The main radiological sign in perforated gastric ulcer. Stomach ulcer x-ray - Treatment of gastritis

Before making a diagnosis of "gastric ulcer", the patient should visit several doctors. The disease can be diagnosed after a visit to the therapist, endoscopist, experienced surgeon, laboratory assistant. In this case, various research methods are used (for example, gastroscopy), which allow you to recognize the disease and determine the most effective methods of treatment and prevent complications in time.

Patient Interview

The patient should be asked in detail about the state of health in order to obtain information about complaints, often indicative of an ulcer and other diseases of the gastrointestinal tract. In the event of a peptic ulcer, pathology can be recognized depending on the symptoms that the patient complains about. The main symptoms are pain, dyspeptic syndrome. The specialist should be alerted by symptoms that appear regularly. Patients claim that they feel sick, they experience pain, heaviness, severe heartburn. Before making a diagnosis, the doctor must make sure exactly where the pain is localized.

Then you need to find out when pain sensations appear (at night or in the morning), their nature and frequency. Consideration should be given to the dependence of these symptoms on eating food, the influence that the number of dishes and their consistency has on the occurrence of such manifestations. You also need to take into account such a sign as the appearance of seizures after a certain time that has passed after eating. At the same time, food can alleviate the existing symptoms, pain can be associated with physical activity, working conditions, nervous strain, injuries. You should find out how painful sensations spread, whether they give to other parts of the body.

Physical examination

The technique is applied during the first visit of the patient to the doctor. The physician must carefully listen to the patient's complaints. After that, the specialist begins the medical examination. Often, health problems can be suspected if a person has changed the color of the skin. Then the patient should show the abdomen so that the doctor can feel it. Due to palpation, it is possible to establish what are the boundaries and outlines of the organs, to identify possible deviations from the norm. After that, the physician performs percussion of the gastrointestinal tract. Percussion reveals many diseases. A preliminary study allows us to characterize the general condition of the patient. If necessary, the therapist refers the patient to other specialists, prescribes tests that will help to make a more complete picture.

X-rays allow you to carefully examine the organs of the digestive tract.

X-ray studies allow you to carefully examine the organs of the digestive tract. The procedure is carried out using special devices that allow you to display one or another organ on a small screen. You can take pictures with film. X-ray examination method allows you to assess the structure of the intestines and stomach. The accuracy of the results reaches 80 percent. Using this technique, examine:

throat
sections of the stomach;
esophagus
diaphragm.

Most often, x-rays are prescribed for patients suffering from the following manifestations:

dysphagia;
discomfort in the stomach;
gagging;
anemia;
weight loss;
bouts of pain;
the presence of seals inside the stomach;
detection in occult blood tests;
disruption of the stomach.

There are several methods of examination: traditional radiography and other types (for example, urgent contrasting). In case of peptic ulcer, X-ray is effective in the case of using the 2nd contrasting method (a contrast agent is used). With the help of radiographs, doctors study the motility of the gastrointestinal tract, compensatory function.

Diagnosis of stomach ulcers allows you to choose the right treatment that will prevent the occurrence of complications.

Endoscopy

The endoscopic method is considered the most reliable, since it allows you to confirm / refute the ulcer, its location, shape, size and control the healing of affected tissues, evaluate the effectiveness of treatment. Endoscopic technique helps to reveal insignificant changes in the structure of the abdominal cavity and duodenal mucosa, to cover the sections in the stomach that are inaccessible to x-rays. In addition, it is possible to obtain the mucosa of the edge-forming area of the ulcer by using a biopsy to conduct a more detailed study of the structure of the tissues.

Gastroscopy and other methods

Peptic ulcer is a clinical and anatomical concept. This is a chronic disease with a polycyclic course, characterized by the formation of an ulcer in those parts of the mucous membrane that are washed to a greater or lesser extent by active gastric juice. Peptic ulcer is a common chronic, cyclically occurring, recurrent disease, which is based on complex etiological and pathogenetic mechanisms for the formation of ulcers in the gastroduodenal zone.

X-ray semiotics of preulcerative state. In the parapyloric zone, it is characterized by several variants, among which "irritable stomach" can be observed. At the same time, in the stomach on an empty stomach there is a significant amount of hypersecretory fluid and mucus, which in most patients increases during the study. The barium suspension first sinks in the liquid, settling on lumps of mucus in the form of flakes, the folds of the mucous membrane are not visible at this moment, and only after the evacuation of a significant amount of the contents under the influence of palpation, the barium suspension mixes with it, after which it becomes possible to study the relief of the mucous membrane. It is usually represented by large, tortuous, often transverse mucosal folds. In a number of patients, the entry of the first sips of barium suspension into the stomach sets its contents in motion, the barium suspension in the form of large lumps also makes erratic movements - the contents of the stomach “bubbling”. The tone of the stomach is somewhat reduced, the peristalsis is sluggish, the stomach is moderately distended. Very often, an initial short-term spasm of the pylorus occurs, after which the tone of the stomach increases, deep peristalsis appears and accelerated evacuation of barium suspension from the stomach into the duodenum begins (within 15-20 minutes the stomach is almost completely freed from barium). The bulb is irritated, contains a lot of mucus, is very quickly released from the contrast agent, which is why its true shape cannot be determined, the mucosal folds are also not visible. In this case, duodenogastric reflux is usually expressed: after the barium suspension enters the descending duodenum, it is often thrown back into the stomach. A niche in the pyloroduodenal zone is not detected. Dyskinetic disorders are also noted in the proximal loops of the small intestine. In a number of patients, cardia insufficiency is determined. The radiological picture of "irritable stomach" is observed rarely, usually in patients with a short history and a pronounced clinical picture of peptic ulcer. X-ray semiotics of peptic ulcer For many decades of the development of X-ray diagnosis of peptic ulcer, various groups of radiological symptoms have been proposed. Most authors singled out direct and indirect symptoms.

A direct radiological symptom of peptic ulcer is a niche on the contour or a spot of barium on the relief. The frequency of detection of the latter depends on many reasons: localization and size of ulceration, deformity, organ, presence of fluid in the stomach, filling of the ulcer cavity with mucus, blood clot, qualifications of the radiologist, etc. With methodically correct X-ray examination in the clinic, this symptom is detected in 89-93 % of cases. A modern, properly conducted x-ray examination allows to detect ulcers with a size of 2-3 mm. The ulcer niche can have a different shape: round, oval, slit-like, linear, pointed, irregular, etc. Some authors believe that the shape of the ulcer niche depends on its size. The rounded and conical shape of the ulcer niche occurs mainly with relatively small ulcers. As the disease progresses and the size of the ulcer increases, the shape of the ulcer becomes irregular. There is an opinion that fresh ulcers have a pointed shape and even contours, and old ulcers have a rounded shape, but it is possible that the pointed shape is associated with insufficiently tight filling of the niche. The shape of the ulcerative niche also depends on the position of the patient during x-ray examination. It has been established that the shape of the ulcer niche changes during the course of treatment. According to endoscopic studies, acute ulcers in patients with peptic ulcer are more often oval, in the stage of scarring - linear or divided into smaller fragments against the background of focal hyperemia of the mucous membrane ("pepper and salt" according to Japanese authors). Summarizing the above data, it should be emphasized that the shape of the ulcer niche is not an objective criterion for assessing the nature and timing of the development of the ulcer. It should be noted that the standard x-ray examination in the conditions of X-ray television (fluoroscopy and radiography, natural pneumography) and double contrast in the detection of ulcers give the same results. The contours of the ulcer niche can be even clear and uneven fuzzy. According to P.V. Vlasov and I.D. Blipchevsky (1982), even contours are characteristic of relatively small ulcers. With an increase in the size of ulcers, the contours increasingly become uneven due to the development of granulation tissue, protruding into the lumen of the ulcerative crater of a naked vessel, a blood clot, food debris and mucus. However, in the process of scarring and small ulcers, in some cases, uneven contours appear. As a result of the fusion of ordinary (up to 20 mm in size) ulcers, large ulcers with uneven contours are formed. These data indicate that in the differential diagnosis of ulcers with malignant ulcerations, the state of the contours of the ulcer should be taken into account only along with other symptoms and the clinical picture. Features of X-ray diagnostics depending on the localization of ulcers in peptic ulcer disease.

Ulcers localized in the upper (cardial) part of the stomach. Difficulties arising in the X-ray examination of the upper part of the stomach due to the peculiarities of its anatomical location, and therefore in the identification of a niche, are emphasized by most authors. The study is carried out necessarily in vertical and horizontal positions, while preference should be given to lateral and oblique projections, as well as a horizontal position on the abdomen with a slight turn to the right side and double contrasting.

The main symptom is a niche on the contour or a niche in the form of a residual spot of barium suspension on the relief. A niche on the contour should be differentiated from a diverticulum, which is often localized in the upper section. The entrance to the diverticulum is narrow, folds of the mucous membrane are determined in it, and barium suspension is retained in its lumen for a long time. The entrance to the niche is wide, it is quickly released from the contrast agent, often folds of the mucous membrane converge to the niche, a shaft is expressed in its circumference, spastic retraction from the side of the greater curvature is noted. Cardiac ulcers are often complicated by bleeding, penetration, and malignancy. X-ray examination in conditions of bleeding and interpretation of the data obtained are often significantly difficult. The pathognomonic symptom of penetration is a three-layer niche, but the niche is not always detected.

Ulcers of the lesser curvature of the body of the stomach. Attention was drawn to the features of the X-ray picture of ulcers of this localization when considering the direct and indirect symptoms of gastric ulcer.

Ulcers of the prepyloric stomach and pyloric canal. In x-ray examination, a direct symptom, as in other localizations of the ulcer, is a symptom of a niche, however, for this localization, a niche in the form of a residual spot of barium suspension on the relief is more important. A niche on the contour is determined in those more rare cases when the ulcer is located strictly along the lesser curvature of the stomach. The true dimensions of the prepyloric ulcers can only be determined by examining the patient in a horizontal position. In connection with the frequent location of the ulcer on the walls of the stomach, a frequent symptom is a shaft, often rounded. The niche symptom is in many cases accompanied by fold convergence, which is almost as common in erosive-ulcerative cancers. The constant companions of the ulcer are hypermotility and regional spasm, antral gastritis (erosive in some patients), duodenogastric and gastroesophageal refluxes (hiatal hernia, reflux esophagitis), dyskinesia of the duodenum and jejunum, in a number of patients with a long course of peptic ulcer enteritis develops . For many years, cicatricial changes in the organ have been of great importance in the diagnosis of peptic ulcer. For the most part, they are typical and depend on the localization of the ulcer and the involvement of muscle bundles in the cicatricial process. In this regard, there is a deformity in the form of an hourglass, which develops as a result of a long-term spasm of the greater curvature of the body of the stomach and Cicatricial changes in the oblique and circular muscle bundles with an ulcer of the lesser curvature of the body of the stomach. In this case, deformation develops in the form of two cavities connected by an asymmetrically located isthmus. Similar changes can be observed in the infiltrative form of cancer, while the deformation is symmetrical. Cochlear deformity, or "purse-string stomach", also develops with an ulcer of the lesser curvature of the body of the stomach and cicatricial changes in the longitudinal muscle bundle. In this case, the lesser curvature of the body of the stomach is shortened, an unbent angle is noted, the antrum and duodenal bulb are pulled up to the lesser curvature, and the sinus sags. In these patients, in the absence of vomiting, after 24 hours, the remainder of the barium suspension is detected in the stomach. Such a deformity develops much less frequently in infiltrative gastric cancer, in which pyloric stenosis, retention of barium suspension in the stomach for 24 hours, and vomiting are observed. In this case, the antrum of the stomach and the duodenum are usually located. Deformities often develop in the antrum, with an ulcer of lesser curvature, Gaudeck's deformity can be observed - a cochlear curvature of the antrum. In this case, cicatricial retraction is also localized on the greater curvature, the axis is curved and the antrum is twisted. However, it should be noted that under the conditions of modern antiulcer therapy, the deformities described above have become less common. According to L. M. Portnoy et al. (1982), the deformity of the stomach is often expressed in a significant shortening, as if the tightness of the lesser curvature. The authors identify five variants of the post-ulcer scar: the first - the contour of the stomach is uneven, the convergence of the mucosal folds to this area; the second - the contour of the stomach is uneven, small rounded filling defects near the uneven contour, the convergence of the folds of the mucous membrane to it; the third is a small niche with mucosal folds convergent to it; the fourth - a small niche without convergence to it of the folds of the mucous membrane; fifth - the contour of the stomach is even, the convergence of the folds of the mucous membrane to the site of the former ulcer.

Indirect functional symptoms. X-ray functional signs include the classic de Quervain's syndrome - local spasm, hypersecretion, local hypermotility, changes in peristalsis, evacuation and tone of the stomach. The dependence of the severity of these symptoms on the localization of the ulcer has been established: they are less pronounced or even absent when the body of the stomach is affected and, conversely, they are most clearly manifested in ulcers of the pyloric and bulb, as well as in the phase of exacerbation of the process. The most permanent of the functional symptoms are hypersecretion, regional spasm of the greater curvature, and a symptom of local hypermotility.

De Quervain's syndrome, as is known, is manifested by spastic retraction of the greater curvature of the body of the stomach when the ulcer is located on the lesser curvature. The retraction is unstable, it can appear and disappear during the study, when using antispasmodics. In practical diagnostics, this symptom is more common in ulcers of the gastric outlet and is of great importance due to the difficulty in detecting ulcers of this localization. A significant amount of fluid in the stomach on an empty stomach is a constant symptom of peptic ulcer and a manifestation of concomitant gastritis. The increase in hypersecretion during X-ray examination is well known.

A symptom of local hypermotility, or increased contractility and accelerated emptying of the section affected by the ulcer, is described with ulcers of the duodenal bulb. This symptom is expressed in ulcers of the apral part of the stomach and duodenal bulb, to the greatest extent in the phase of exacerbation of peptic ulcer.

Problems with the gastrointestinal tract occur due to disorders of the mucous membrane. Proper diagnosis of stomach ulcers is the basis for solving the problem. The disease is characterized by the appearance of a burning sensation in the abdominal cavity. It should be understood that it is impossible to cure it, and the process becomes chronic. Treatment of stomach ulcers is indicated for every sick person, since the disease causes a lot of discomfort and painful symptoms. To detect an ulcer, a range of examinations is recommended, according to the results of which the patient is prescribed a set of measures to help avoid complications.

Information about stomach ulcers

Pathology is characterized by damage to the gastric mucosa. It has a chronic course with periods of remission and exacerbations.

A tenth of the entire population has stomach problems, more often men in middle age or women after menopause suffer from it. A peptic ulcer of the stomach has the following symptoms: heartburn, vomiting, nausea and bloating. With such a disease, the functions of the gastrointestinal tract are disturbed in a person, there is severe discomfort when digesting food, especially spicy food. A sign of a complication is gastric bleeding, which, in the absence of timely assistance, ends in death.

The main causes of ulcers include:

malnutrition;
stressful situations;
physiological characteristics and predisposition to this disease;
hormonal disruptions or changes (in women).

Diagnostic methods

To detect gastric ulcer, examinations are carried out in combination to make a differential diagnosis. The following types of diagnostics are assigned:

gastroscopy;
x-ray;
general blood analysis;
analysis of feces for blood discharge;
electrogastroenterography;
biopsy.

X-ray and its importance in ulcers

Radiography is a procedure based on the use of x-rays to detect any defects in the mucous membrane. It allows you to assess the condition in which the stomach is located. This examination helps to identify diseases of the gastrointestinal tract, tumors and other defects in the early stages. This procedure is indicated for everyone except pregnant women, patients with the last stage of an ulcer, in which bleeding in the stomach can be observed, as well as children under 7 years of age. Do not eat for at least 6 hours before the examination. The accumulation of gases in the abdominal cavity on the eve of the X-ray is unacceptable, so carbonated drinks, acidic foods, juices, beans and other things should be abandoned. For constipation, a medicated enema is given. The study itself is carried out in 3-6 projections for clarity of the picture.

Endoscopic diagnostics

Endoscopy is a method of examining organs into which a device can be inserted for examination. Among such organs, one can distinguish the gastrointestinal tract, bronchi, vessels, gallbladder and others that contain a cavity. This diagnosis helps to identify dangerous diseases in the early stages, such as stomach ulcers, cancer, gastritis, and so on. Modern devices allow you to clearly determine the focus of the disease, which will help in the future to adjust the treatment.

There are rigid and flexible devices for endoscopic examination of tissues, flexible ones are more often used, since they can be used to climb into small cavities where large and clumsy tubes will not fit. Modern technology allows patients who are afraid of swallowing probes to use capsules with chambers, they are practical and painless.

Gastroscopy as the main diagnostic method

An examination method that shows the localization of the pathology, its extent and depth. It helps to take a biopsy for histological examination, to detect the focus of bleeding, to remove pathogenic growths. The procedure is carried out with a fiberscope, which is a flexible optical device. The device is inserted into the oral cavity, and then enters the region of the stomach and duodenum. The image from a small camera at the end of the device is displayed on the screen, and the gastroenterologist examines the patient. Complications from gastroscopy occur in 0.07% of cases, but they can lead to death due to bleeding in the stomach or anaphylactic shock. This examination is not suitable for patients with:

mental disorders;
poor blood clotting;
myocardial infarction or stroke;
obvious symptoms of the last stage of the ulcer;
bronchial asthma.

Other types of examination

When the considered diagnostic methods are contraindicated, patients are referred for ultrasound and computed tomography. CT makes it possible to obtain a picture of the state of the gastrointestinal tract at low x-ray doses. As an addition, an ultrasound examination is performed, it is harmless. There are external and endoscopic ultrasound. With an external person, the abdominal cavity is examined with an ultrasonic sensor, while the information is displayed on the monitor. In the second case, the examination is carried out by introducing the device into the esophagus.

To detect defects in the folds of the stomach, its palpation is performed. The doctor, by lightly pressing on the belly, palpates it to smooth out the stomach walls and get complete information about his condition. Such a procedure requires caution, since due to physical effects, the ulcer may begin to bleed. When a tumor is detected, a biopsy is taken. To plan further tactics, you need to find out the results of such indicators as:

pH-metry;
physical examination;
PCR method for the detection of Helicobacter pylori;
blood test.

According to the results of the diagnosis, the patient is individually prescribed complex treatment. It consists of drug therapy, diet and the fight against concomitant diseases such as gastritis. With acute symptoms, the patient is indicated for surgical intervention. Signs of gastrointestinal disease cannot be ignored, they can be fatal.

Indications for x-ray examination of the stomach are very wide due to the high prevalence of "gastric" complaints (dyspepsia, abdominal pain, lack of appetite, etc.). X-ray examination is carried out with suspicion of peptic ulcer, tumor, in patients with achilia and anemia, as well as with gastric polyps, which for some reason have not been removed.

Chronic gastritis

In the recognition of gastritis, the main role is assigned to the clinical examination of the patient in combination with endoscopy and gastrobiopsy. Only by histological examination of a piece of the gastric mucosa, it is possible to establish the shape and extent of the process and the depth of the lesion. At the same time, in atrophic gastritis, X-ray examination is equivalent in efficiency and reliability to fibrogastroscopy and is second only to biopsy microscopy.

X-ray diagnostics is based on a set of radiological signs and their comparison with a set of clinical and laboratory data. A combined assessment of the thin and folded relief and function of the stomach is mandatory.

The leading value is the definition of the state of the areola. Normally, a finely meshed (granular) type of thin relief is observed. Areoles have a regular, mostly oval shape, clearly defined, limited by shallow narrow grooves, their diameter varies from 1 to 3 mm. Chronic gastritis is characterized by nodular and especially coarse nodular types of thin relief. With the nodular type, the areola is irregularly rounded, 3–5 mm in size, limited by narrow but deep grooves. The gross-nodular type is distinguished by large (over 5 mm) areolas of irregular polygonal shape. The furrows between them are widened and not always sharply differentiated.

Changes in the folded relief are much less specific. Patients with chronic gastritis have thickening of the folds. On palpation, their shape changes slightly. The folds are straightened or, on the contrary, strongly twisted; small erosions and polyp-like formations can be detected on their crests. At the same time, functional disorders are recorded. During the period of exacerbation of the disease, the stomach contains liquid on an empty stomach, its tone is increased, peristalsis is deepened, an antral spasm may be observed. During remission, the tone of the stomach is lowered, peristalsis is weakened.

Peptic ulcer of the stomach and duodenum

Radiology plays an important role in recognizing an ulcer and its complications.

In the x-ray examination of patients with peptic ulcer of the stomach and duodenum, the radiologist faces three main tasks. The first is an assessment of the morphological state of the stomach and duodenum, primarily the detection of an ulcerative defect and the determination of its position, shape, size, shape, and the state of the surrounding mucosa. The second task is to study the function of the stomach and duodenum: detection of indirect signs of peptic ulcer disease, establishing the stage of the disease (exacerbation, remission) and evaluating the effectiveness of conservative therapy. The third task is to recognize the complications of peptic ulcer disease.

Morphological changes in peptic ulcer are caused both by the ulcer itself and by concomitant gastroduodenitis. Signs of gastritis are described above. A niche is considered a direct symptom of an ulcer. This term refers to the shadow of a contrasting mass that filled the ulcerative crater. The silhouette of the ulcer can be seen in profile (such a niche is called contour) or full face against the background of mucosal folds (in these cases they speak of a niche in relief, or a relief niche). The contour niche is a semicircular or pointed protrusion on the contour of the shadow of the stomach or duodenal bulb. The size of the niche generally reflects the size of the ulcer. Small niches are indistinguishable under fluoroscopy. To identify them, sighting radiographs of the stomach and bulb are necessary.

With double contrasting of the stomach, it is possible to recognize small superficial ulcerations - erosion. They are more often localized in the antral and prepyloric parts of the stomach and have the appearance of round or oval enlightenments with a dotted central accumulation of a contrasting mass.

The ulcer can be small - up to 0.3 cm in diameter, medium in size - up to 2 cm, large - 2-4 cm and giant - more than 4 cm. The shape of the niche is round, oval, slit-like, linear, pointed, irregular. The contours of small ulcers are usually even and clear. The outlines of large ulcers become uneven due to the development of granulation tissue, accumulations of mucus, blood clots. At the base of the niche, small indentations are visible, corresponding to edema and infiltration of the mucous membrane at the edges of the ulcer.

The relief niche has a pitchfork of a persistent rounded or oval accumulation of a contrasting mass on the inner surface of the stomach or bulb. This accumulation is surrounded by a light structureless rim - a zone of mucosal edema. In a chronic ulcer, the relief niche may be irregular in shape with uneven outlines. Sometimes there is a convergence (convergence) of the folds of the mucous membrane to the ulcer.

As a result of scarring of the ulcer at the level of the niche, straightening and some shortening of the contour of the stomach or bulb are revealed. Sometimes the ruby process reaches a significant degree, and then gross deformations of the corresponding part of the stomach or bulb are determined, which sometimes takes on a bizarre shape. Scarring of an ulcer in the pyloric canal or at the base of the bulb can lead to pyloric stenosis or duodenal stenosis. Due to a violation of the evacuation of the contents of the stomach is stretched. Contrasting is found in it on an empty stomach).

There are a number of indirect x-ray symptoms of peptic ulcer disease. Each of them individually does not give grounds for establishing the diagnosis of an ulcer, but in the aggregate their value is almost equal to the identification of a direct symptom - a niche. In addition, the presence of indirect signs forces the radiologist to look for an ulcer with special attention, performing a series of sighting radiographs. A sign of a violation of the secretory function of the stomach is the presence of fluid in it on an empty stomach. This symptom is most indicative of an ulcer of the duodenal bulb. When the body is in a vertical position, the liquid forms a horizontal level against the background of a gas bubble in the stomach. An important indirect symptom is regional spasm. In the stomach and bulb, it usually occurs at the level of the ulcer, but on the opposite side. There, a retraction of the contour with even outlines is formed. In the stomach, it is shaped like the end of a finger, hence the name of this symptom - “pointing finger symptom”. With an ulcer of the bulb during the period of exacerbation, as a rule, a spasm of the pylorus is observed. Finally, with ulcers, a symptom of local hyperkinesia is noted, which is expressed in the accelerated advancement of the contrast agent in the ulcer zone. This symptom is explained by increased irritability and motor activity of the wall in the area of ulceration. Another indirect symptom is associated with it - a symptom of point pain and local tension of the abdominal wall during palpation of the area corresponding to the location of the ulcer.

In the stage of exacerbation of peptic ulcer, an increase in the niche and an expansion of the inflammatory shaft surrounding it are observed. During the period of remission, there is a decrease in the niche up to its disappearance (after 2-6 weeks), the functions of the stomach and duodenum are normalized. It is important to emphasize that the disappearance of the niche does not mean a cure if symptoms of impaired function persist. Only the elimination of functional disorders guarantees a cure, or at least a long-term remission.

With peptic ulcer and chronic gastritis, duodenogastric reflux is often observed. To identify it, the patient undergoes dynamic scintigraphy. For this purpose, he is injected intravenously with radiopharmaceutical 99mTc-butyl-IDA or a related compound with an activity of 100 MBq. After obtaining an image of the gallbladder on scintigrams (these drugs are excreted in the bile), the patient is given a fatty breakfast (for example, 50 g of butter). On subsequent scintigrams, it is possible to observe the emptying of the bladder from radioactive bile. With pyloric insufficiency, it appears in the stomach cavity, and with gastroesophageal reflux - even in the esophagus.

The ulcerative niche may vaguely resemble a diverticulum of the stomach - a kind of developmental anomaly in the form of a saccular protrusion of the wall of the digestive canal. In 3/4 cases, the diverticulum of the stomach is located on the back wall near the esophageal-gastric junction, i.e. near the foramen magnum. Unlike an ulcer, a diverticulum has a regular rounded shape, smooth arcuate contours, and often a well-formed neck. The folds of the mucous membrane around it are not changed, some of them enter the diverticulum through the neck. Diverticula are especially common in the descending and lower horizontal parts of the duodenum. Their radiological signs are the same, only with the development of diverticulitis, the contours of the protrusion become uneven, the mucous membrane around is edematous, palpation is painful.

An important role is played by radiation methods in the diagnosis of complications of peptic ulcer. First of all, this refers to the perforation of a stomach or duodenal ulcer. The main sign of perforation is the presence of free gas in the abdominal cavity. The patient is examined in the position in which he was brought to the X-ray room. The gas that has penetrated into the abdominal cavity through the perforation hole occupies the highest sections in it. When the body is in a vertical position, gas accumulates under the diaphragm, when positioned on the left side - in the right lateral canal, when positioned on the back - under the anterior abdominal wall. On radiographs, the gas causes a clearly visible enlightenment. When the position of the body changes, it moves in the abdominal cavity, which is why it is called free. Gas can also be detected by ultrasound.

Two signs indicate the penetration of the ulcer into the surrounding tissues and organs: the large size of the niche and its fixation. In penetrating ulcers, there is often a three-layer content: gas, liquid and contrast agent.

If acute ulcerative bleeding is suspected, emergency endoscopy is usually performed. However, valuable data can be obtained from an X-ray examination, which is advisable to carry out if fibrogastroduodenoscopy is not possible or is not indicated. After stopping bleeding or even during a period of ongoing bleeding, fluoroscopy and radiography of the stomach and duodenum with barium sulfate can be performed, but with the patient in a horizontal position and without compression of the anterior abdominal wall.

As a result of scarring of the pyloric ulcer, stenosis of the gastric outlet may develop. According to x-ray data, the degree of its severity is determined (compensated, subcompensated or decompensated).

Stomach cancer

Initially, the tumor is an island of cancerous tissue in the mucosa, but in the future, various ways of tumor growth are possible, which predetermine the radiological signs of small cancer. If necrosis and ulceration of the tumor predominate, then its central part sinks in comparison with the surrounding mucous membrane - the so-called in-depth cancer. In this case, with double contrasting, an irregularly shaped niche with uneven contours is determined, around which there are no areolas. The mucosal folds converge to ulceration, expanding slightly in front of the niche and losing their outlines here.

With another type of growth, the tumor spreads mainly to the sides along the mucous membrane and in the submucosal layer - a superficial, or flat-infiltrating, cancer that grows endophytically. It causes an area of altered relief, in which there are no areolas, but at the same time, unlike in-depth cancer, there is no ulceration and there is no convergence of mucosal folds to the center of the tumor. Instead, randomly located thickenings are observed with lumps of contrasting mass unevenly scattered over them. The contour of the stomach becomes uneven, straightened. There is no peristalsis in the infiltrate area.

In most cases, the tumor grows in the form of a node or plaque, gradually protruding more and more into the stomach cavity - "towering" (exophytic) cancer. In the initial stage, the x-ray picture differs little from that of an endophytic tumor, but then a noticeable uneven deepening of the contour of the shadow of the stomach appears, which is not involved in peristalsis. Further, a marginal or central filling defect is formed, corresponding in shape to a tumor protruding into the lumen of the organ. With plaque-like cancer, it remains flat, with polyposis (mushroom-shaped) cancer, it has an irregular rounded shape with wavy outlines.

It should be emphasized that in most cases, it is impossible to distinguish early cancer from peptic ulcer and polyp using radiation methods, and therefore endoscopic examination is required. However, X-ray examination is very important as a method of selecting patients for endoscopy.

With the further development of the tumor, various x-ray pictures are possible, which, perhaps, never copy one another. However, several forms of such “advanced cancer” can be conventionally identified. A large exophytic tumor gives a large filling defect in the shadow of the stomach filled with a contrast mass. The contours of the defect are uneven, but quite clearly delimited from the surrounding mucous membrane, the folds of which are destroyed in the area of the defect, peristalsis is not traced.

In a different "guise" appears infiltrative-ulcerative cancer. With it, not so much a filling defect is expressed as destruction and infiltration of the mucous membrane. Instead of normal folds, the so-called malignant relief is determined: shapeless accumulations of barium between pillow-shaped and structureless areas. Of course, the contours of the shadow of the stomach in the affected area are uneven, and there is no peristalsis.

The radiographic picture of saucer-shaped (cup-like) cancer is quite typical; tumors with raised edges and a decaying central part. On radiographs, a round or oval filling defect is determined, in the center of which a large niche stands out - an accumulation of barium in the form of a spot with uneven outlines. A feature of saucer-shaped cancer is a relatively clear demarcation of the edges of the tumor from the surrounding mucosa.

Diffuse fibroplastic cancer leads to narrowing of the gastric lumen. In the affected area, it turns into a narrow, rigid tube with uneven contours. When the stomach is inflated with air, the deformed section does not expand. On the border of the narrowed part with unaffected sections, small ledges can be seen on the contours of the shadow of the stomach. The mucosal folds in the tumor area thicken, become immobile, and then disappear.

A tumor of the stomach can also be detected by computed tomography and ultrasound. On sonograms, areas of thickening of the stomach wall are distinguished, which makes it possible to clarify the volume of the tumor lesion. In addition, sonograms can determine the prevalence of infiltrate in the surrounding tissues and detect tumor metastases in the lymph nodes of the abdominal cavity and retroperitoneal space, liver and other organs of the abdominal cavity. Ultrasound signs of a tumor of the stomach and its germination in the wall of the stomach are especially clearly determined by endoscopic sonography of the stomach. With CT, the wall of the stomach is also well visualized, which makes it possible to identify its thickening and the presence of a tumor in it. However, the earliest forms of gastric cancer are difficult to detect on both sonography and CT. In these cases, the leading role is played by gastroscopy, supplemented by targeted multiple biopsy.

Benign tumors of the stomach

The X-ray picture depends on the type of tumor, the stage of its development and the nature of growth. Benign epithelial tumors (papillomas, adenomas, villous polyps) originate from the mucous membrane and protrude into the lumen of the stomach. Initially, an unstructured rounded area is found among the areolas, which can be seen only with double contrasting of the stomach. Then the local expansion of one of the folds is determined. It gradually increases, taking the form of a rounded or slightly oblong defect. Mucosal folds bypass this defect and are not infiltrated.

The contours of the defect are even, sometimes wavy. The contrast mass lingers in small depressions on the surface of the tumor, creating a delicate cellular pattern. Peristalsis is not disturbed if malignant degeneration of the polyp has not occurred.

Non-epithelial benign tumors (leiomyomas, fibromas, neurinomas, etc.) look completely different. They develop mainly in the submucosal or muscular layer and little protrude into the stomach cavity. The mucous membrane over the tumor is stretched, as a result of which the folds are flattened or moved apart. Peristalsis is usually preserved. The tumor can also cause a round or oval defect with even contours.

Postoperative diseases of the stomach

X-ray examination is necessary for the timely detection of early postoperative complications - pneumonia, pleurisy, atelectasis, ulcers in the abdominal cavity, including subdiaphragmatic abscesses. Gas-containing abscesses are relatively easy to recognize: in the pictures and with transillumination, it is possible to detect a cavity containing gas and liquid. If there is no gas, then a subdiaphragmatic abscess can be suspected by a number of indirect signs. It causes a high position and immobilization of the corresponding half of the diaphragm, its thickening, uneven outlines. There is a "sympathetic" effusion in the costophrenic sinus and foci of infiltration at the base of the lung. In the diagnosis of subphrenic abscesses, sonography and computed tomography are successfully used, since accumulations of pus are clearly visible in these studies. An inflammatory infiltrate in the abdominal cavity gives an echo-inhomogeneous image: there are no areas free of echo signals in it. An abscess is characterized by the presence of a zone devoid of such signals, but a denser rim appears around it - a display of an infiltrative shaft and a pyogenic membrane.

Among the late postoperative complications, two syndromes should be mentioned: adductor loop syndrome and dumping syndrome. The first of them is radiologically manifested by the flow of a contrast mass from the stomach stump through the anastomosis into the afferent loop. The latter is expanded, the mucous membrane in it is edematous, its palpation is painful. Particularly indicative is the long retention of barium in the afferent loop. Dumping syndrome is characterized by a significant acceleration in the emptying of the stomach stump and the rapid spread of barium through the loops of the small intestine.

A peptic ulcer of the anastomosis may occur 1-2 years after surgery on the stomach. It causes a radiological symptom of a niche, and the ulcer is usually large and surrounded by an inflammatory shaft. Her palpation is painful. Due to the concomitant spasm, there is a disorder in the functions of the anastomosis with a delay in the contents in the stomach stump.

Symptoms of pain in gastritis in the stomach area are the main signs of the development of pathology.

Gastritis is an inflammatory disease of the stomach lining. Gastritis can be considered as an independent disease, and can be a consequence of other diseases of the stomach.

Information about acute gastritis

Gastritis is divided into acute and chronic, as well as primary and secondary.

The reasons for the development of gastritis can be the following circumstances:

Food poisoning with toxins (salmonellosis) - can often occur during the hot season.
Eating poor-quality food, such as expired or poorly cooked foods.
Eating food that can injure the gastric mucosa.
Taking certain medications that can damage the stomach lining.
Nervous strain, constant physical and psychological stress, poor sleep, inadequate rest.

In some cases, gastritis can occur as a secondary manifestation of the underlying disease. So, for example, after radiation therapy, chemotherapy, kidney failure, burn disease, against the background of these procedures, gastritis may occur as a consequence.

You can divide gastritis according to the depth and severity of the course:

Superficial gastritis. In this form, only the mucous membrane is damaged, when the surface of the stomach swells and becomes covered with a significant layer of mucus, the folds of which become thicker. If superficial defects or hemorrhages appear on the mucus, then gastritis is called superficially erosive.
Phlegmonous gastritis. The deeper layers of the stomach are already involved here. It occurs in rare cases, mainly as a consequence of an ulcer or stomach cancer. Or, in the case of any infection - staphylococcal, streptococcal, with typhoid fever.

The disease in most cases is diagnosed in people after 30 years. Even dogs and other animals are susceptible to this disease. The disease can be asymptomatic for a long time. And even when the disease has made itself felt, bouts of pain can be replaced by a long lull. Gastritis cannot be cured overnight. It will take a long course of treatment - medications, diet, physiotherapy, etc.

The causative agent of the disease can be Helicobacter pylori. This bacterium is able to infect the gastric mucosa, causing diseases such as gastritis and ulcers.

Gastritis can also occur due to internal burns, for example, if you take low-quality alcohol, alkalis and foods with a strong acid content. Foods containing salt, sugar, hot spices, animal fats can provoke gastritis. Reduced human immunity can contribute to the progression of the disease.

The main symptoms of acute gastritis

The first signs of the disease may appear 2 or more hours after eating food. The main symptoms include:

pain in gastritis in the epigastric region;
nausea and vomiting;
a feeling of fullness in the stomach;
increased salivation;
general weakness.

Vomiting may be accompanied by food debris, bile and mucus. After vomiting, the person experiences some relief, but other symptoms remain: weakness, dizziness, thirst, headache, and general malaise. The body temperature may rise slightly, but not always, the person turns pale, the tongue becomes grayish, the pressure drops, the pulse quickens. How long does a gastritis attack last? Many people want to know the answer to this one. An attack can last up to 4 days on average, but more often within 2 days.

If an attack of gastritis began as a result of food intoxication, then bloating, cramping pains, loose stools with mucus, fever, general intoxication, and weakness join the pain in the stomach. Despite the severe course of the disease, with proper treatment, relief can occur in 2-3 weeks. If not treated properly and neglect the advice of doctors, acute gastritis can become chronic with a constant exacerbation of pain.

Treatment of acute gastritis

The first aid, if an attack of gastritis has begun, may be the removal of toxins from the stomach that cause this phenomenon. To do this, it is worth washing with a probe, if this is not possible, then you need to drink enough water and induce vomiting yourself.

In order for toxins to completely leave the body, you need to drink magnesium sulfate and lie down comfortably. After all these procedures, symptomatic treatment and antibiotics are prescribed. In the first two days of treatment, they drink only water, for 2-3 days you can take liquid food, mashed potatoes, pureed boiled meat. It will be possible to switch to the general table gradually only after 1-2 weeks, depending on the general condition of the patient.

Chronic gastritis

Chronic gastritis appears as a consequence of undertreated acute gastritis. It is characterized by periodic outbreaks of acute gastritis. Chronic gastritis is less intense than acute, but carries a great danger. A prolonged inflammatory reaction appears, while the mechanisms of healing of the gastric mucosa are disrupted. Gradually, atrophic processes are formed in the stomach.

Symptoms of chronic gastritis

The patient often complains of heartburn, stomach pain, belching, flatulence, diarrhea. Gastritis can occur with high and low acidity. If the acidity decreases, then the food is digested slowly and incompletely. Such food irritates the intestines, inflammatory processes appear, putrefactive and fermentative, manifested by flatulence, belching and loose stools.

If the acidity is increased, then the pains of gastritis are acute, they are aggravated by walking or shaking.

If you take food, soda or antacids, then the pain stops.

If chronic gastritis proceeds for a long time, then food is digested with difficulty, and the following symptoms appear:

hemoglobin decreases, anemia appears;
immunity decreases;
there is a lack of vitamins in the body;
intestinal dysbacteriosis;
pallor of the skin;
general weakness of the body;
the skin dries;
gums begin to bleed.

Over time, there are changes in the liver, pancreas, in the nervous system, in the blood. All these factors, as well as external circumstances (unrest, stress, malnutrition, bad habits, refusal of treatment) can lead to seasonal exacerbations.

Diagnosis of pathology. In addition to general tests, fibrogastroduodenoscopy is performed. It is aimed at identifying Helicobacter pylori. Further X-ray of the esophagus, stomach and duodenum. Ultrasound examination of the abdominal cavity and other types of diagnostics.

Treatment of chronic gastritis

Treatment is long, carried out in several stages. While exacerbations begin, you need to move as little as possible, stop taking alcohol and cigarettes. A strict diet is prescribed. People with chronic gastritis must constantly follow a diet. The doctor prescribes medications, and if, during the diagnosis, Helicobacter pylori were detected, then antibiotic therapy is carried out to destroy this bacteria. If the acidity is increased, then the doctor may advise taking one of the drugs such as Maalox, Gastal, Almagel, Vikalin. If the acidity is low, carnitene, romazulan can help.

In addition, for chronic gastritis, enzymes, antispasmodics, probiotics, sedatives, herbal medicine, etc. are taken. If possible, then during periods when there are no exacerbations, you can be treated in an appropriate sanatorium.

Causes, signs and therapy of duodenal ulcer

Duodenal ulcer (DU) is a mucosal lesion due to the harmful effects of acidic contents and pepsin. The disease proceeds in the form of exacerbations and remissions. The main symptom is the presence of an ulcerative wall defect.

Along with the duodenum, the stomach is often affected. Combined diseases should be called combinations of peptic ulcer of the stomach and 12 duodenal ulcer or peptic ulcer of the stomach and esophagus.

Anatomy, physiology and function of the duodenum

To understand the cause of the development of this disease, why lesions of the stomach and duodenal ulcers appear more often, and not ulcers of other localizations, it is necessary to familiarize yourself with the anatomy of the intestine.

To better understand the methods of treatment, it is necessary to understand what substances are released into the lumen, consider the action and functions of the intestine.

Anatomical structure and topographic location of the duodenum

The duodenum is the initial part of the intestine. Located in front of the small intestine. The duodenum begins from the stomach, in the region of the pylorus, ends with a transition to the jejunum. The length of the duodenum is 30 cm. The diameter is approximately 5 cm.

It is located below the epigastrium, covering the pancreas. The length of the intestine is divided into a number of departments. The ampullar part, the site of the ulcer, begins in the region of the pylorus, then bends, passing into the descending part at the level of the III lumbar vertebra, where it bends again and forms the next part - the horizontal one. The described part of the intestine crosses the abdominal aorta and, bending, returns to the II lumbar vertebra - the ascending part of the intestine is called.

The structure of the wall of the duodenum

The intestinal wall consists of 3 membranes. External is serous, which continues from the stomach. The middle shell is muscular, consists of an outer layer and an inner layer of muscle fibers. The inner lining is mucous. The shell is a collection of folds and villi, in the depths of which there are special glands responsible for the production of duodenal juice. A number of hormones are produced in the mucosa of the duodenum. The manifested effect of hormones is visible with sufficient secretion of gastric contents.

WPC function:

Normalization of the Ph level for further processing of the contents in the intestine.
Participates in the regulation of the amount of pancreatic enzymes and gastric juice.
Participates in the processes of opening / closing of the pyloric part of the stomach.
Secretes hormones involved in digestion.

Etiology and pathogenesis of the disease

The causes of duodenal ulcers are multifaceted. The origin of the disease consists of factors that, coming together, attack the mucous membrane. One of several factors is an imbalance of protective and aggressive factors in the intestinal environment. For example: hydrochloric acid of the stomach with an increase in the acidity of gastric juice. This happens due to the insufficiently effective work of the pyloric part, causing damage to the mucosa in the area of contact of the contents of the stomach and duodenum.

The bacterium Helicobacter pylori (HP) is able to secrete substances that increase the acidic environment. Reproducing and developing in the duodenum and stomach, it releases substances that have a destructive effect on the intestinal wall. In case of a lack of "protective factors": sufficient blood supply, an intact bicarbonate barrier, a sufficient number of T- and B-lymphocytes, there is a shift in favor of aggression factors, leading to the formation of an ulcer. Until the end, the disease has not been studied, the etiological factors of its occurrence have not been elucidated.

Risk factors

Peptic ulcer of the duodenum occurs due to adverse environmental factors. Risk factors include activities, diseases that favor an increase in acidity. These include: smoking, abuse of strong drinks: alcohol, coffee. An important role is played by the presence of a history of gastritis, which is a pre-ulcerative condition, gross violations of the diet (fast food, starvation, malnutrition). The use of spicy, smoked, salty foods leads to a decrease in Ph, increasing acidity. Such a violation of the diet leads to disorders of the gastrointestinal tract of other localizations.

When used in a significant amount of non-steroidal anti-inflammatory drugs or glucocorticosteroids, acidity increases significantly. A genetic factor is not excluded: predisposition to high acidity of the stomach.

Clinical picture of the disease

A duodenal ulcer manifests itself during periods of exacerbations that occur in the spring and autumn. The first complaints of the patient occur on soreness, resembling cutting pain with localization in the epigastric region. Often the pain is acute, radiating to the hypochondrium on the right or back. Soreness is often associated with eating, eating disorders and occurs in the region of 2 hours from the moment of eating. The duodenum and stomach produce hydrochloric acid at night, pain can occur at night.

Flatulence, bloating, nausea, vomiting, occasional heartburn. Violation of the stool in the form of constipation. Appetite is absent or significantly reduced.

Diagnosis of duodenal ulcer

Diagnosis is based on criteria. They include the collection of complaints, examination of the patient and a complete examination according to the list: blood tests, X-ray and other research methods specific to this disease.

The procedure for prescribing methods is determined by the doctor. Based on the clinical picture, the doctor decides which study needs to be done immediately, and for which there are no indications in a particular situation.

Collection of data for the presence of pathology of the gastrointestinal tract

To begin with, a thorough collection of complaints is made at the doctor’s appointment, because the disease manifests itself with the corresponding clinical picture (soreness in the epigastric region, cutting in nature, associated with food intake and dietary errors, sometimes weight loss is unmotivated). Collection of anamnestic data (when these complaints first appeared, whether the person was examined earlier, what drugs he took to relieve pain, dosage of drugs, etc.).

Unreasonable intake of non-steroidal anti-inflammatory drugs in a large dose provokes the formation of gastric and duodenal ulcers. The diet is specified: addiction to what types of food and drinks are present to a greater extent, whether the patient consumes spicy dishes. The symptoms of a duodenal ulcer in women and men are identical.

A family history is ascertained (whether such diseases were recorded in relatives of the 1st line of kinship, malignant tumors of the gastrointestinal tract). Symptoms of peptic ulcer are found out from the relatives of the patient, the disease is definitely infectious. The doctor draws the patient's attention to the time of year when symptoms appear or worsen.

You should pay attention to the signs of duodenal ulcers: early pain in the epigastric region. Appear in half an hour - an hour after eating, have a seasonal character. When the disease of the stomach and intestines is affected, the symptoms remain similar, but the pains appear early after eating and later. Gastric ulcers are characterized by late pain that occurs one and a half or 2 hours after eating. Characterized by pain that occurs during long breaks in food - starvation. A diet that includes fasting moments, for example, with obesity, is prohibited.

Considering that often a stomach and duodenal ulcer occurs in one patient, it is necessary to collect anamnesis and complaints about the pathology of the stomach and not only the intestines.

Objective research

Inspection of covers. Skin of normal color and moisture, clean. Palpation examination determines the tension of the anterior abdominal wall, pain in the upper abdomen (in the area of the stomach ulcer and 12 duodenal ulcer), to the right of the umbilical region, at a point at the level of the 12th rib from the back along the paravertebral line. When tapping the area under the xiphoid process of the sternum with your fingers, soreness and muscle tension are determined.

Laboratory methods of examination

In a detailed blood test with an uncomplicated course of the disease, there will be no changes. If the ulcer "opened" and bleeds into the intestinal lumen, erythrocytosis may occur, a decrease in hemoglobin in a detailed blood test. Feces are examined for occult blood - with an uncomplicated course, blood is not found.

Instrumental survey methods

Diagnosis of the disease is structured, includes measurements:

The presence of antibodies to Helicobacter pylori (HP) in the patient's blood serum.
Measurement of the level of acidity in gastric juice. If a patient has a duodenal ulcer, the level will be elevated due to increased secretion of hydrochloric acid.
X-ray of the duodenum. X-ray symptoms of gastric and duodenal ulcers. Barium retention (during X-ray with contrast) at the site of the duodenal membrane defect; index finger - retraction of the mucosa on the opposite side of the ulcer (mirror ulcer). The appearance of inflammatory zones around the ulcerative defect of the mucosa. The arrangement of folds in the form of a star in the area around the ulcer. Acceleration or, conversely, slowing down the evacuation of contrast (liquid barium) from the intestine.
Fibrogastroduodenoscopy. With the help of a fiberscope, the location of the ulcer, its size, and complications are determined.
Microscopy of a biopsy specimen from the wall of the duodenum, obtained during duodenoscopy, to determine the presence of Helicobacter pylori.

Treatment

If the above complaints appear, you should consult a doctor. Treatment includes:

Diet.
Antibiotic therapy as recommended. Three or four component circuits. New generation schemes.
Surgical treatment according to indications.
Prevention of complications (bleeding, perforation of the ulcer).

Given the versatility of treatment, consider the points in order.

Diet

Consists of limiting a certain number of products that affect the acidity of gastric juice. Unlimited food: dairy products (cottage cheese, milk), low-fat fish products, chicken, crackers, vegetables, fruits, vegetable oil. From the diet should be excluded: alcohol, salty, spicy, citrus fruits, fatty meat, canned food.

Medicines for treatment

Surgery

Surgical treatment of a duodenal ulcer is acceptable only in cases of complications: bleeding from an ulcer, degeneration into a malignant one, perforation.

A formidable complication is duodenal stenosis. With frequent relapses, the formation of a complication occurs - a scarring ulcer. On the one hand, such a process means the closure of the ulcer and the absence of the danger of perforation of the ulcer or bleeding. But the scar is a dense connective tissue that tightens the walls of the intestine. Intestinal patency is disturbed, cicatricial congestion appears, which is an indication for surgical treatment. A complication appears in the form of profuse vomiting, occurs due to the appearance of a scar: the gastric contents cannot penetrate further into the intestine and stagnates.

Surgical treatment is a resection of the affected area of the intestinal tube, the intersection of the branches of n.vagus. Thanks to the measures taken, the secretion of hydrochloric acid and gastric juice is reduced.

Physiotherapy treatment

Thermal procedure using heating pads, compresses with a warming effect. The effect is achieved by reducing the spasm of the myocytes of the duodenal wall, relieved by heat. Treatment has contraindications: complicated course of the disease, suspicion of oncology.
Electrophoresis. Drugs that relieve spasmolytic pain (drotaverine, papaverine) are used. When taking the solution orally, galvanic currents are applied.
Magnetotherapy.
Hydrotherapy.
Oxygen therapy.
Hyperbaric oxygenation.

Prevention of the onset of the disease

Helicobacter pylori must be prevented. Need:

Use an exceptionally clean plate, spoon, mug.
Do not use dishes that have been previously used by a stranger and have not been washed. Peptic ulcer is an infectious disease. Transmitted through saliva. For this reason, you can not taste food, drink from a mug, use a cup of a family member. You can't taste each other's food in cafeterias with friends.
Timely identified and treated erosive and ulcerative lesions of the duodenal mucosa.

It will be necessary to prevent a significant increase in the level of hydrochloric acid in the gastric juice. The solution implies the strictest adherence to dietary recommendations - the exclusion from food of fried, spicy dishes, spices, overly salty products, canned food, winter preparations. Patients with gastric and duodenal ulcers often neglect the diet that underlies their treatment.

Interesting data have been obtained regarding the beneficial effects of sleep on digestion. Doctors came to the conclusion that after dinner a short sleep is shown to a person. It is believed that during rest, more blood enters the brain and heart. It has been proven that during sleep, these organs work in an “energy-saving” mode, most of the blood, compared to waking hours, enters the stomach and intestines, leading to a sufficient intake of nutrients, rapid regeneration of the duodenal mucosa, and providing a therapeutic effect.

Ulcer disease is considered not only as an independent disease. Often, pathology is the cause of undertreated erosions. Erosion - changes in the mucosa on the inner layer. Erosive and ulcerative lesions, with proper treatment, disappear without a trace, with a neglected case, they turn into an ulcer.

Cancer alertness

Many doctors and scientists believe that duodenal ulcer can turn into colon cancer. Conditions should appear: a genetic predisposition to cancer, a burdened family history of oncology, frequent recurring exacerbations of duodenal ulcer. Has the ulcer been fully treated? When was the last treatment? It is necessary to study the erosive and ulcerative lesions in history, turning into an ulcer.

Symptoms of cancer are sometimes non-specific, it is necessary to obtain a certain alertness of the patient about the possible malignancy of the ulcer, to motivate the patient to adhere to the diet, diet and medication. Even a scarring variant of a duodenal ulcer is a high risk of malignancy: an incompletely closed ulcer can again be complicated by bleeding. By following the doctor's instructions, the purity of relapses and the risk of malignancy of the ulcer will decrease. Only a doctor should treat a duodenal ulcer. With improperly prescribed treatment or self-medication, the risk of frequent relapses of the disease is high. This will lead to severe complications of peptic ulcer. After treatment of a duodenal ulcer, the patient remains under dispensary observation by a therapist at the place of residence.

Answers to patients' questions

Which doctor should deal with the treatment of peptic ulcer? Answer: therapist or gastroenterologist.
Can peptic ulcer of the stomach and duodenum be cured? Answer: yes, absolutely.
Is the disease inherited? Answer: no, the disease is not transmitted, only a predisposition to the disease.
Can peptic ulcer of the stomach and duodenum be found in one patient? Answer: this happens.
Will it be possible to independently determine the disease of the stomach and intestines? The answer is positive if symptoms are revealed: pain in the upper abdomen, acute cutting character. They appear in spring - autumn and are associated with food intake. They are considered the first signs of an ulcer.
Is it possible to play sports if a stomach ulcer is diagnosed. Answer: only with compensation. An untreated ulcer can open at any time, bleeding will occur.
Is bleeding from gastric and duodenal ulcers treated? Answer: hemostatic preparations and surgical suturing of the wound.
What to do if the patient discovered an ulcer, being in old age? Answer: Be sure to consult a therapist at the first symptoms. Treatment does not depend on the age of the person. Contraindications are known only for surgical treatment.
Will an ulcer hurt the baby during pregnancy? Answer: during pregnancy, most drugs cannot be prescribed, if complaints appear, you need to undergo FGS, an ulcer is terrible with complications. The disease in pregnant women will be similar to other population groups.
Is it true that complications of peptic ulcer disease can occur during flights? Answer: in part - yes, complications can occur at any time with an untreated form of the disease.
What are the symptoms and treatment of the disease? Answer: described in the article above. Methods include: diet, antibiotic therapy, surgical treatment of complications.
Which diseases are similar to duodenal ulcer? Answer: peptic ulcer of other localizations, gastritis, enteritis.
How long does it take for an ulcer to heal? Answer: several years. With adequate antibiotic treatment - a few months. With surgical treatment - a few months.
Are diseases of the stomach and intestines capable of becoming cancerous? Answer: ulcer malignancy is possible, polyps are also malignant.
What localizations of the ulcer are possible? Answer: duodenum, stomach, esophagus. The first of those described, the causes of which are indicated above, is more common than esophageal ulcers.

How is a barium stomach x-ray done?

X-ray is in a sense an additional tool for determining the specifics of gastritis and ulcers.

It primarily helps to cut off the likelihood of other ailments and detect abnormal anatomical conditions. During this examination, the shape of the stomach sections is examined, the relief of the mucous membrane is assessed.

How to prepare and what to expect?

Do not eat anything before the appointed time. You should not eat in the evening and skip breakfast on the day of the procedure. Smoking is also prohibited, as well as - pay attention - the use of chewing gum.

When chewing, even if it does not eventually lead to swallowing food, the release of hydrochloric acid and enzymes increases, saliva accumulates profusely.

All this can prevent uniform enveloping of the mucosa with a contrast agent.

Barium sulfate is usually used as an enveloping substance (in case of individual hypersensitivity, it is replaced with a substance containing iodine).

The patient drinks the prescribed amount of barium suspension. Don't be scared - just a couple of sips.

The stomach is first translucent in a vertical position - the patient is standing, not lying down.

Two shots are taken - on the right front side (or straight) and on the left obliquely. Further, the stomach is already translucent horizontally.

With ready-made images, the examined person goes to a gastroenterologist or at least to a therapist. The patient is prescribed medication.

What abnormalities can be detected by x-ray?

First of all - structural, associated with a change in the contours of the body:

hypertrophic formations, including polyps;
Menetrier's disease;
hiatal hernia;
developed ulcers;
cancerous tumors;
narrowing of duodenal channels.

Radioscopy - is it dangerous?

X-rays should not be taken too often. Three times a year is too much. If you have had it in the recent past for some other purpose, your doctor may advise you to refrain from taking an extra dose of radiation. The dose, of course, is small, and yet it is by no means useful for the body. Why take the risk?

No less complete data can be obtained using computed tomography, through fibrogastroscopy. These methods are relatively modern and informative.

gastritis diagnosis ulcer diagnosis