse of rough food - the disease often develops in vegetarians;
changes in intra-abdominal pressure indicators.

At the initial stage of the disease, there is a sharp pain in the abdomen, which radiates to the left hypochondrium, bloating and a feeling of heaviness, and sometimes there are problems with swallowing.

At the initial stage of gastric volvulus, there is severe pain in the left hypochondrium

With acute volvulus, the pain occurs sharply, can radiate to the back, shoulders, and shoulder blade, accompanied by severe nausea and vomiting, regurgitation occurs even after a sip of water. Against the background of gastric pathology, disruptions in the functioning of the heart occur, severe intoxication, and death are possible. Any form of the disease is characterized by a lack of stool, severe thirst, and a sharp increase in temperature.

Important!

Abdominal pain is not always a sign of stomach disease. In a child, such symptoms often appear with a sore throat, a cold, or against a background of stress and nervous experiences.

Reflux stomach disease

One of the most common chronic pathologies of the digestive system, it develops due to regular penetration of the contents of the abdominal cavity and duodenum into the esophagus. The disease is accompanied by severe sore throat, sour belching, heartburn, discomfort in the solar plexus area, and diseases of the bronchi and trachea may occur. The ICD-10 code is K21.

Causes of the disease:

decreased muscle tone of the lower sphincter due to alcohol abuse, caffeine, taking certain medications, smoking, hormonal imbalance during pregnancy;
increased intra-abdominal pressure;
diaphragmatic hernia;
eating on the go;
duodenal ulcer.

Excessive consumption of animal fats, mint tea, spicy and fried foods can provoke the development of reflux disease.

Duodenal ulcers can cause gastric reflux disease

Gastroenteritis

Intestinal flu, a rotavirus infection, develops when pathogenic microorganisms penetrate the digestive system; the disease is often diagnosed in children and the elderly. The infection is transmitted by airborne droplets, through contact and household contact, but most often the bacteria enter the body through dirty vegetables and hands. The ICD-10 code is K52.

Symptoms:

cough, runny nose, red throat, pain when swallowing - these symptoms appear a few hours before dyspepsia and pass quickly;
diarrhea 5–10 times a day - gray-yellow stool has a pungent odor, no inclusions of pus or blood;
vomiting, increasing weakness;
pain near the navel or lower abdomen;
temperature increase;
dehydration.

Such symptoms may indicate either ordinary poisoning or the development of cholera or salmonellosis, so you need to call a doctor and get tested.

Gastroenteritis is characterized by frequent diarrhea

Etiology of the disease

There are many reasons given, as well as theories, but none of them is a direct provocateur. The main factors for the appearance of ulcers are dietary errors, accompanying pathologies of the gastrointestinal tract and an unhealthy lifestyle. Particularly harmful are repeated stress, irregular food intake, smoking and alcohol. All this leads to the fact that gastric juice has a destructive effect on the gastric mucosa.

In recent years, the bacterium Helicobacter pylori has been called the culprit of the ulcer. When it multiplies, it alkalizes the stomach, food digestion worsens, and gastritis with low acidity occurs. Currently, the presence of bacteria has been detected in almost all people, but they live in an acidic environment and do not cause harm to everyone.

Helicobacter pylori is a factor in the development of ulcers only in 40% of cases. Otherwise, the culprits are:

abuse of spicy foods, poor diet, caffeine-containing and energy drinks;
anomalies of the autonomic system;
stress;
infections that reduce immunity - HIV and tuberculosis;
smoking and alcohol;
uncontrolled use of anti-inflammatory drugs.

The provocateurs are:

bad heredity;
peritoneal injuries;
anemia and hypovitaminosis;
disorders in the lungs, heart and kidneys.

Prevention

To prevent pain in the stomach you need to:

Treat gastrointestinal pathologies in a timely manner.
Follow a diet; food should be rich in valuable substances.
Eliminate bad habits.
Do not take medications that worsen a stomach ulcer without a doctor’s prescription.
Avoid tense situations as much as possible, relieve stress properly and learn to relax.
Carry out regular diagnostics of the body.
Do moderate exercise.
Undergo sanatorium-resort treatment.

You need to take it as a rule: if you experience regular pain in the stomach, you should immediately seek medical help. Firstly, these actions will prevent the occurrence of serious complications: stomach cancer, perforated ulcers, bleeding into the abdominal cavity and peritonitis. Secondly, timely detection of pathology will allow the patient to quickly recover and get rid of pain.

Classification of stomach ulcers

So, the ulcer can be:

with bleeding;
with perforation;
combined;
without bleeding or perforation.

Systematization of YaBZh:

in size: small – up to 5 mm; average – up to 1 cm; large – up to 3 cm; giant – more than 3 cm;
by quantity - single and multiple ulcers;
by stages of scarring;
with latent, moderate and severe course;
according to the level of acidity – hyperacid and hypoacid processes, zero acidity;

Depending on the location of a stomach ulcer, it can be:

cardiac department;
body of the stomach;
antrum;
pyloric;
combined ulcers (simultaneously in the stomach and duodenum).

Perforated gastric ulcer: symptoms and manifestations

Perforation of an ulcer is a perforated form of the disease, in which a through hole is detected in the stomach and spread to a neighboring organ. This is a serious complication of the disease that requires emergency hospitalization, otherwise the person may die. The urgency of the problem lies in the fact that, despite the development of medicine and the modern approach to treatment, the frequency of such cases is increasing. The condition is characterized by a sudden onset and progressive severe course.

The pathology can be recognized if the following symptoms and manifestations of a perforated gastric ulcer occur:

abrupt onset;
the appearance of sudden intense pain, which intensifies with movement, and becomes diffuse over time;
increased pain several days before the appearance of special symptoms;
abdominal retraction when inhaling;
often an increase in temperature;
severe tension in the muscles of the anterior abdominal wall;
positive Shchetkin-Blumberg symptom.

A perforated ulcer may be accompanied by bleeding, which increases the risk of an unfavorable outcome. Therefore, first aid consists of immediate surgery, in which the defect is sutured.

Symptoms

Symptoms of stomach ulcers in adults at the initial stage do not differ from gastritis:

Spasmodic drawing gastralgia in the center at the angle of the sternum.
Sour belching.
Heartburn.
Intermittent nausea after eating.
Decreased appetite and weight loss.

How to understand that a stomach ulcer has occurred:

Nausea and pain become constant.
Sour belching with bitterness.
Heartburn.
Vomit.
Constipation.
Decreased appetite.

What kind of pain occurs with a stomach ulcer? During an attack, the pain is unbearable and manifests itself in the form of contractions and spasms. Accompanied by tachycardia, pallor of the skin. After eating, heaviness and a feeling of fullness in the stomach often appear.

The nature of pain with a stomach ulcer can be supplemented by a fairly common symptom - this is pain at night. After eating or taking antacids it decreases and disappears. A white coating appears on the tongue, a heavy metallic odor from the mouth, and the skin changes. There is an aversion to food or a decrease in appetite, night hunger pains arise, which must be eaten, sweating increases and a tendency to constipation.

Other symptoms of stomach ulcers in adults: a person’s hair becomes dry and brittle, the complexion turns pale, the lips are dry, with puffiness in the corners of the mouth. The ulcer sufferer is constantly tired, anxious and irritable.

Where does it hurt with a stomach ulcer? Localized just below the ribs, the pain often radiates under the shoulder blades, into the sternum. Therefore, it can be confused with a heart attack. The danger of an ulcer lies in its silence: it can occur without symptoms, but the processes of destruction in the wall of the stomach continue. There is a risk of gastric bleeding and peritonitis. People with low acidity are at risk for developing cancer, while high acidity more often provokes perforation of an ulcer.

How does a stomach ulcer hurt? Pain is almost always present, even unexpressed. Already at the initial stage after eating, discomfort occurs. At first, this is felt only with harmful foods - pickles, smoked foods, fats, and then the sensation occurs with any food.

How does a stomach ulcer hurt? In ¾ of all patients, pain is localized in the center of the epigastrium. It is seasonal. In half of the patients the picture is blurred, but the pain always intensifies with physical effort, consumption of prohibited foods, and smoking.

Where does the pain from a stomach ulcer go? It tends to radiate to the heart area, back, and navel, which makes diagnosis difficult. There may also be other manifestations: flatulence, increased appetite, but quick satiety, decreased mood and poor sleep, hyperhidrosis of the palms.

Abdominal pain with a stomach ulcer usually gradually subsides after eating. They manifest themselves differently depending on the location of the ulcer. For example, an ulcer in the cardiac region has the following symptoms: pain occurs after eating 20 minutes, it is not sharp, it is located closer to the heart, in the upper abdomen. Accompanied by vomiting and nausea.

How does a stomach ulcer manifest itself (symptoms) with an ulcer in the lesser curvature? Here the ulcer is prone to perforation. A dangerous complication is peritonitis. The localization of pain is along the midline of the abdomen to the left. Occurs after eating at different times. Intensifies with a long break in use. Characterized by aching pain at night.

How does a stomach ulcer (symptoms) manifest on the greater curvature? This type is more often diagnosed in men over 30 years of age. More than 50% of such ulcers become malignant. The pain is mild and often goes unrecognized.

Characterized by the following features:

the abdominal area ache slightly;
nausea, maybe vomiting;
no appetite, a whitish coating on the tongue;
constipation.

How does a stomach ulcer (symptoms) manifest in the antrum? This type is diagnosed in 15% of cases, more often in young people. Gives complications in the form of bleeding and cancer. The symptoms are reminiscent of a duodenal ulcer: stomach pain when hungry, pain worse at night, persistent heartburn and vomiting, a feeling of fullness in the stomach and blood in the stool.

How does a stomach ulcer (symptoms) manifest in the pyloric part? Helicobacter pylori likes to settle here more often than other departments, which is why it got its name. The most characteristic signs:

prolonged (more than half an hour) night pain;
a lot of saliva in the mouth;
the stomach is bloated after eating;
heartburn and belching;
sometimes vomiting sour;
nausea.

What criteria characterize ulcer pain?

Pain syndrome is considered the most typical manifestation of gastric and duodenal ulcers. The symptom is caused by direct erosion not only of the inner mucosa, as with inflammation of the stomach, but also of the submucosal, muscular layer, where there are quite a lot of pain receptors.

Gastritis is considered a precursor to ulcers. Ignoring timely treatment worsens the condition of the organ and digestion as a whole. In order to fully characterize which pain is most typical with a stomach ulcer, you should dwell in more detail on the description of the symptom.

Localization

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

if the lesion concerns the cardiac and subcardial region - under the xiphoid process of the sternum;
in the body area - the left side of the epigastrium;
in the pylorus and duodenum - on the right in the epigastrium.

Intensity

In half of the cases, patients consider the pain tolerable, in 1/3 of the cases it is severe. More pronounced at a young age and with complications. They are relieved by taking alkaline mineral water, drugs that suppress the secretion of gastric juice (Omez, Famotidine), antacids (Gastal, Almagel).

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

What are they connected with?

There is a clear connection - with food intake, with the time of year (exacerbations in spring and autumn). Depending on the food, it is customary to divide pain:

Early - they begin half an hour to an hour after eating, increase gradually, last up to two hours, decrease, then disappear when the food bolus passes into the intestine. More typical for localization of the lesion in the body of the stomach. If the ulcerative process affects the cardiac, subcardial and fundic sections, it appears immediately after swallowing food.
The late ones bother patients one and a half to two hours after eating, unlike the “early” ones, they intensify as the contents pass into the duodenum. Typical for ulcers located in the pyloric region and in the duodenal bulb.
At night or “hungry” - they occur two to four hours after dinner and are relieved by eating. Typical for localization in the duodenum, pyloric section of the stomach.

Different combinations and multiplicity of ulcerations are expressed simultaneously in early and late pain.

In 75% of patients, the cause is considered to be infection with Helicobacter, so peptic ulcer disease can be classified as an infectious disease with its own routes of infection and transmission

Possible complications

Complications include the following:

The most common occurrence is perforation of the ulcer followed by bleeding or peritonitis.
Pyloric stenosis with the development of even obstruction.
Malignization - the transition of an ulcer to a tumor - is observed in 2-12% of cases; The causes of degeneration have not been fully explored.
Gastric perforation can occur suddenly and has a reactive development.
Stomach bleeding in the form of small blood losses becomes the norm for the pathology. This is usually due to a damaged artery. Profuse bleeding occurs when an ulcer is perforated. Vomiting of “coffee grounds” is characteristic, the skin is pale, cold sweat appears, the pulse increases and decreases, the pressure drops, the stool turns black (melena). An urgent ambulance call and hospitalization are required.
Penetration - occurs when the stomach wall is destroyed, when the ulcer moves to the surface of a neighboring organ. Most often this is the pancreas.
Acute destructive pancreatitis - develops when gastric juice enters the pancreas.

Symptoms and treatment of exacerbation of stomach ulcers

A stomach ulcer is considered a chronic disease, capable of worsening depending on the time of year, under the influence of a number of external and internal causes. Symptoms and treatment depend on the origins.

It is extremely difficult to completely cure peptic ulcer disease, but it is possible to put it into a state of stable remission. You will have to put in a lot of effort and effort. If you strictly adhere to a strict diet and strictly follow the recommendations of your doctor, you can achieve a long-term state of remission. If you violate your diet or lead an unhealthy lifestyle, a relapse of the disease may occur.

Why does it worsen?

Periodic recurrence of gastric ulcers is caused by a violation of protective mechanisms. The most aggressive factor affecting the walls of the stomach is hydrochloric acid. An increase in the production of the substance during exacerbation of a gastric ulcer by parietal cells leads to irritation of the walls, the development of inflammation and the formation of new ulcerative surfaces. Deterioration of the condition can be caused by the backflow of bile into the stomach cavity from the duodenum.

When eating excess amounts of spicy, fatty and salty foods, prolonged stressful situations, and overwork, the protective properties of gastric mucus are reduced. Taking certain medications may aggravate the condition. The main cause of the development of the ulcerative process is the microorganism Helicobacter pylori.

Clinical signs

The first clinical sign of exacerbation of a gastric ulcer is the appearance of pain in the upper abdomen - the epigastric region and slightly to the right.

Pain and its nature

Pain from a peptic ulcer is of a similar nature:

The pain is predominantly localized in the middle part of the epigastric region.
From time to time, irradiation of pain to the right, left, to the navel or back is possible.
The localization of pain depends on the location of the ulcer and the nature of the food consumed. Pain appears in spring and autumn.
After taking full-fat milk and antacid medications, the pain gradually subsides.
If the patient vomits, relief occurs later due to the removal of excess hydrochloric acid from the stomach.
The pain begins immediately after eating or after a few hours, occurs on an empty stomach, at night. Later it may disappear spontaneously.
When the ulcer is localized in the pyloric region, the pain begins three hours after the last meal.
At night, the pain is intense and causes insomnia in the patient. A person strives to drink more milk.

Dyspeptic disorders

In addition to pain, during exacerbation of peptic ulcers, digestive dysfunctions are noted. The patient is worried about nausea, vomiting, heaviness in the stomach, and a bloated abdomen. The patient's appetite remains high, sometimes excessive. Some patients deliberately moderate the amount of food they eat out of fear of possible pain.

Asymptomatic ulcer

Most often, patients have an asymptomatic ulcer or an ulcer with minimal pain. This one is called dumb. This clinical form, with no signs of exacerbation, is often found in weakened and elderly patients with diabetes. A similar type occurs when taking non-steroidal anti-inflammatory drugs. Asymptomatic ulcers are often found among people who abuse alcoholic beverages.

In such cases, the ulcer does not appear for a long time. If the disease is not diagnosed and treated in time, a perforation of the wall will soon occur, leading to bleeding and the development of stenosis. Then the usual conservative antiulcer therapy is not enough. The patient is subject to hospitalization in a surgical hospital and intensive treatment. Complicated types of the disease are the most dangerous.

Stomach ulcer and bleeding

According to patients, bleeding inevitably develops with an ulcer. This statement is not true. Bleeding may appear, remain hidden, or be absent. If there is heavy bleeding, the patient begins to vomit blood mixed with blood or in the form of coffee grounds. The patient's stool becomes black, semi-liquid and unformed. At the same time, with heavy bleeding, the clinical picture of acute blood loss develops, reaching the development of hemorrhagic shock. The patient becomes pale, dizzy, the heart rate increases, and loss of consciousness is possible.

With chronic bleeding in small volumes of blood loss, the clinical picture of anemia gradually develops. Hidden signs of bleeding are detected when stool is tested for occult blood.

Complications of ulcers

Long-term untreated exacerbation of gastric ulcer entails a number of complications. The ulcer begins to spread to neighboring organs and tissues. The pancreas becomes a common site of germination. In this case, the patient begins to experience severe pain, which is not relieved by taking antacids and antispasmodics.

Stenosis of the pyloric lumen is a common consequence of a gastric ulcer. With the mentioned complication, a narrowing of the lumen of the duodenal bulb occurs. A feeling of bloating and heaviness in the abdomen develops. Belching appears with an unpleasant putrid odor.

Long-term untreated disease can develop into stomach cancer. To prevent a terrible diagnosis, it is necessary to undergo regular examinations, see a gastroenterologist, and undergo endoscopic examination.

Diet for exacerbation of peptic ulcer

A necessary condition for eliminating an exacerbation is the normalization of the diet and nature of nutrition. It is important to follow the rules and principles:

After eating, the mucous membrane should not experience irritation.
Products that increase the production of hydrochloric acid are excluded from the diet.
Dishes for a patient with an ulcer should not be hard. In the acute period, it is necessary to give preference to grated and semi-liquid dishes.
A single serving should not be too large. It is optimal to stick to the portion that fits on the saucer.
Meals should be frequent.
Food should not be cold or hot. It is optimal to eat foods that are slightly warm or at room temperature.
The amount of table salt is kept to a minimum.

The fight against exacerbation of stomach ulcers involves milk and dairy products in the diet. They have an enveloping effect on the stomach wall.

The products should not contain an excess of refractory animal fats, rich meat, mushroom broths, or raw coarse vegetable fiber. Eliminate beans and corn from your diet. The calorie content of the daily diet should not exceed 3000 calories.

Drug treatment

Along with prescribing a diet, the attending physician prescribes drug therapy for exacerbation of a stomach ulcer. You should not independently treat the acute period of a peptic ulcer, so as not to wait for the development of serious complications.

A gastroenterologist will prescribe laboratory and instrumental studies and, based on the results, an individual therapeutic regimen. First of all, conservative therapy is aimed at destroying the microorganism Helicobacter pylori in the stomach, which causes pathological processes in the stomach.

Antibacterial therapy

To destroy Helicobacter pylori, the patient is prescribed certain antibiotics. There are three types of effective antimicrobial agents that relieve exacerbation of gastric ulcers.

Macrolide group drugs. Clarithromycin is often used. The drug erythromycin is older, it is used much less frequently, and is considered no longer relevant. It is suggested to take the medicine twice a day
Amoxicillin is a drug from the penicillin group. Take the tablet twice a day.
Metronidazole, trichopolum is an antimicrobial and antiprotozoal drug that is effective for gastric ulcers.

Reducing the acidity of gastric juice

An ulcer is not always caused by a microbe; in some cases, the pathology is aggravated by taking medications that have a detrimental effect on the stomach. In such cases, drugs are prescribed that reduce the activity of gastric juice and protect the walls of the stomach.

Histamine receptor inhibitors – ranitidine.
Proton pump inhibitors – omeprazole. They are used more often than the first group due to their greater efficiency.
Antacids - Maalox, phosphalugel. Reduce acidity levels and make gastric juice less aggressive.
Gastroprotectors – de-nol, bismuth preparations.

The prescribed medicine is taken for two weeks. In combination with medications, it is not prohibited to treat ulcers using traditional methods.

Against the background of the therapy, the manifestation of inflammation and ulcerative process gradually stops. For preventive purposes, it is recommended to adhere to a diet, give up bad habits, and avoid stressful situations.

Pain from a stomach ulcer can be of different types. Discomfort is almost always localized in the abdominal area, but sometimes the navel and shoulder blades can become sore.

Pain with gastric and duodenal ulcers is similar. Therefore, it is quite difficult to determine which organ of the gastrointestinal tract is affected by the ulcer, only by the nature of the painful sensations. A detailed examination is required.

What kind of pain can it be?

You should know what pain occurs with a stomach ulcer in order to prevent the negative consequences of the pathology. Ulcers most often occur against the background of prolonged hunger or overeating, consumption of unwanted foods that irritate the mucous membrane of the stomach or duodenum.

early - begins 1.5–2 hours after eating, passes quickly;
late - appears 7 hours after eating;
emaciation (hunger pain) - disturbs a person at night and in the morning.

Medications

Medicines prescribed:

Groups of antibiotics used for Helicobacter pylori infection: macrolides (“Erythromycin”, “Clarithromycin”); penicillins: Amoxicillin"; nitroimidazoles: Metronidazole and its analogues. To destroy Helicobacter, 1-2 courses of antibiotics are prescribed.
Antacids reduce the acidity of gastric juice and protect the walls of the stomach - Maalox, Rennie, Almagel, activated carbon and Polysorb.
Antisecretory agents include: H-2 histamine receptor antagonists. They block the receptors of cells that produce hydrochloric acid - Ranitidine, Nizatidine, Famotidine.
Proton pump inhibitors (PPIs) are the main drugs used in the treatment of ulcers. They block the final stage of the formation of hydrochloric acid: “Omez”, “Omeprazole”, “Rabeprazole”, “Rabelok”, “Lansoprazole”, “Pariet”, “Nexium”.
Pain relief from stomach ulcers, which is not blocked by antispasmodics and antacids, is produced by M-cholinergic receptor blockers. There is only 1 drug and its analogues - “Pirenzipine” (“Piregexal”, “Gastrotsepin”, “Gastromen”).
Protection of the mucous membrane - gastroprotectors: “Venter, De-Nol”, “Solcoseryl”, “Misoprostol”.
To normalize acidity and increase mucus production, Cytotec and Misoprostol are used.
Preparations for the repair of the mucous membrane – “Sucralfate”; “Biogastron”, “Kaved-S”, “Entrostil” also accelerate the restoration of the gastric mucosa.
Bismuth preparations have an antiseptic, enveloping and astringent effect, for example, Vikalin.
Ganglion blockers are aimed at blocking the passage of impulses from the sympathetic nervous system. This promotes the healing of ulcers and ultimately reduces pain - “Quateron”, “Benzohexonium”, “Dimecoline”.

How to relieve pain with a stomach ulcer? Just the above-mentioned drugs.

Nutrition for a patient with a stomach ulcer

What can you eat if you have a stomach ulcer?

Patients with stomach ulcers need a specific diet plan. First of all, there are two main requirements for the diet: products should not irritate the gastric mucosa, but at the same time they should fully meet the body's needs. You should eat at least five times a day, but portions must be strictly dosed so as not to stretch the diseased organ.

It is important that the cooked food is not too cold or hot; food should not be fried. The main cooking method is steaming.

The patient is allowed to use:

Slimy soups made from cereals, semolina, rice and oats;
Lean meat (chicken, turkey or veal);
Liquid mashed porridges;
Eggs in the form of an omelet or soft-boiled;
Kissels, compotes;
Honey can be used as a dessert;
Among dairy products, you should give preference to cottage cheese and cream, but with a low fat content.

What should you exclude from your diet?

Alcohol;
Everything fried, smoked and fatty;
Flour (bread and bakery products);
Vegetables and fruits are prohibited, but not all, but those that irritate the stomach. These are tomatoes, legumes, cabbage, radishes, dates, gooseberries, citrus fruits;
It is worth giving up sauces, canned food, spicy seasonings;
Coffee, cocoa, and strong meat broths are not recommended.

On the subject: Diet for stomach ulcers - what can and cannot be eaten?

Operation

Surgical intervention is indicated in the following cases:

ulcer perforation, bleeding;
cicatricial narrowing of the pylorus;
there has been no effect from conservative treatment for more than six months;
frequent exacerbations – up to 4 times a year;
ulcers suspicious for malignancy.

The operation is performed using a classic incision or laparoscopy.

Excision of the ulcer is performed - resection, intersection of the vagus nerve (to reduce the secretion of hydrochloric acid and create conditions for scarring of the ulcer).

In addition, physical therapy, herbs, and diet help. Treatment of concomitant stomach diseases is mandatory.

Physiotherapy is applicable outside of exacerbations: electrophoresis, ultrasound, UHF. Spa treatment is useful.