X-ray signs of a stomach ulcer. Diagnosis of gastric ulcer: X-ray, gastroscopy. Etiology and pathogenesis of the disease

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Anomalies of the stomach on x-ray. X-ray diagnostics of functional disorders of the stomach

Among the anomalies of the stomach are:

• doubling of the stomach;
• narrowing of the antrum;
• pyloric stenosis;
• gigantism of folds;
• congenital and acquired diverticula of the stomach;
• reverse position of the stomach and other internal organs;
• "thoracic" stomach.

Functional disorders of the stomach are divided into the following groups:

• violation of the tone of the stomach;
• change in peristalsis;
• secretion disorder.

Full and partial doubling of the stomach on x-ray

There are the following options for doubling the stomach:

• Full doubling. In this case, the second part of the stomach is fully involved in digestion.
• Partial doubling. With partial doubling, tubes or cysts are formed in which digestion is not carried out.

X-ray picture of diverticula of the stomach

Most often, diverticula are located in the following parts of the stomach:

• cardiac department ( 75% );
• pyloric department;
• body of the stomach.

A complication of a diverticulum is inflammation of the stomach wall - diverticulitis. In this case, the wall of the diverticulum becomes inflamed and swells. In the cavity of the diverticulum, the barium mass lingers, fluid and gas accumulate. These areas create a three-layer effect. With spasm of the neck of the diverticulum, necrosis of its contents may occur, therefore, in this case, an operation is performed to remove it.

Diagnosis of a hernia of the stomach using x-rays

Hernia of the stomach is easily diagnosed by x-ray with a contrast agent. The hernial sac stains well with a contrast agent. The difference between a hernia and a diverticulum is the location of the hernia not in the abdominal cavity, but in the chest. A biopsy or computed tomography is sometimes performed to clarify the diagnosis and exclude complications ( CT) of the abdominal cavity.

Hiatus hernia is controlled by diet. Surgical treatment of a hernia is also quite effective, however, if possible, it is better not to perform an operation, but to treat it conservatively. Hernia of the stomach for a long time can be asymptomatic.

Congenital and acquired pyloric stenosis on x-ray of the stomach

Pyloric stenosis can be of two types:

• congenital;
• acquired.

Radiographic signs of pyloric stenosis are:

• narrowing of the pylorus lumen 0.5 cm or less;
• lengthening of the pyloric canal;
• strengthening of peristaltic waves;
• thickening of the folds of the mucous membrane or their deformation;
• delayed evacuation of barium mass from the stomach;
• delayed filling of the intestines with barium mass.

Aperture ( partial narrowing) antrum on x-ray

An X-ray shows difficulty in filling the part of the stomach behind the diaphragm. If its lumen is large enough, then without double contrasting, the diaphragm may not be noticeable. If a gastric diaphragm is suspected, a small amount of barium mass is used to color its contour, but not completely block it. The diaphragm of the antrum can be combined with an ulcer, and the following symptoms may appear - pain, burning, associated with eating.

Atony and hypotension of the stomach on x-ray

The following causes of reduced stomach tone are distinguished:

• abdominal trauma;
• cachexia ( exhaustion due to malnutrition or various diseases);
• postoperative period;
• stress, emotional overstrain;
• intoxication ( including alcohol);
• infectious diseases;
• chronic gastritis and other diseases of the stomach.

Hypotension of the stomach is a dangerous condition. Food in such a stomach cannot be completely digested, as a result, a person receives less vitamins and nutrients. The action of the acidic environment of the stomach dramatically increases the risk of peptic ulcer of the stomach and intestines. To eliminate hypotension of the stomach, it is necessary to treat its root cause. After surgical interventions, it is necessary to apply physical activity in a dosed manner. It will help restore the tone of skeletal muscles and muscles of internal organs.

increased tone ( hypertension) of the stomach on x-ray. Spasm of the stomach

With hypertension, an X-ray shows a small stomach in the shape of a horn. The gas bubble is spherical, and the contrasting mass penetrates into its lower sections for a very long time. The barium mass evacuation time has also been increased. Atypical transverse folds may be observed in the stomach.

Spasm of the stomach can deform its wall. Local spasm is usually associated with a stomach ulcer. At the same time, on the X-ray, the stomach takes the form of an "hourglass" - a local narrowing between two wider sections. In order to distinguish gastric spasm from cicatricial deformity, the subject is given atropine, after which the spasm disappears for a short time. To reduce the tone and relieve stomach spasm, antispasmodics are used ( no-shpa), diet, gastric lavage with potassium permanganate, chamomile decoction.

Is it possible to detect an increased or decreased secretion of gastric juice using an x-ray?

Hypersecretion of gastric juice is a symptom of the following diseases:

• peptic ulcer;
• antral gastritis;
• spasm and stenosis of the pyloric sphincter.

Decreased secretion of gastric juice is called achilia. Achilles cannot be diagnosed by x-ray, but it is often accompanied by decreased gastric tone and weakened peristalsis, which has certain radiological signs. Achilia is diagnosed using a histamine test. Reduced gastric secretion leads to the formation of polyps of the mucous membrane, chronic gastritis.

Duodenogastric reflux on x-ray

Duodenogastric reflux can provoke the following diseases of the stomach:

• peptic ulcer;
• chronic gastritis;
• pyloric stenosis;
• malignant tumors.

Diagnosis of acute and chronic gastritis using X-ray

Chronic gastritis on x-ray of the stomach

Chronic gastritis is manifested by indigestion, changes in stool, insufficient digestion of food. During exacerbations, discomfort and pain in the stomach may appear. These symptoms make it possible to suspect chronic gastritis and are an indication for an X-ray examination. It is with the help of x-rays that you can study the relief of the mucous membrane, which changes significantly in chronic gastritis. Visual diagnosis of the mucous membrane can be carried out using endoscopy of the stomach.

Chronic gastritis can have the following clinical forms:

• catarrhal. It is characterized by edema and an inflammatory increase in the folds of the mucous membrane.
• Erosive. Inflammation includes the formation of mucosal defects in the form of erosions.
• Polypoid. The proliferation of the mucous membrane, which is observed in response to inflammation, takes the form of polyps. They may disappear completely when the condition returns to normal.
• Sclerosing ( rigid). With this type of chronic gastritis, there is a deformation of the stomach wall and a violation of its contraction.

The main radiological signs of chronic gastritis are:

• Enlargement of gastric fields. The gastric fields, located in the body of the stomach, are the outlet ducts of the glands of the mucous membrane. In chronic gastritis, the diameter of these fields becomes more than 3–5 mm; on an x-ray, they acquire a granular appearance due to the penetration of the contrast mass deep into the dilated ducts.
• Expansion of mucosal folds. Chronic gastritis is characterized by a violation of the course of the folds of the mucous membrane. There is more space between them, which creates a jagged appearance on the x-ray. However, chronic gastritis can also be observed with normal mucosal relief.
• Increased secretion of mucus. Mucus is a protective layer between the epithelium of the stomach wall and the acidic environment of the gastric contents. In chronic gastritis, its amount increases. Mucus can interfere with the staining of the folds with a contrasting mass. This effect of fuzzy folds is called the marble relief of the mucous membrane.
• Violation of the tone of the stomach. In chronic gastritis, the tone of the stomach decreases, and the rate of its purification from the barium mass is reduced. With exacerbations of gastritis, the tone may increase. The patient may feel an increase in tone in the form of spastic pain.

Erosive chronic gastritis on x-ray

Erosions are usually located on the front or back wall. On x-rays, such erosions look like a spot up to 1 centimeter in size. When located in the region of the left or right contour of the stomach, erosions look like a small accumulation of barium mass. However, more often such erosions are not visible due to their small size. Taking pictures in different projections helps in their determination. Erosion of the mucous membrane must be distinguished from an ulcerative defect and from tumor processes. This can help examination of the gastric mucosa using endoscopy.

The erosive process, unlike gastric ulcers, is reversible. The mucous membrane can be restored, since the epithelium has the ability to regenerate. For the treatment of erosive chronic gastritis, drugs are used that reduce the activity of microflora, as well as drugs that reduce the secretion of gastric juice. In addition to a special diet, gels can be used to coat the stomach wall and protect it from irritants.

Polypoid and rigid chronic gastritis on x-ray

Warty growths of the mucous membrane appear against the background of smoothed folds of the mucous membrane. Their size does not exceed 5 mm. They are also covered with mucus and may not be visible when between the folds. On x-ray, polypoid gastritis is characterized by small protrusions with fuzzy boundaries inside the stomach against the background of an altered mucous membrane. This form of the stomach must be distinguished from tumor formations of the mucosa. They are large, and the mucous membrane around them is not changed.

Rigid chronic gastritis develops in the antrum. It proceeds slowly and leads to a decrease in muscle activity in this area. Chronic inflammation in rigid gastritis leads to the formation of an excess amount of connective tissue in the deep layers of the gastric wall.

Rigid chronic gastritis is characterized by the following radiographic features:

• deformity of the antrum;
• violation of the tone of the stomach and peristalsis;
• change in the relief of the mucous membrane.

Acute gastritis. Diagnosis of acute gastritis by X-ray

Acute gastritis has the following forms:

• Catarrhal gastritis. This is the mildest form, since only the superficial layers of the mucous membrane are affected. They are quickly replaced by new cells when irritants are eliminated. Catarrhal gastritis is accompanied by swelling of the mucous membrane and a large formation of mucus.
• Erosive gastritis. Acids and alkalis can form mucosal defects in high concentrations. If the defect reaches the submucosa, then scarring and narrowing of the gastric lumen occurs over time.
• Phlegmonous gastritis. Bacteria rarely develop in the stomach due to the acidic environment of the stomach. However, with their development, an accumulation of pus is formed in the wall of the stomach ( phlegmon). This dangerous condition is accompanied by pain, nausea and vomiting and requires surgical treatment.

Diagnosis of peptic ulcer and tumor formations of the stomach using x-rays

X-ray method is a very convenient way to diagnose stomach ulcers. A large number of direct and indirect signs allow almost unmistakable diagnosis of stomach ulcers. A stomach ulcer is diagnosed with the use of contrast agents. To do this, a series of images is taken, during which the gastric mucosa is examined at different degrees of its filling.

Tumor diseases of the stomach are detected on x-rays if they are larger than 3 mm. There are also difficulties in distinguishing between benign and malignant tumors. Therefore, if necessary, an x-ray of the stomach with contrast is supplemented by computed tomography, endoscopy or biopsy ( microscopy of a piece of tissue). Only with the help of a biopsy can one accurately determine the nature of the tumor.

Ulcer disease. X-ray signs of a stomach ulcer

During the course of peptic ulcer, the following stages are distinguished:

• pre-ulcer state;
• initial stage;
• formed ulcer;
• ulcer complications.

X-ray signs of an ulcer on an x-ray are:

• A niche in the contour of the stomach wall. A niche is called the shadow of a contrast agent that has penetrated into the ulcer. It can be round or oval, have different sizes ( from 0.5 cm to 5 cm or more).
• Irregular contour of the mucous membrane. The edges of the ulcer are pitted and uneven. They contain granulation tissue, blood, food. However, in small ulcers, the edges may be even.
• Increase in the number and volume of folds. The folds are enlarged due to inflammation of the wall area around the ulcer. When using double contrast, you can see that the folds are directed towards the ulcer.
• Increased secretion of gastric juice. A sign of hypersecretion is the presence in the stomach of a horizontal level of liquid located under the gas bubble.
• Local spasm of the gastric wall. Spasm occurs at the level of the ulcer, but on the opposite side. It looks like a small, persistent retraction of the stomach wall.
• Rapid advancement of the contrast agent in the area of ​​the ulcer. This is due to the fact that, under the control of nervous and reflex mechanisms, the gastric wall tries to reduce the contact time of the affected area with a potential irritant.

Complications of peptic ulcer. Cicatricial deformities of the stomach on x-ray. Cascading stomach

Complications of peptic ulcer are:

• scarring and deformation of the stomach wall;
• pyloric stenosis;
• perforation of the stomach;
• penetration of the ulcer into neighboring organs;
• cancerous degeneration of the ulcer.

Serious deformities are rarely seen on x-rays today. This is due to the fact that modern methods of treatment can prevent major complications. For example, an hourglass deformity appears if scarring occurs along the circular muscle fibers with a constriction in the center of the stomach and its division into two parts. In case of deformation of the lesser curvature, the output and initial sections are pulled towards each other. Such a stomach is called a purse-string or cochlear.

Cascading stomach - a deformity in which a constriction is formed that separates the cardiac section ( upper section) of the stomach from the rest. Thus, the stomach is divided into two levels ( cascade). This deformation greatly complicates the passage of food through the gastrointestinal tract and usually requires surgery to eliminate.

Despite the fact that massive deformities are less and less common in the modern world, small areas of scarring can be found in the stomach even in people who consider themselves healthy. This is due to the fact that the ulcer can be asymptomatic and heal on its own. On x-rays, small scars of the stomach look like irregularities in the contour of the shadow of the stomach and the area to which the folds converge. There are no folds on the scar site itself. In the scar area, the peristaltic wave is not detected or is weakened.

X-ray diagnostics of penetration and perforation of the ulcer

There is penetration of the ulcer into the following formations:

• spleen;
• abdominal wall;
• ligaments of the stomach.

Ulcer perforation is the communication of the stomach with the abdominal cavity through the ulcer. At the same time, free gas is determined in the abdominal cavity, which looks like an enlightenment in the form of a sickle under the diaphragm. To detect it, it is enough to perform an overview x-ray of the abdominal cavity. The patient can indicate the exact time of perforation on his own, as it is accompanied by severe pain. After 2 hours, gas can already be detected in the abdominal cavity, which initially accumulates on the right side under the diaphragm. The pain of a perforated gastric ulcer is very similar to heart pain, so perforation can be confused with a myocardial infarction, which can be costly in time.

Diagnosis of stomach cancer at the site of the ulcer process using X-ray

With the development of cancer, an ulcerative defect acquires the following radiological signs:

• an increase in the size of the ulcer up to 3 centimeters;
• uneven edges of the cancerous ulcer;
• complete immobility of the walls of the stomach in the area of ​​​​the ulcer;
• the formation of a shaft around the ulcer and undermined edges of the ulcer niche.

Stomach cancer on x-ray. Saucer-shaped cancer

Gastric cancer has a variety of forms and variants of the course. Initially, the tumor is a small island of tumor cells on the surface of the mucous membrane. It can protrude into the lumen of the stomach or be in its thickness. Subsequently, an area of ​​necrosis and ulceration forms in the center of the tumor. At this point, a cancerous tumor is very similar to a peptic ulcer. If cancer develops at the site of an ulcer, then it goes through the initial stages. In most cases, x-rays cannot tell cancer from an ulcer. This requires an endoscopic examination. But with the help of x-rays, it is possible to determine those who really need endoscopic examination ( FEGDS).
The diversity of cancerous tumors leads to the fact that on x-rays there are rarely cancerous tumors that look the same.

X-rays can be used to distinguish between the following types of stomach cancer:

• exophytic cancer. Protrudes into the lumen of the stomach. It looks like a deepening of the contour of the shadow of the stomach, in which there is no peristalsis. Exophytic cancer may look like a plaque ( flat spot) or polyp ( mushroom on a thin or wide base).
• Infiltrative-ulcerative ( endophytic) crayfish. With this form of cancer, part of the mucosa is destroyed, which looks like a filling defect. The contours of the defect are uneven, the folds in the area of ​​the tumor are destroyed, this area is not involved in peristalsis.
• diffuse cancer. With this form of cancer, the stomach evenly narrows due to changes within its wall. The deformation is stable, that is, the stomach does not straighten out when it is filled. To diagnose this type of cancer, it is necessary to examine a piece of tissue under a microscope.

Gastric cancer is manifested at first by loss of appetite, weight loss, aversion to meat food. Subsequently, there is pain in the upper abdomen, vomiting, bleeding. Almost the only treatment for stomach cancer is surgery to remove part of the stomach wall. In order to prevent the occurrence of malignant tumors, you need to carefully monitor the state of your body, especially for chronic diseases such as gastritis or peptic ulcer.

Benign tumors of the stomach on x-ray

Benign tumors can be of the following types:

• Epithelial. Grow in the form of polyps inside the lumen of the stomach. Their ability to be detected on x-rays depends on their size. Polyps larger than 3 mm appear as depressions in the contour of a rounded contrasting mass. In this case, one of the folds expands, while the other folds move away from it. Peristalsis is not disturbed, and the contours of this formation are even and clear.
• Non-epithelial. They are composed of muscle cells, nervous tissue, or connective tissue cells. These tumors are located inside the wall of the stomach. The mucous membrane is not changed, but the mucosal folds are smoothed and flattened. The lumen of the stomach evenly narrows by a small amount. Peristalsis is also preserved, however, with a large tumor, it may be difficult to pass food.

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X-rays play an important role in the diagnosis of various diseases. It is with the help of x-rays that one can not only diagnose, but also examine a stomach ulcer in more detail. The picture clearly shows its location, size, and deformation during progression. An x-ray of a stomach ulcer is diagnosed on it, even when there are no symptoms present. And such ulcers are very common. But, unfortunately, not a single modern equipment is able to detect a stomach ulcer during absolutely any study. And many surgeons have repeatedly proven that the diagnosis of gastric ulcer, made with the help of x-rays, is reliable in 95% of cases.

Signs of a stomach ulcer that are visible on x-rays can be divided into two groups:

- The first includes indirect signs, that is, indirect.

To the second - straight lines. It can be an ulcer niche, cicatricial formations.

X-ray of the stomach - preparation

Basically no preparation is required. But there are two recommendations that everyone must adhere to, these are:

- Since the x-ray is performed on an empty stomach, you can’t eat anything eight hours before it.

Also, do not drink alcohol, smoke or take any medication.

If the patient has a disease of the digestive tract, then he is advised to sit on a special diet for a couple of days. This also applies to older people.

As with any type of x-ray, the patient must remove all jewelry.

Symptom "niche"

During the diagnosis, the “niche” symptom is important. In the picture, it looks like an additional shadow to the outlines of the stomach itself. Its sizes vary. For example, the "niche" of the stomach differs from the duodenum in large size.

The presence of a "niche" is not present in all patients with ulcers. It depends on the location of the ulcer, size, mucosal defects. It is also affected by the method of diagnosis, the attentiveness of the radiologist and repeated examinations.

"Niche" sign on x-ray

Even when the ulcer has an impressive size, but it is filled with blood, food debris, and this does not allow it to be filled with barium, it is impossible to detect a “niche”. In addition, it is impossible to detect a “niche” if there is mucosal edema, the anatomical structure of the organ is changed, or its walls are stretched. When there is inflammation, the "niche" can be found only after it subsides.

For example, with high-lying ulcers, no "niche" can be found if the patient is examined in a standing position.

A subcardinal ulcer is diagnosed in a very careful manner. It is necessary to observe when a sip of barium occurs, at this time to slow it down a little with your hand. During this procedure, the person must be rotated. But sometimes diagnosing an ulcer is possible in the supine position.

Bulb of the duodenum with a profile niche

Sometimes, to find a pyloric ulcer, it is necessary to carefully feel the walls of the organ. Symptoms of this ulcer may be disruption of the stomach.

Antrum with relief niche

With this diagnosis, the mucosa is deformed so that it looks like a shamrock or a butterfly, sometimes a tube or a protruding pocket.

Sometimes patients on an empty stomach accumulate fluid in the stomach. If the diaphragm of the patient on the left side is high, then this is an indirect sign of an ulcer. However, this is not the only symptom; others must be present.

Contraindications for x-ray

Like any other procedure, an x-ray of a stomach ulcer has its own contraindications, these are:

- The first three months of pregnancy.

If the general condition of the patient is very severe.

The presence of bleeding in the stomach.

A contrast x-ray, that is, with the use of barium, cannot be done if the patient has an individual intolerance to barium, or is allergic to iodine.

X-ray result

The result of an x-ray is the resulting image. It can be on tape, disc or in digital format. During the x-ray procedure itself, the radiologist can see the stomach in real time on the screen. And at this time, the equipment is still taking pictures.

The picture is issued to the patient, already half an hour after the examination.

Symptoms:

b. Inflammatory shaft around the niche

c. Fold convergence

d. Symptom of contralateral retraction - "pointing finger"

X-ray semiotics of stomach cancer.

The most common and most common symptoms of advanced stomach cancer are:

1) filling defect,

2) atypical relief,

3) aperistaltic zone at the site of tumor transition.

These 3 symptoms are necessarily present in any localization of the tumor of the stomach.

Exophytic growth Endophytic growth

Filling defect

This symptom is the most characteristic and easily detected.

There are: marginal filling defect and central filling defect.

Edge filling defect it is well revealed at tight filling of body. If there is a tumor on the inner surface of a hollow organ, then its mass displaces the contrast agent from a certain volume corresponding to the size and shape of the tumor mass. This is where a filling defect occurs. The tumor gives a marginal filling defect only if the tumor is located on the wall that forms the edge of the organ. If a large tumor is located on the back or front wall of the stomach and extends partially to the edge, then it also gives a filling defect. If the tumor occupies only the anterior or posterior wall and is not edge-forming, then it does not give a filling defect, and in order to bring it to the contour, it is necessary to turn the patient.

less common central filling defect. It is more common with large tumors on the back wall of the stomach. This symptom is more reliably detected when examining a patient lying on his stomach. In this case, due to compression by body weight, this tumor will be visible. Sometimes a small tumor can be seen with local compression - symptom of "Pelota".

The symptom of a filling defect is characteristic not only for malignant tumors, but also for benign ones.

The symptom of a marginal defect is characteristic only for malignant tumors and is rarely observed in benign ones.

The contours of the defect in cancer are uneven, indistinct, as if jagged. With a rough, knobby surface of the tumor, the contours of the defect will be very uneven; with polypoid cancer and some other forms, they can be more even and smooth. In exophytic forms of cancer, it is often outlined by a more uneven and broken line, while in endophytic cancers it has relatively even contours.

Differences in the marginal defect in gastric cancer, its length give an idea of ​​the size of the tumor. Depending on the pathoanatomical form of cancer, the boundaries of the marginal defect may be more or less pronounced. If the tumor is well demarcated, then a step (corner, ledge) appears between the edge of the defect and the adjacent unchanged wall - "Gaudeck step". With flat-infiltrating tumors, this angle can be very obtuse, barely noticeable. With nodular tumors, it is straight or even sharp, with an undermined edge (a symptom of undermining). Usually determine the length and depth of the defect. flat defect filling is usually observed in endophytic, flat-infiltrating forms of cancer. Sometimes, even with an extensive lesion of the stomach, the defect may go unnoticed due to its negligible depth. In these cases, pay attention to the fuzziness and blurring of the contour, its jaggedness. When translucent, these signs go unnoticed. In the diagnosis of a flat defect, it matters symptom of a flat concave arch ("sickle defect"). The arcs along the contour are convex outwards. The exceptions are the contours of lesser and greater curvature in the subcardial part of the stomach, where often both of these contours are represented by slightly concave arcs. A flat filling defect in cancer is also more often formed by a flat, slightly concave arch, which differs from the rest of the gastric arches. The tumor gradually sprouts not only the length, but also its walls around the circumference. This is observed more often in tumors of mixed morphological structure.

Symptom of a circular filling defect with continuous germination of the tumor, with exophytic forms of cancer, most often in the antrum of the stomach. At the same time, it is observed symptom of persistent narrowing of the lumen. Moreover, in the antrum, the narrowing can be so significant that it looks like a narrow, tortuous canal or tube. Sometimes referred to as the "cancer tunnel". Rarely, this symptom can be observed in the middle or lower third of the body of the stomach. Then the stomach (with an ulcer) has the shape of an hourglass. The narrowing is asymmetrical and adjacent to the lesser curvature, while the narrowing due to cancer is always more or less symmetrical, due to a marginal defect on the lesser and greater curvature.

Marginal defect in cancer and a symptom of persistent retraction of the contour of a spastic or cicatricial nature. More often, spastic retraction is observed in the antrum on the greater curvature with peptic ulcer. It is easy to distinguish this retraction from a filling defect. The retraction contours are always smooth, smooth transitions to neighboring sections of the stomach wall. The depth of cicatricial retraction is always greater than the length. With cancer, the opposite is true: the length is greater than the depth.

Change in the shape of the stomach. In flat-infiltrating forms, when the defect itself is not visible or not conspicuous, in the x-ray picture it differs from one or another part of the stomach, it is associated with a tumor.

Deformation of the stomach is an x-ray symptom of stomach cancer. Stomach in shape hourglass, cochlear stomach shortening of the entire lesser curvature.

Extension of the angle of the lesser curvature of the stomach associated with infiltration of the lesser curvature of the stomach and due to its straightening and the disappearance of the angle. It almost always occurs in flat-infiltrating tumors of the stomach.

symptom is important atypical relief. With cancer, there is no longer a mucous membrane in the stomach, and the visibility of the relief is the surface of the tumor. The relief picture in this case can be very polymorphic. The main element of the atypical relief is relief defect. In accordance with this site, reflecting the tumor node, towering above the mucosa, there is an area devoid of folds. The barium mixture flows around this area. More often this defect has an irregular shape, indefinite vague outlines. Most often, this defect is not one, but several of them, they merge and display the bumpy surface of a cancerous tumor, in some places barium lingers in ulcerations. This picture is observed in exophytically growing tumors - these are indistinctly defined areas, barely perceptibly rising above the level of the surrounding mucosa. Sometimes they are visible in the form of expanded, thickened folds. Between them are delimited defects. A typical sign of the relief of a cancerous tumor, regardless of location, is persistent barium stain due to ulceration of the tumor. The disintegration of the tumor is more often observed when the tumor is localized in the body and antrum of the stomach. The boundaries of the atypical relief in cancerous lesions are not so pronounced. With exophytic cancer, the boundaries of the atypical relief are more distinct. With endophytic - atypical relief imperceptibly passes into a normal relief.

Symptom of broken folds- boundary of atypical relief. With flat-infiltrating tumors, this can be expressed in the breakage of only one or two folds running along the lesser curvature of the stomach.

Relief rigidity- invariability of the relief of the gastric mucosa. The relief pattern in all cases depends on the amount of barium suspension introduced and compression. An excess of barium or insufficient compression can distort the picture of pathological changes. A cancerous tumor in the process of its development germinates the submucosa, infiltrates the muscle. The wall becomes unyielding, rigid, loses the ability to peristaltize. Arises aperistaltic zone corresponding to the spread of the tumor. This symptom acquires the greatest significance in flat-infiltrating, endophytic cancer, when the filling defect is hardly noticeable. In these cases, the aperistaltic zone may become the leading symptom. In order to get a symptom of the aperistaltic zone, it is necessary that the tumor be edge-forming. Limited lesions on the anterior and posterior walls that do not reach a large or small curvature may not be detected at all using this method. The upper third of the stomach and subcardiac calving, the fornix of the stomach is even less favorable for the detection of this symptom. In the upper sections, peristalsis is either completely absent or very weakly expressed, so it cannot be registered. As a stimulant - prozerin 1.0 ml - 0.05% solution subcutaneously, 5 - 10 minutes after the injection, they look. Prozerin increases the tone of the stomach, increases the amplitude of contractions without accelerating the rhythm.

Under the influence of morphine, the tone of the stomach changes, peristalsis becomes deeper, and the pattern of the mucous membrane changes, especially in the antrum. Therefore, if there are diagnostic difficulties, then using morphine, you can see changes in the mucosa, and this will speak against cancer.

The most reliable x-ray symptom of an ulcer (direct sign) is an ulcer niche, which is visible as a protrusion of the contour of the stomach in a tangential position. When transilluminated en face, the niche is revealed as a persistent contrasting spot.

Approximately 85% of ulcerative niches are located on the lesser curvature of the stomach. The remaining 15% are ulcers of greater curvature (localization in the horizontal part is especially suspicious for cancer), ulcers of the posterior wall (especially in the elderly, the leading clinical symptom is back pain), ulcers in the pylorus. A niche symptom can also be observed in gastric cancer.

Indirect signs of an ulcer include:

a) spastic retraction on the opposite wall of the stomach. This retraction, referred to as a symptom of the index finger, is not unconditionally conclusive for an ulcer, since it can also be observed in adhesive processes of various origins. When the ulcer heals, an hourglass pattern may occur due to cicatricial wrinkling of the lesser curvature and spastic retraction of the greater;

b) the study of the relief of the gastric mucosa sometimes reveals mucosal folds concentrically going to the ulcer;

d) with a chronic ulcer of the lesser curvature, retraction of the lesser curvature and the resulting displacement of the pylorus to the left are noted.

X-ray definition of a stomach ulcer

In the diagnosis of peptic ulcer, the radiological method plays a significant role. Modern equipment and research methods allow an experienced radiologist to establish reliable signs of peptic ulcer in 90-95% of cases. Equally important is the dynamic study of the ulcerative process. At the same time, it should be emphasized that the statement of only morphological changes should not be the only basis on which the clinical diagnosis of peptic ulcer is based, because such forms and such localization of ulcers are known in which an X-ray diagnostic study may be untenable.

There are direct and indirect radiological signs of peptic ulcer disease. The main direct sign is a "niche" - an x-ray display of ulcerative pathomorphological changes in the stomach wall.

"Niche" usually appears as a small protrusion or bulge on the contour of the shadow of the stomach or as a persistent "contrast spot" on the mucosal relief ("niche relief"). In both cases, its image is due to the ingress of a contrasting suspension into the ulcer crater. The size and shape of the latter can be different, and therefore, respectively, quite diverse shapes and sizes of the "niche" are distinguished in the radiological display. Reactive inflammatory changes around the ulcer, reflex spasm of the muscles cause the presence around the "niche" of a circular, sometimes scalloped or labial ("niche on the contour") filling defect, the so-called inflammatory shaft. Sometimes the latter can be so pronounced that it closes the entrance to the crater and the "niche" is not detected radiographically, since the contrast mass does not penetrate into the defect in the stomach wall. Negative X-ray data can also be obtained in cases where the ulcerative crater is filled with a blood clot, mucus, etc. relief. Targeted shots are a valuable auxiliary method here. Due to the anatomical conditions, the most difficult is the radiodiagnosis of ulcers located in the cardial and subcardial sections of the stomach.

The long-term chronic course of peptic ulcer leads to the fact that the mucosa around the ulcer undergoes a number of changes leading to cicatricial processes, to wrinkling, as a result of which radial convergence of folds can be detected radiographically around the "niche". The cone-shaped, pointed shape of the "niche" is more common in fresh ulcers, irregular with a flat bottom and the presence of convergence - chronic callous. A penetrating ulcer is large, deep, often three-layered (barium, liquid, air), motionless on palpation and fixed on displacement. In a penetrating ulcer, barium can linger for a long time. The appearance of polygonal contours in a chronic flat "niche" with rigid walls may be due to malignancy of the ulcer.

The statement of the so-called indirect, functional signs of peptic ulcer is an important reinforcing, and often a decisive factor in the diagnosis of ulcerative changes in the stomach. In this case, changes in the motor activity of the stomach are manifested, on the one hand, by increased, deep, sometimes segmenting peristalsis, and on the other hand, by its absence at the site of the localization of the ulcer in a limited area (the latter symptom is also observed in some other diseases). In addition, there is an increase in muscle tone, a local spasm of the circulatory muscles in the form of a different magnitude of persistent retraction of the stomach wall on the greater curvature against an ulcer located on the lesser curvature (“pointing finger symptom”). A similar retraction can sometimes be observed in hysteria and neuroses. Peptic ulcer is also characterized by the presence of a hypersecretory intermediary layer, spasm of the pylorus and delayed emptying - more often with localization of ulcers in the antrum, sometimes gaping of the pylorus and accelerated emptying, concomitant gastritis, the presence of a strictly localized tender point.

It should be noted that none of the indirect signs in itself can be decisive, especially since many of them can also occur in other diseases. Only a combination of several of them in the presence of a certain clinical picture can become the basis for the diagnosis of peptic ulcer.

X-ray examination is also important for the diagnosis of complicated peptic ulcer. The most formidable complications are ulcer perforation and bleeding. A reliable symptom of perforation is the presence of free gas in the abdominal cavity. If the patient lies on his back, free gas accumulates over the liver and loops of intestines under the anterior abdominal wall. Sometimes, if this does not detect gas in the abdominal cavity, the patient should be carefully examined in an upright position, when gas is collected under the dome of the diaphragm.

If earlier it was believed that X-ray examination after bleeding from the upper digestive tract can be carried out no earlier than 5-6 weeks later, these periods were reduced to 10-14 days, and recently X-ray examination is sometimes performed in the first hours after bleeding. The use of contrast agents for the study of the digestive tract in the first 24 hours after massive bleeding is contraindicated. Only serious, strictly justified indications can serve as a basis for careful X-ray examination 2 days or more after bleeding.

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:

1. Food poisoning with toxins (salmonellosis) - can often occur during the hot season.
2. Eating poor-quality food, such as expired or poorly cooked foods.
3. Eating food that can injure the gastric mucosa.
4. Taking certain medications that can damage the stomach lining.
5. 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 flow:

1. 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.
2. 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, curving, 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:

1. Normalization of the Ph level for further processing of the contents in the intestine.
2. Participates in the regulation of the amount of pancreatic enzymes and gastric juice.
3. Participates in the processes of opening / closing of the pyloric part of the stomach.
4. 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 clarified: 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 regarding 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:

1. The presence of antibodies to Helicobacter pylori (HP) in the patient's blood serum.
2. 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.
3. 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.
4. Fibrogastroduodenoscopy. With the help of a fiberscope, the location of the ulcer, its size, and complications are determined.
5. 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:

1. Diet.
2. Antibiotic therapy as recommended. Three or four component circuits. New generation schemes.
3. Surgical treatment according to indications.
4. 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, which 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

1. 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.
2. Electrophoresis. Drugs that relieve spasmolytic pain (drotaverine, papaverine) are used. When taking the solution orally, galvanic currents are applied.
3. Magnetotherapy.
4. Hydrotherapy.
5. Oxygen therapy.
6. Hyperbaric oxygenation.

Prevention of the onset of the disease

Helicobacter pylori must be prevented. Need:

1. Use an exceptionally clean plate, spoon, mug.
2. 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.
3. 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

1. Which doctor should deal with the treatment of peptic ulcer? Answer: therapist or gastroenterologist.
2. Can peptic ulcer of the stomach and duodenum be cured? Answer: yes, absolutely.
3. Is the disease inherited? Answer: no, the disease is not transmitted, only a predisposition to the disease.
4. Can peptic ulcer of the stomach and duodenum be found in one patient? Answer: this happens.
5. 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.
6. 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.
7. Is bleeding from gastric and duodenal ulcers treated? Answer: hemostatic preparations and surgical suturing of the wound.
8. 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.
9. 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.
10. 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.
11. What are the symptoms and treatment of the disease? Answer: described in the article above. Methods include: diet, antibiotic therapy, surgical treatment of complications.
12. Which diseases are similar to duodenal ulcer? Answer: peptic ulcer of other localizations, gastritis, enteritis.
13. 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.
14. Are diseases of the stomach and intestines capable of becoming cancerous? Answer: ulcer malignancy is possible, polyps are also malignant.
15. 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