Thursday, April 19, 2012

Ulcer disease

Ulcers of the stomach and duodenum

What is a peptic ulcer? (Ulcers in the stomach and duodenum)
Peptic ulcer is the value of the stomach or duodenal wall that marks the beginning of the small intestine. Peptic ulcer disease is often caused by bacterial infection, and sometimes long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as. aspirin, ibuprofen, diclofenac, and the like. In a few cases, ulcers can cause malignant tumors of the stomach or pancreas. Hot spices or stress are not its agents as previously thought, but it can encourage its development and worsen symptoms.

The disease is usually caused by the bacteria Helicobacter pylori (H. pylori). Recently it was found that this bacteria causes almost all peptic ulcers and stomach to 80% and 90% of the duodenum. But if you are infected with the bacteria H. pylori does not mean that you will surely have an ulcer. Most likely, infection depends on characteristics of ill, the type of H. pylori and other yet unknown factors. We still do not know the exact route of transmission of infection (food, water, direct contact, mouth to mouth like. Kissing, dirty hands, etc..).
H. pylori weakens the protective power of the stomach and duodenum, which allows the penetration of acid through the layer below it. Acid and the bacteria irritate the layer, creating value, or ulcer. H. pylori can survive in stomach acid because it secretes enzymes that neutralize. This mechanism of bacteria make their way to a safe area, ie. the protective lining that still pierces through its spiral shape.

The most common symptom is pain that is usually uneven and dull. It appears and disappears at intervals of several days to several weeks. In duodenal ulcer occurs 2-3 hours after eating. It can occur at night (on an empty stomach), and calms the food intake. If the ulcer is present in the gastric wall pain is usually worse after eating.Other symptoms include weight loss, loss of appetite, bloating, belching, nausea and vomiting. Symptoms may be very slight or not at all appear. If you experience sharp, sudden and persistent stomach pain, consult a doctor immediately. Bloody or black colored stools, vomiting blood contents or contents that looks like coffee beans can be signs of serious problems, such as. perforation of stomach or duodenal wall. Bleeding performance if acid or the ulcer damaged blood vessel.

To verify connectivity with ulcer symptoms is carried out X-ray search of the esophagus, stomach and duodenum, and endoscopy. Drinking a barium porridge, and then recording gets a clear picture of target organs and ulcers. Endoscopy performed endoscopy, which consists of a thin, lighted tube with an end of a small camera.The patient is mildly sedated and the doctor carefully introduce the endoscope through his mouth and throat to the stomach and duodenum. Thus it is possible to observe the lining of organs, and can take photos of ulcers and biopsy (taking a piece of tissue) for microscopic examination.

Diagnosing H. pylori
In the case of ulcer findings, conducted tests on the bacteria H. pylori. This test is important because the treatment of ulcers caused by H. pylori is different from that caused nestroidnim anti-inflammatory drugs. H.pylori is diagnosed from the blood, breath, and tissues. Blood tests reveal antibodies to the bacterium H. pylori.Blood is taken from a finger, the doctor's office. Search for breath is most often performed after treatment to verify the success of therapy, but also for diagnostic purposes. It is called the urea breath test. In medical practice the patient drinks a urea solution that contains a special carbon atom. H. pylori breaks down urea and releases carbon that reaches the blood in the lungs and exhale it from them ejected. The accuracy of this test is 96-98%.Results of tissue (biopsy) are performed on tissue taken during the endoscopy.

Treatment: self + GP
Peptic ulcer caused by the bacterium H. pylori is treated with medicines that kill pathogens, reduce the acidity of the stomach lining and gastric mucosa protective layer. H. pylori is destroyed with antibiotics, but due to the acidic environment in which bacteria live to be affected by the reduction of acid secretion. On the market there are two groups of preparations were reduced gastric acidity: H2-antagonists (ranitidine, cimetidine, famotidine) and proton pump inhibitors (omeprazole, pantoprazole, lansoprazole). The combined treatment: antibiotics, acid secretion blockers, and drugs that have a protective effect on the mucous membranes (protectives). So now is the most reliable. triple therapy with two antibiotics against H. pylori in combination with a drug that blocks the secretion of acid or protectives (eg, azithromycin + amoxicillin + omeprazole). It can relieve ulcer symptoms, kills his cause in more than 90% of cases prevents recurrence of disease (relapse). Checking the effect of drugs on H. pylori is made by endoscopic examination or examination of breath for 4 weeks after the treatment. Antacids (Gastal) are used to remove the symptoms of disease and as adjuvant therapy. However, triple therapy is the most reliable way to treat peptic ulcers.
If the ulcer is not caused by the bacteria H. pylori (which is much rarer case) is not necessary to take antibiotics, it is sufficient to take the secretion of acid blockers (H2 receptor antagonists or proton pump blockers).

Specialist treatment
In case of complications (bleeding, perforation) must be performed endoscopy or surgery.

Proper treatment reduces the likelihood of ulcer recurrence of disease in almost 90% of cases. It is important that patients comply with physician instructions and be persistent in implementing treatment.

It is not known how the H. pylori spreads, making it difficult to prevent disease. After the emergency, and before eating is mandatory hand washing. Researchers are working on a vaccine against the infection.
If the ulcer is formed by taking non-steroidal anti-inflammatory drugs such as. aspirin, continue to take medication in this group very carefully or consult your doctor for an effective replacement. 

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