Treatment of gastric and 12 peptic ulcers

Patients with uncomplicated peptic ulcer disease are subject to conservative treatment.

Treatment of peptic ulcer disease is carried out in two stages:

• active therapy of exacerbation or newly diagnosed ulcer,
• prophylactic treatment to prevent relapse (return).

At the beginning of an exacerbation, the patient needs physical and mental rest, which is achieved by maintaining a semi-bed rest regime and organizing a reasonable psycho-emotional environment. Then, after about 7-10 days, it is advisable to expand the regime in order to include the body's reserve capabilities for self-regulation.

Indications for hospitalization

• Peptic ulcer with a clinical picture of severe exacerbation: severe pain syndrome, vomiting.
• Detection of gastric ulcers requiring differential diagnosis between benign ulcers and gastric cancer.
• Signs of gastrointestinal bleeding (melena, vomiting of blood, etc.), perforation and penetration of the ulcer defect.
• Peptic ulcer of the stomach and duodenum with a history of complications (primarily gastrointestinal bleeding).
• Peptic ulcer with concomitant diseases. Patients with exacerbation of gastric ulcer are treated in general therapeutic or gastroenterological departments.

Inpatient treatment is provided for newly diagnosed gastric ulcers, for giant ulcers, for outpatient treatment that is ineffective, and for complications. Inpatient treatment for uncomplicated gastric ulcers lasts 20-30 days, and for duodenal ulcers - 10 days. Upon discharge from the hospital, the patient is given a legally binding document (extract from the medical history), which indicates the full diagnosis of the disease and individual characteristics of the disease (localization and size of the ulcer, complications of peptic ulcer disease, previous operations for peptic ulcer disease, treatment recommendations), and also records concomitant diseases.

Patients with uncomplicated peptic ulcer disease are subject to conservative treatment on an outpatient basis.

Goals of peptic ulcer treatment

• Eradication of H. pylori.
• Rapid elimination of disease symptoms.
• Achieving stable remission.
• Prevention of complications.

Surgical treatment of peptic ulcer

Indications for surgical treatment of peptic ulcer disease are complications of this disease: perforation; bleeding; stenosis with severe evacuation disorders.

When choosing a surgical treatment method, preference is given to organ-preserving operations.

Further management of the patient with peptic ulcer disease

Eradication therapy for H. pylori, if the bacteria are successfully eliminated, reduces the risk of relapse of peptic ulcer disease and complicated course of the disease in the vast majority of patients. To prevent exacerbations of gastric ulcer, duodenal ulcer and their complications, two types of therapy are recommended.

Continuous (for months or even years) maintenance therapy with an antisecretory drug at half the dose: for example, daily intake of either 150 mg ranitidine, or 20 mg famotidine, or 20 mg omeprazole.

Indications:

• ineffectiveness of the eradication therapy;
• complications of peptic ulcer disease (ulcer bleeding or perforation);
• the presence of concomitant diseases requiring the use of NSAIDs (proton pump inhibitors are preferred);
• concomitant with peptic ulcer disease GERD;
• peptic ulcer disease not associated with H. pylori.

Patient education

The patient should be convinced of the need to strictly adhere to the recommended regimen of eradication therapy for H. pylori, since arbitrarily changed regimen of frequency and dosage of drugs is the main reason for the persistence of H. pylori infection.

The patient should be advised to avoid taking NSAIDs and to adjust their lifestyle and diet. It is advisable to limit alcohol and caffeine consumption and to quit smoking.

The patient should be given detailed information about the signs of a relapse of peptic ulcer disease and its complications (bleeding, perforation, pyloric stenosis) and convinced of the need to urgently consult a doctor if they occur.