Treatment of gastric and duodenal ulcers
Last reviewed: 19.10.2021
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Patients with an uncomplicated course of peptic ulcer are subject to conservative treatment.
Treatment of peptic ulcer is carried out in two stages:
- active therapy of exacerbation or a newly diagnosed ulcer,
- preventive treatment to prevent recurrence (return).
At the beginning of an exacerbation, the patient needs physical and mental rest, which is achieved by observing the semi-fast regime and organizing a reasonable psycho-emotional environment. Then, after about 7-10 days, the regime should be expanded to include reserve capabilities of the organism for self-regulation.
Indications for hospitalization
- Ulcer disease with a clinical picture of severe exacerbation: severe pain syndrome, vomiting.
- Detection of ulcers in the stomach, requiring a differential diagnosis between benign ulcers and stomach cancer.
- Signs of gastrointestinal bleeding (melena, vomiting of blood, etc.), perforation and penetration of a ulcerative defect.
- Peptic ulcer of the stomach and duodenum with the presence of complications in the anamnesis (primarily gastrointestinal bleeding).
- Ulcer disease with concomitant diseases. Patients with exacerbation of gastric ulcer are treated in general therapy or gastroenterology departments.
Inpatient treatment is carried out with a newly diagnosed stomach ulcer, with a giant size of the ulcer, with no effect from outpatient treatment and with complications. Inpatient treatment of uncomplicated form of stomach ulcers lasts 20-30 days, ulcers of the duodenum - 10 days. When discharging from the hospital, the patient is issued a legally valid document (an extract from the medical history), which indicates the complete diagnosis of the disease and the individual characteristics of the disease (localization and size of the ulcer, complications of peptic ulcer disease, relapsed operations for peptic ulcer disease, treatment recommendations), and are concomitant ulcer diseases.
Patients with uncomplicated course of peptic ulcer are subject to conservative treatment in outpatient settings.
Purposes of treatment of peptic ulcer
- H. Pylori eradication.
- Quick elimination of the symptoms of the disease.
- Achieve persistent remission.
- Prevention of complications.
Surgical treatment of peptic ulcer
Indications for surgical treatment of peptic ulcer are complications of this disease: perforation; bleeding; Stenosis with pronounced evacuation disorders.
When choosing the method of surgical treatment, preference is given to organ-preserving operations.
Further management of a patient with peptic ulcer disease
H. Pylori eradication therapy with successful bacterial elimination reduces the risk of recurrence of peptic ulcer and complicated course of the disease in the vast majority of patients. For the prevention of exacerbations of gastric ulcer, duodenal ulcer and their complications, two types of therapy are recommended.
Continuous (for months and even years) maintenance therapy with an antisecretory drug in a half dose: for example, a daily intake of either 150 mg ranitidine, or 20 mg famotidine, or 20 mg omeprazole.
Indications:
- inefficiency of eradication therapy;
- complications of peptic ulcer (ulcerous bleeding or perforation);
- presence of concomitant diseases requiring the use of NSAIDs (proton pump inhibitors are preferred);
- concomitant of peptic ulcer of GERD;
- ulcer disease not associated with H. Pylori.
Patient education
The patient should be convinced of the need to clearly observe the recommended scheme of H. Pylori eradication therapy , since an arbitrarily changed mode of multiplicity and dosing of drugs is the main reason for the preservation of H. Pylori infection.
It is necessary to advise the patient to avoid taking NSAIDs and adjust the lifestyle and nutrition. It is advisable to limit the use of alcohol and caffeine, as well as to quit smoking.
It is necessary to give the patient detailed information about the signs of relapse of peptic ulcer and its complications (bleeding, perforation, stenosis of the pylorus) and convince him of the need to urgently consult a doctor when they arise.