Ulcer of duodenal bulb: acute, chronic, specular

Feeling the pain in the stomach, we often refer this symptom to his account. Coming up with various reasons (stale or indigestible food, poisoning with medicines or chemicals, starting gastritis or even stomach ulcer), we do not think that the cause of pain and discomfort in the abdomen can be associated not with the stomach. The nature of pain, as well as the results of a gastrological examination, which clearly shows erosions on the mucosa of the intestinal tract adjacent to the stomach, allow the doctor to diagnose "duodenal bulb ulcer" with great accuracy, and this finally confuse us.

Let's figure it out, so what kind of an organ is this in the digestive system, what are its functions and why ulcers form on its mucous, causing such unpleasant sensations resembling gastritis with acidity. And let's try to understand how to identify and effectively fight with a peptic ulcer that affects the stomach or 12-colon, and often both organs at once.

Something of anatomy

The digestive system is one of the most multifunctional and the most extended systems in the human body. It includes a variety of organs that perform the functions of grinding, promoting, digesting and assimilating food. Some organs, such as the intestine, have such a complex structure that different departments perform different functions related to the functioning of the digestive tract. The initial part of the intestine is called the duodenum (DPC), which got its name because of its length (about 12 fingers together).

The upper (initial) department of the duodenum is a kind of continuation of the pylorus, which carries out the function of further transportation of food through the digestive tract. Because of the unusual shape resembling the head of onions, and the size of about 5 cm, it is called the bulb of the duodenum. Its function is to regulate the acidity of the contents of the stomach for its safe movement to the lower intestine, i.e. Protection of the intestines from irritation.

Ulcers of the bulb of the duodenum can not only bring some discomfort to the life of the patient with this diagnosis, but also prevent the initial bowel department from performing its function, as a result of which the other organs of the digestive system will suffer.

Epidemiology

Epidemiological studies show that most often ulcer bulb DPC develops on the background of ulcerative lesions of the stomach, which is understandable in connection with the proximity of these organs and the functions performed by them. Therefore, the diagnosis in most cases sounds like "a stomach and duodenal ulcer."

Ulcerous lesions of the gastrointestinal tract are a fairly common disease, affecting about 3-5% of the adult population of the world. In men, this pathology occurs almost 4 times more often than in women. In addition, the course of the disease in young women is characterized by a mild pain syndrome, although all other symptoms are present in full.

Ulcer of the bulb of the duodenum can be considered a disease of the young, in contrast to the ulcer of the stomach, often developing in old age.

By the way, urban residents suffer from peptic ulcer 2 times more often than residents of villages and towns. Perhaps the reason lies precisely in the food preferences of the townspeople and the increased stressful situation associated with work and the difficulties of household accommodation, especially in large cities.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the duodenal ulcer ulcers

Like the stomach ulcer, and the ulcerative lesion of the duodenal ulcer is caused precisely by an elevated level of hydrochloric acid, which seems to corrode the mucous organs. The stomach and the bulbous region of the initial section of the small intestine, which is called to fight with increased acidity, are most susceptible to the negative effect of acid in the gastric juice composition, providing an alkaline environment of chyme (half-digested food) at the stomach outlet.

Hence, it is the increase in the level of acidity due to a number of reasons that causes the appearance of erosion on the mucosa of the duodenum. Proceeding from this, the causes of ulcer development of the bulb of the duodenum can be considered the same reasons that contribute to increasing the level of acidity of gastric juice, in particular:

• increased secretion of a special hormone (gastrin), which regulates the digestive function of the stomach,
• malnutrition with a lot of bitter, salty, sour food, uncontrolled consumption of fatty and fried foods, pickles, marinades, preservatives,
• inclination to snacks in the dry at the expense of a full breakfast and lunch, evening overeating,
• long-term use of certain medications, especially when administered orally. Most often this refers to hormonal and anti-inflammatory drugs (corticosteroids and some NSAIDs),
• psychological traumas (both single stressful situations, and regular nervous overstrain),
• bad habits, such as smoking and alcoholism, affecting the normal operation of the gastrointestinal tract in connection with its irritating receptors action.

Even a slight increase in the acidity of gastric juice creates the best conditions for the multiplication and increase of activity of the bacterium Helicobacter pylori, which causes the development of inflammatory processes in the stomach and duodenum. Therefore, such a disease of the stomach as a gastritis often becomes the main cause of development and ulcers of the bulb of the duodenum. However, like duodenitis, which is an inflammation of the mucosa of the duodenum.

As for severe stress, it is one of the main reasons for the development of this pathology, although many patients are still inclined to deny the influence of nerve reactions on the development of GIT diseases, not recognizing the universally recognized truth that all diseases are from nerves.

Sometimes doctors diagnose ulcers on the mucosa of the duodenal ulcer, resulting from the development of such pathologies as an increase in the calcium content in the body (hypercalcemia), insufficient kidney and liver function, in particular with liver cirrhosis, COPD with shortness of breath, chronic inflammation of the gastrointestinal tract (Crohn's disease ). The presence in the body of HIV infection and some other diseases can also become real, albeit infrequent, risk factors for the development of ulcer of the bulb of the DPC. Doctors and hereditary factors in the development of this pathology, which significantly increase the risk of its development among the patient's relatives, do not exclude doctors.

[10], [11], [12], [13], [14], [15], [16]

Pathogenesis

Ulceration of the bulb of the duodenum is a disease with a chronic course characterized by alternation of periods of exacerbation and remission. I distinguish 3 main stages of the disease:

• stage of exacerbation (acute course of the disease) with marked clinical symptoms, the presence of ulceration and inflammatory process on the mucosa of the DPC,
• the stage of fading (or subsiding) exacerbation, when there are no clinical manifestations, but the inflammation still holds, and fresh scars form in the place of sores,
• the stage of remission, when the inflammatory process is sluggish, but scar changes on the mucosa remain.

In the pathogenesis of peptic ulcer of the bulb of the duodenum, scientists assign the main role to the imbalance between agents of aggressive action and protection of the mucosa of the duodenum in the direction of strengthening the first and reducing the activity of the second. In a healthy person, this balance is maintained by the coordinated work of the various departments of the neuroendocrine system (this is the answer to the question of why nerve reactions affect the functioning of the digestive tract).

Inconsistency of the factors of aggression and protection within the body and lead to the formation of erosions and ulcers on the mucosa of the gastrointestinal tract. However, in the case of ulcer of the bulb of the duodenum, nevertheless, the intensification of the activity of aggression factors plays a decisive role, among which there is an increase in the acidity of the gastric juice due to increased production of gastrin, activity of the harmful gastric bacterium Helicobacter pylori and other factors mentioned above.

So the ulcer of the bulb of the duodenum is characterized by an increase in the tone of the musculature of the stomach and increased its peristalsis, an increase in the number of parietal cells of the stomach that produce hydrochloric acid (HCl) and a disruption of the inhibitory function that limits the activity of the glands of the stomach in producing pepsin and HCl. This situation is the cause of increased secretion of gastric juice even outside meals and a sharp increase in the level of acidity of the stomach, leading to the destruction of cells of the mucosa of the bulb of the duodenum.

[17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27],

Symptoms of the duodenal ulcer ulcers

Cases when the duodenal bulb ulcer occurs without symptoms corresponding to the disease, are so rare that they should not be stopped. Usually this pathology of the gastrointestinal tract is characterized by symptomatology, which is marked by a noticeable intensity. In general, the manifestations of ulcer bulb 12 duodenal ulcer (duodenal ulcer) are similar to the main signs of a stomach ulcer (in particular, its pyloric department).

The first signs of DCA ulcers are severe pain localized in the navel area. They are easily cured with antacids, which reduce the acidity of the stomach. Depending on the physiological characteristics of the patient's body and the nature of the food used, the pains can be either sharp or dull whining. Painful sensations (usually in the region of the right epigastric region, giving back) can occur at night or 1-2 hours after eating (late pain).

Frequent cases of the appearance of pain, when the stomach is completely freed from the remnants of food. Food intake removes such manifestations of an ulcer as "hungry" pain, as well as the accompanying symptoms in the form of eructations, nausea and even vomiting.

Eating and nausea can also occur after eating with heartburn, a sour taste in the mouth, and a feeling of heaviness under the spoon and in the pharynx.

Often an empty feeling of hunger, after a short time after eating, can also be a symptom of a duodenal bulb ulcer. As, however, the appearance of constipation, cases of bloating and flatulence, peculiar to this type of ulcerative lesion of the gastrointestinal tract.

The symptomatology of the duodenal ulcer is characterized by the periodicity of manifestation. Symptoms worsen in the spring-autumn period, as well as under the influence of stressful situations. During periods of remission, the ulcer may not manifest itself in any way, even if the patient does not adhere to a special diet.

Mirror duodenal ulcer

Among ulcerative lesions of the duodenum, such varieties as ulcer of the lower (descending) division, bulbous and mirror ulcer, when deep ulceration are observed not only on the mucous bulb, but also at the opposite end of the duodenum, can be distinguished.

Bulbous forms of pathology are considered the most common, but the ulcer of the descending department is much less common.

Mirror ulcer of the duodenum is of special interest. It is not a rare phenomenon, but its course is complicated by the presence of not one, but several ulcers, resulting in a slow cicatrization of ulcers and frequent exacerbations. Together with the number of ulcers on the mucosa of the duodenum, the likelihood of developing various complications also increases.

This type of pathology has the same symptoms as in the ulcer of the bulb of the duodenum, but the localization of pain may be somewhat different. More often patients with a mirror ulcer complain of strong painful sensations in the field of epigastrium from the left side. And sometimes the pain is localized in the region of the left hypochondrium.

[28], [29], [30]

Complications and consequences

Ulceration of the bulb of the duodenum is a rather dangerous disease, which can not be ignored. The consequences of irresponsible treatment of their health against the background of the appearance of symptoms of peptic ulcer can be various complications, such as chronic, developing for a long time (penetration, stenosis, periduodenitis), and those that arise suddenly and pose a threat to the life of the patient (bleeding and perforation).

Penetration of ulcers is called its spread to the area of nearby organs. In the case of bulbous ulcer there is a high probability of its expansion into the pancreas region. Painful sensations change, there are girdling pains that can not be taken off the antacids.

Stenosis is the narrowing of the lumen in the initial section of the small intestine, where the bulb of the DPC is located, which negatively affects the whole process of digestion, making it difficult to move food from the stomach into the intestine. Now the symptoms of ulcers, depending on the stage of stenosis, are complicated by a constant feeling of heaviness in the stomach, paleness of the skin, constant weakness, dry skin and mucous membranes, general exhaustion. An eructation changes its odor from sour to rotten, in vomit masses there is an admixture of undigested food.

Further prognosis depends on the stage of development of pathology. Compensated stenosis, if it is caused by functional disorders (swelling or spasm during peptic ulcer exacerbation), is well treatable. The subcompensated and decompensated form of stenosis are pathologies that are difficult to treat and dangerous for life.

Periduanitis is characterized by an inflammatory process in the serosa of the duodenum, which is a fairly common complication of the ulcer and is often accompanied by the formation of adhesions and deformation of the duodenal bulb. In the future, the pathological process can spread to other organs (stomach, gallbladder, etc.), causing partial obstruction of the duodenum and other serious diseases that can cause limited work capacity.

The danger of bleeding, I think, once again, it is not worth talking about. And in fact they are the most frequent complications of an ulcer of a bulb DPK. Practically at each exacerbation there are hidden bleedings, not representing a special danger, which can not be said about obvious bleeding with a large loss of blood. They are characterized by bloody vomiting, a liquid stool, in color reminiscent of tar, pale skin, weakness and other symptoms of acute blood loss.

Perforation is also one of the most common complications of duodenal ulcer, and in the male population this complication develops a couple of dozen times more often than the fair sex.

Perforation, or perforation, ulcers of the duodenal bulb is termed end-to-end dysfunction of the wall of the duodenum, in which partially digested food can enter the intestine, causing inflammation in the abdominal cavity (peritonitis). It is accompanied by sharp severe pains in the epigastric region, increased tonus of the muscles of the abdominal wall, fever and other symptoms of pneumoperitoneum, and subsequently peritonitis.

[31], [32], [33],

Diagnostics of the duodenal ulcer ulcers

When we feel pain in the lower part of the stomach, we rarely think about the fact that a painful condition can be associated with its continuation, which is the duodenum or with the pancreas located in the same area. To diagnose an ulcer of a bulb of a duodenal ulcer or development of the same pancreatitis independently it is practically impossible in view of similar to other pathologies of GASTROINTESTINAL TRACT symptoms and localization of unpleasant sensations. Therefore, the diagnosis of gastrointestinal problems should be addressed by a gastroenterologist.

The symptomatology of various types of peptic ulcer of the stomach and duodenum is so similar to each other that it is difficult even for a specialist to distinguish one pathology from another. Nevertheless, the important point of differential diagnosis is the study of subjective symptoms from the patient's words: periodicity and localization of pain, reaction to drugs that reduce acidity, the presence of other dyspeptic disorders (nausea, vomiting, heartburn, etc.).

The study of the anamnesis should be accompanied by palpation, which is very likely to help determine the development of the ulcerative process. But to determine its localization is possible only with the help of a set of studies that include instrumental diagnostics, laboratory tests (an expanded blood test, a biochemical blood test, feces analyzes: general and for Gregersen's reaction, analyzes for determining the level of gastrin and tests for the presence of Helicobacter pylori ), histological studies and other methods of diagnosis.

The most popular and accurate methods of instrumental diagnosis, which determine the location of the ulcer and make the final diagnosis, are esophagogastroduodenoscopy and radiography of the peritoneal organs. The first method is not only more accurate, but also the most informative, because it allows not only to assess the condition of the gastrointestinal mucosa and determine the localization of ulcers and large ulcers, but also the degree of ulcer disease development, and also to carry out an analysis that allows to detect the presence of pathogenic bacteria, in particular Helicobacter Pylori.

The use of the radiographic method is advisable if there are dystrophic changes in the bulb of the duodenum, reducing its patency and the ability to visually examine it from the inside. Radiography can also provide useful information if there are various neoplasms in the GI tract. Often in parallel with an x-ray examination, ultrasound of the abdominal cavity is prescribed.

Additional, rather informative methods that allow to assess violations of the functionality of the digestive tract are electrogastrography, phono- and balloonography. With these methods, the doctor monitors changes in the motor function of the intestine and other organs involved in the digestive process.

Such an integrated approach makes it possible to diagnose with great accuracy, avoiding mistakes and confusion in the need to distinguish the ulcer of the bulb of the duodenum and other pathologies of the initial portion of the small intestine.

[34], [35], [36], [37], [38], [39],

Treatment of the duodenal ulcer ulcers

Treatment of duodenal ulcer is a long and multistage process. It includes medical therapy, alternative treatment, physical procedures, diet compliance. All these methods are not used simultaneously, their appointment depends on the stage of development of pathology.

Since the ulcer of the duodenal bulb can be caused by a variety of causes that are of different nature, then the approaches to treatment in connection with this should be different. After all, you first need to calculate and remove the pathogenic factor, and then fight against its consequences. Drug therapy for ulcers of the bulb of the duodenum is just applied for this purpose.

The formation of sores on the mucosa of WPC occurs against a background of increased acidity, and therefore, in the first place, it is necessary to fight precisely with it. Reduce the acidity of gastric juice and slightly reduce the production of hydrochloric acid and pepsin is helped by drugs called antacids.

Now there are many medicines belonging to the group of antacids. But the most popular of them are "Omez" or its analog "Omeprazole". Preparations "Gastrozol", "Zerotsid", "Omitox", "Pepticum", "Ultop" and some others are also analogues of the above medicines, because the same active substance - omeprazole - is based on the same principle.

The same inhibitors of the proion pump (H ⁺ -K ⁺ -AFT-ase), but with another active substance, esomeprazole, are also applicable to the treatment of duodenal ulcers. These drugs are "Nexium", "Neo-Zext", "Esomeprazol".

Well proven in terms of inhibition of the secretion of hydrochloric acid and such budgetary drugs as "Ranitidine" and "Famotidine." And the drugs "Almagel" and "De-Nol" will be indispensable at an acute stage of the development of the process to protect the mucosa from the aggressive action of hydrochloric acid.

If the stressful situation has become the reason for the acidity increase and the development of the ulcerative process, and its effect has not been stopped to this day, it makes sense to prescribe sedatives that normalize the mental state and sleep, and prevent the subsequent negative influence of nervous overstrain on the functioning of the digestive tract. To once again not to injure the stomach and intestines, such preparations must be selected from a series of herbal remedies (tincture of motherwort, "Barboval", soothing herbal teas). To more serious drugs such as antidepressants or neuroleptics due to diseases of the PDK doctors rarely resort.

Disease-causing bacteria, especially Helicobacter pylori, are also a very common cause of gastritis, gastric and duodenal ulcers. And, as is known, the fight against bacterial infection without the use of antibiotics is simply unthinkable. A good effect in the treatment of duodenal ulcer ulcers, provoked by Helicobacter pylori, gives a joint intake of 2 drugs: Clatrimycin and Amoxicillin. Sometimes, antimicrobial agents such as Metronidazole, Erythromycin, Ampiox, etc. Can be prescribed in addition to them or as a primary drug.

Antibiotic therapy is performed as part of complex therapy, including mandatory antisecretory drugs (antacids). And antacids are shown to patients with peptic ulcer lesions of the stomach and duodenal ulcers throughout life with certain courses or one-time to relieve heartburn and other symptoms of increased acidity.

To improve the nutrition of the intestinal mucosa and activate regenerative processes, Solcoseryl, Actovegin, vitamins and vitamin-mineral complexes containing vitamin A can be prescribed.

Reception of antacids usually relieves pain, but if this is not enough, you can try taking spasmolytics, such as "No-shpa", "Spazgan", etc.

You can fight with nausea and vomiting through Metoclopramide, Motilium, Cerucal and similar preparations.

As for physiotherapeutic treatment, it is applicable at the stage of remission or subsiding exacerbation. Effective procedures: mud treatment, mineral and coniferous baths with a temperature close to body temperature, novocaine electrophoresis, UHF procedures.

More about medicines

"Omeprazole" - cheaper, but no less effective analogue of the popular "Omez". It is used to treat the acute phase of peptic ulcer in the PDC, and also as an anti-relapse drug. It is issued in the form of capsules, which allows it to begin to act exactly where its action (neutralization of the acid) is necessary.

If an exacerbation of duodenal bulb ulcers was caused by stress or a negative effect of medications, omeprazole is taken in a dosage of 1 capsule (20 mg) per day for 2 to 4 weeks.

If the development of peptic ulcer is not without the influence of Helicobacter Pylori, then "omeprazole" is taken as part of complex therapy together with antibiotics (double and triple therapy).

When double therapy with the use of "omeprazole" and 1 antibiotic treatment is 2 weeks. Treatment regimens:

• "Omeprazole" - 1-2 capsules plus "Amoxicillin" - 750 mg = 2 times a day.
• "Omeprazole" - 2 capsules (1 time per day) plus "Clarithromycin" - 500 mg (3 times a day).
• "Omeprazole" - 2 capsules (once a day) plus "Amoxicillin" - from 750 to 1500 mg (2 times a day).

With triple therapy ("omeprazole" plus 2 antibiotics), the course of treatment is reduced to 1 week. Treatment regimens:

• "Omeprazole" - 1 capsule plus "Amoxicillin" - 1000 mg plus "Clatrimycin" 500 mg = 2 times a day.
• "Omeprazole" - 1 capsule plus "Clarithromycin" - 250 mg plus "Metronidazole" - 400 mg = 2 times a day.
• "Omeprazole" - 2 capsules (once a day) plus "Amoxicillin" - 500 mg (3 times a day) plus "Metronidazole" - 400 mg (3 times a day).

"Omeprazole" - an effective drug that significantly reduces the acidity of gastric juice, but its use can cause some unwanted symptoms. To side effects of the drug in relation to the gastrointestinal tract are: disorders of stool in the form of diarrhea or constipation, the appearance of pain in the stomach, dyspeptic phenomena, a violation of taste perception, hepatitis. Other side effects: headaches, myasthenia gravis, arthralgia, changes in blood composition, rashes on the skin, accompanied by itching, allergic manifestations, vision impairment, hyperhidrosis, swelling of the hands and feet, etc.

But there are very few contraindications to the use of the drug. These are the periods of pregnancy and lactation, as well as hypersensitivity to the drug. The drug is not used in pediatric practice. But adult patients with liver pathologies should be careful in the application of "omeprazole", for them the maximum dose is 2 capsules per day.

"Nexium" - another effective inhibitor of the proton pump, neutralizing hydrochloric acid in the composition of gastric juice. For the treatment of ulcerative PDC lesions, the drug is most commonly used in the form of tablets or granules for the preparation of a suspension taken orally (for children and those who have difficulty swallowing tablets).

The method of administration and dose of the drug depend on the form of release. So the tablets are swallowed whole, not crushing, and the granules are diluted in plain water at the rate of 1 packet per 15 ml of water. The dosage depends on the indications for use.

For treatment and prevention of duodenal ulcers on the background of taking NSAIDs take 20 to 40 mg of the drug once a day. The therapeutic course can be from 4 to 8 weeks.

If the culprit of the ulcer is Helicobacter Pylori, then the drug is administered in combination with antibiotics. The scheme for treatment and prevention is one: "Nexium" - 20 mg plus "Amoxicillin" - 1000 mg plus "Clarithromycin" - 500 mg = 2 times a day course in 1 week.

Side effects of the drug are similar to omeprazole. And he does not have much more contraindications: children's age, intolerance to fructose and hypersensitivity to any of the components of the drug, parallel reception of "Atazanavir" and "Nelfinavir." Caution should be observed during pregnancy, lactation, kidney failure.

"Famotidine" is an antiulcer medication available to virtually all patients. Produced in the form of tablets of 20 and 40 mg.

For the treatment of peptic ulcer during the exacerbation for 1-2 months appoint 40 mg per day, to prevent relapse - at night 20 mg.

To the side effects characteristic of the drugs described above, in the case of "Famotidine," you can add a decrease in sexual desire, amenorrhea, disorders in the hematopoiesis system, cardiac rhythm disturbance, lowering blood pressure, etc.

Contraindications also do not differ enviable variety: periods of pregnancy and lactation, sensitivity to the components of the drug and age younger than 3 years.

Alternative treatment

Alternative treatment of duodenal ulcer ulcers is effective if the disease is not associated with the activity of Helicobacter pylori. But again, in order to achieve quick and lasting results, the use of prescriptions for alternative medicine must be agreed with the physician and taken in conjunction with drug therapy.

Here are some useful recipes that help to remove unpleasant symptoms of the disease:

1. Fresh potato juice does not require special advertising, since it is applicable wherever it is necessary to reduce acidity and protect the mucous membrane of the gastrointestinal tract. To drink it it is necessary within 3 weeks on a quarter of a glass before the basic receptions of nutrition (for 15-20 minutes).
2. Effective and tasty remedy, which helps the ulcer to last for 3 weeks, can be made from butter and natural honey. Oil and honey are mixed in equal amounts and browned until brown. Store in a cool place. Take the formula in the morning on an empty stomach before eating at a dosage of 10 g.
3. If there is no good oil, then in principle honey itself is able to treat peptic ulcer. To do this, 35 grams of honey stir in a glass of water and drink. You can eat not earlier than in an hour and a half. Treatment continues for a month.
4. The oil of sea-buckthorn bones is irreplaceable for any ulcerative processes in the gastrointestinal tract. Take it you need 1 tsp. Before each meal.

Treatment of herbs ulcerative lesions PDK is especially effective if the herbs are used as part of special medical fees that can be found in pharmacies. Although some herbs may themselves bring appreciable relief to ulcer patients. These include: calendula, blue cyanosis, mint. Useful also: fennel, chamomile, capercaillie, horsetail, yarrow, etc.

[40], [41], [42], [43], [44]

Homeopathy

To reduce pain, especially "hungry" pain in ulcer of the bulb of the duodenum, the most effective means of homeopathy is Anacardium. The drug is also useful for constipation.

The homeopathic drug Cimicifuga, which removes the symptoms of persistent hunger and pains that intensify in the premenstrual period, is a good help to women in this regard.

With very severe pains that force a person to bend forward, Colocynthis, which is taken in high potencies, will be effective. And the drugs Acidum sulfuricum, Conium, Natrium sul-furicum and Capsicum help get rid of painful heartburn, which is an indicator of the increase in the level of hydrochloric acid in the stomach.

Prevent the appearance of adhesions, rough scars and intestinal stenosis in severe cases of duodenal ulcers will help Calcium fluoricum.

All homeopathic preparations in doses prescribed by a doctor are safe for the health of patients. Without serious contraindications and minor side effects in the form of allergic rashes, they are a good alternative to synthetic drugs.

Operative treatment is considered expedient only in severe cases of peptic ulcer of the DPC, when there are possible complications such as bleeding from the gastrointestinal tract, perforation of the ulcer, scar change in the bulb, or stenosis of the duodenum, which creates intestinal obstruction.

Diet with ulcer of the bulb of the duodenum

Well, it is simply impossible to effectively combat gastrointestinal diseases, if you do not adhere to a special diet that facilitates the work of the stomach and intestines, prevents the aggressive influence of certain foods on the mucosa and prevents the acidity of the gastric juice.

With the ulcer of the bulb of the duodenum, it is not necessary to adhere to a strict diet all the time, but during periods of exacerbation certain restrictions and rules will help to significantly alleviate the patient's condition and make the treatment more effective:

• Fractional nutrition is the basis of any diet for diseases of the digestive tract. Take food every 3 hours, reducing the usual portions, so that from the table the patient gets up a little hungry.
• Slow and thorough chewing of food, the use of strictly ground foods is simply necessary during periods of exacerbation of the disease.
• The food should be warm, which will prevent the irritating effect of high and low temperatures on the gastric mucosa, helping it to work and not causing an increase in the production of hydrochloric acid and pepsin.
• Some restrictions in the choice of food are associated with their ability to increase the acidity of gastric juice and irritate the stomach and intestinal mucosa, because during illness, chemical or mechanical irritation can cause an exacerbation of the disease and the formation of new ulcers.

Boiled broths of meat, fish or vegetables, bakery products, fresh vegetables, fatty meat, smoked and fried dishes, mushrooms, preserves, sorrel, tomatoes - all these foods and dishes will have to be abandoned (for a while or even forever).

Diet with duodenal ulcer means also limiting the amount of salt used up to a maximum of 15 g. But milk, fruits, grated cereals, steamed vegetables and meat, eggs (up to 3 per day), diluted juices will be only useful, because they will satiate the body with the necessary vitamins and nutrients.

[45], [46], [47], [48], [49]

Prevention

Prevention of ulcer bulb of the 12-colon is the exclusion of life factors that provoke the development of pathology. To prevent a dangerous disease from ever bothering you, you need to adjust something in your life:

• Refuse bad habits (smoking and drinking alcohol), or minimize such manifestations.
• Forget about all sorts of "dry" snacks, fast food, giving preference to a full-fledged diet.
• Do not get carried away with drugs, especially from the NSAIDs, take them under the supervision of a doctor in conjunction with drugs that protect the gastrointestinal mucosa from the negative effects of irritants.

Calm attitude to life, ability to cope with stress, proper and adequate nutrition on the background of a healthy lifestyle - the best protection against peptic ulcers of any etiology.

Ps If without exaggeration to undergo a full course of treatment of peptic ulcer of the DPC and adhere to a further sparing diet, the ulcer of the bulb of the duodenum will not let you know about yourself for a long time. And it is quite possible, it will be possible to forget about it forever.

[50], [51], [52], [53], [54],

Forecast

Ulceration of the bulb of the duodenum is not a tension headache, which can be cured with a single pill. This requires long-term treatment, adherence to diet and special diet.

The prognosis of peptic ulcer and the necessity (or lack thereof) of surgical intervention depends on how prompt the patient turned for help, how effective and correct it was to treat and fulfill all the additional requirements for the diet regime.

[55], [56], [57], [58],