Stomach ulcer tiredness: Stomach ulcer – Complications – NHS
Stomach ulcer – Complications – NHS
Complications of stomach ulcers are relatively uncommon, but they can be very serious if they do occur.
Internal bleeding is the most common complication of stomach ulcers. It can occur when an ulcer develops at the site of a blood vessel.
The bleeding can either be:
You should visit your GP if you have persistent symptoms of anaemia. If they think you may have a stomach ulcer, they may refer you to a gastroenterologist for an examination and treatment.
Contact your GP or NHS 111 immediately, or go to your nearest accident and emergency (A&E) department, if you have symptoms of more severe bleeding.
An endoscopy will be used to identify the cause of the bleeding and treatment can be given during the endoscopy to stop the bleeding.
Sometimes specialised procedures carried out under X-ray guidance are used to stop bleeding ulcers, although surgery may occasionally be required to repair the affected blood vessel.
Blood transfusions may also be needed to replace the blood you have lost.
A rarer complication of stomach ulcers is the lining of the stomach splitting open, known as perforation.
This can be very serious because it enables the bacteria that live in your stomach to escape and infect the lining of your abdomen (peritoneum). This is known as peritonitis.
In peritonitis, an infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure and can be fatal if left untreated.
The most common symptom of peritonitis is sudden abdominal pain that gets steadily worse.
If you have this type of pain, contact your GP immediately. If this isn’t possible, call NHS 111 or your local out-of-hours service.
Peritonitis is a medical emergency that requires hospital admission. In some cases, surgery may be needed.
Read more about treating peritonitis.
Gastric outlet obstruction
In some cases, an inflamed (swollen) or scarred stomach ulcer can obstruct the normal passage of food through your digestive system. This is known as gastric outlet obstruction.
Symptoms can include:
- repeated episodes of vomiting, with large amounts of vomit that contain undigested food
- a persistent feeling of bloating or fullness
- feeling very full after eating less food than usual
- unexplained weight loss
An endoscopy can be used to confirm the obstruction. If the obstruction is caused by inflammation, proton pump inhibitors (PPIs) or h3-receptor antagonists can be used to reduce stomach acid levels until the swelling goes down.
If the obstruction is caused by scar tissue, surgery may be needed to treat it, although it can sometimes be treated by passing a small balloon through an endoscope and inflating it to widen the site of the obstruction.
Page last reviewed: 17 September 2018
Next review due: 17 September 2021
Oz’s Reasons You’re Tired and Cures for Fatigue
Has your energy level been low? Have you felt exhausted, despite regulating your sleep and stress? If so, you’re not alone. Nearly one-third of US primary care patients report significant fatigue, accounting for 7 million office visits every year. Learn four surprising reasons that could account for your exhaustion, along with Dr. Oz’s unusual—but effective—cures. Of course, if your energy level is unusually low, get your blood checked by your physician.
Bad Bacteria in Your Gut Prevent Deep Sleep
Two-thirds of the world’s population—over 4.5 billion people—have bad bacteria known as H. Pylori living in their stomach. This harmful bacteria can be a major source of fatigue. Your stomach’s inner lining produces acid to digest food, while simultaneously creating protective mucus to guard from this acid. H. pylori bacteria invade the stomach, destroying your protective mucus layer and leaving you vulnerable to ulcers, or tiny sores on the stomach’s lining. While you sleep, acid can escape the stomach through these ulcers and flow up into your esophagus, causing a sore throat and ruining your ability to get deep, restorative sleep. Additionally, as blood escapes from the ulcers, it may cause anemia, further lowering your energy throughout the day.
Fortunately, H. Pylori infection is easy to detect and treat. A simple breath test from your doctor will detect the bacteria. Antibiotics can kill the bad bacteria and acid-reducing medications will treat the ulcers. You can also try taking antacids before bed; if they seem to lead to a better night’s sleep, it may indicate the presence of H. Pylori.
Phlegm Build-Up May Clog Airways
Healthy breathing draws oxygen through your nose and down to your lungs, giving your body the energy it needs. But as you sleep, phlegm can build up in the back of your throat, blocking the passage of oxygen from the nose to the lungs. You may compensate by breathing through the mouth, but a recent study shows that doing so is correlated to a significantly lower blood-oxygen level, which can lead to fatigue. Gargling every morning, whether with mouthwash or salt water, can help clear the throat’s phlegm, allowing more oxygen to reach the lungs which boosts your energy.
Next: The coffee conundrum
Peptic Ulcer Symptoms
Peptic ulcers are sores within the lining of the stomach, upper region of the small intestine (duodenum), or sometimes the esophagus. Peptic ulcers are most commonly caused by infection with the Helicobacter pylori bacteria, which secrete a substance that irritates and damages the protective mucous layer of the stomach and small intestine. It is estimated that up to two-thirds of the world’s population is infected with the H. pylori bacteria. Peptic ulcers can also be caused by overuse of non-steroidal anti-inflammatory drugs (NSAIDS), which are commonly taken for pain and to reduce inflammation. The two most common symptoms associated with peptic ulcers are pain and bleeding.
The most common symptom experienced by sufferers of peptic ulcers is abdominal pain, which occurs from the ulcer itself and from when cells of the inner gastric lining come into direct contact with stomach acid. The pain can be located anywhere between the navel and breastbone, and it can last from a few minutes to a few hours. The incidents of pain can come and go over the course of several days or weeks. When the peptic ulcer is located in the duodenum, the abdominal pain typically occurs two to three hours after a meal and may indicate a gastric blockage. Some patients with peptic ulcers find that the pain is worse when the stomach is empty, especially late at night. This could be because certain foods act as a buffering system that neutralizes stomach acid or coat the inner stomach and duodenal lining, preventing acid from reaching the exposed underlying cells. In other cases, eating certain foods can make the patient’s pain feel worse. Although it is now known that spicy foods do not directly cause ulcers, these types of foods can exacerbate the pain associated with an existing ulcer.
Some patients with peptic ulcers experience no pain at all and may be completely unaware of the presence of an ulcer until more serious symptoms arise.
Another common symptom of peptic ulcers is bleeding (ulcer-associated hemorrhaging). Untreated or asymptomatic ulcers may be more likely to bleed because longer-lasting ulcers may inflict greater damage to the gastric lining. A slow-bleeding ulcer can result in the patient finding blood in their stool, which may appear reddish or black in color. Greater quantities of blood can cause melena, which is jet-black stool with a tar-like consistency. Patients with a slow hemorrhage may also find blood in their vomit, with the partially digested blood resembling coffee grinds. In some cases, the bleeding caused by an ulcer is so slow that it goes unnoticed by the patient until that patient becomes anemic. Symptoms of anemia include fatigue, weakness, and shortness of breath.
In severe cases, the ulcer itself can perforate the stomach or intestinal wall. This results in rapid hemorrhaging into the abdominal cavity and is a serious medical emergency requiring immediate attention.
Other, less common, symptoms of peptic ulcers include nausea, vomiting, loss of appetite, bloating or a feeling of fullness, and weight loss.
Causes of Abdominal Pain and Fatigue
Image Credit: ake1150sb/iStock/GettyImages
Abdominal pain accompanies a host of short- and long-term medical conditions, some more serious than others. Most directly involve the digestive system. The presence of fatigue along with abdominal pain helps narrow the list of possible culprits. In general, fatigue accompanying abdominal pain might occur as a primary symptom of the underlying medical condition, result from malnutrition or both.
Infectious gastroenteritis describes inflammation of the lining of the stomach and small intestines caused by a viral, bacterial or parasitic infection or preformed toxins present in food. Also known as a foodborne illness or food poisoning, typical symptoms of infectious gastroenteritis include crampy abdominal pain, diarrhea and possibly nausea and vomiting as well as fatigue. Leading causes, such as norovirus and staph food poisoning, usually clear up within 1 to 3 days. Other culprits, such as Campylobacter jejuni and Cryptosporidium, often cause more protracted diarrhea with ongoing fatigue and possibly weight loss.
Inflammatory Bowel Disease
Inflammatory bowel disease includes ulcerative colitis and Crohn disease. These chronic conditions are characterized by ongoing inflammation of the digestive tract, usually with episodic symptom flareups. Inflammation can occur anywhere in the digestive tract with Crohn disease but is limited to the large bowel and rectum with ulcerative colitis. Abdominal pain and fatigue characterize both types of inflammatory bowel disease, particularly during flareups. Other symptoms might include bloody and/or mucousy stool, poor appetite, fever and weight loss.
Bleeding Peptic Ulcer
With peptic ulcer disease, areas of the lining of the stomach or first part of the small bowel undergo erosion and form ulcers. This usually occurs due to infection with Helicobacter pylori bacteria or use of nonsteroidal anti-inflammatory medicines, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve) or celecoxib (Celebrex). Ulcers frequently cause gnawing or burning pain in the upper abdomen, although many people experience no pain. Fatigue can develop due to slow bleeding from peptic ulcers, eventually leading to anemia. Other possible symptoms include bloating, nausea and decreased appetite.
The pancreas produces blood-sugar-regulating hormones as well as digestive enzymes that empty into the small intestine. With inflammation of the pancreas, or pancreatitis, production of these digestive enzymes substantially decreases leading to reduced breakdown and absorption of food nutrients. Characteristic symptoms include boring pain the central area of the upper abdomen along with fatigue, nausea, vomiting and greasy stools. Pancreatitis most frequently develops as a complication of gallbladder disease or excessive alcohol use. Tumors of the pancreas can also cause symptoms similar to pancreatitis.
Many other conditions can trigger abdominal pain, which might be accompanied by fatigue — although other coexisting signs and symptoms tend to be more prominent or common. Examples include:
- Kidney infection (pyelonephritis)
- Diverticulitis, an inflammatory condition of the colon
- Liver inflammation (hepatitis)
- Abdominal or pelvic cancer
- Heart disease
- Pelvic inflammatory disease (PID)
- Sickle cell crisis
Warnings and Precautions
Abdominal pain and fatigue accompanied by diarrhea and lasting only a few days usually represents a foodborne illness, which generally does not require medical care. If your belly pain and fatigue persist for longer than a week, see your doctor. Seek immediate medical care if you experience any warning signs or symptoms, including:
- Severe or worsening abdominal pain
- Vomiting blood or material that resembles coffee grounds
- Passing bloody or maroon stool
- Fever, chills or clammy skin
- Shortness of breath or difficulty breathing
- Lightheadedness, dizziness or fainting
A peptic ulcer is an open sore in the lining of the stomach. It may also occur in the first part of the small intestine (duodenum).
The most common causes of ulcers are:
H. pylori bacteria infection
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen
Other factors that can increase the risk for ulcers include older age and family history of peptic ulcers, and use of certain medicines. Tobacco and alcohol use are also risk factors. Emotional stress, worry, and spicy foods don’t cause peptic ulcers.
A peptic ulcer may or may not cause symptoms. If symptoms do occur, they can include:
Dull or burning pain anywhere between your belly button and breastbone
Loss of appetite
Heartburn or upset stomach
Nausea or vomiting. Vomit may be bloody or look like coffee grounds.
Black, tarry, or bloody stools (which means the ulcer is bleeding)
Sometimes the bleeding is not seen. In these cases, it may be discovered by symptoms of low blood count (anemia) such as dizziness, weakness, shortness of breath, pale skin, trouble with exercise, or a blood test.
If an ulcer is suspected, your healthcare provider may check for H. pylori infection. To do this, you may have blood, stool, or breath tests. Upper endoscopy (EGD) is usually done to check for ulcers and take samples (biopsies) to be evaluated under the microscope. An X-ray test called an upper GI series can be done in some cases, but it could miss small ulcers that would be seen on the upper endoscopy.
Without treatment, a peptic ulcer may worsen. This can lead to serious problems such as bleeding, blockage, or a hole (perforation) in the stomach or duodenum. Treatment is needed to prevent these problems.
Medicines are the most common treatment for peptic ulcers. In severe cases, surgery may be needed.
If you’re prescribed medicines, be sure to take them as directed. Common medicines prescribed include:
Antibiotics. These kill H. pylori bacteria. In many cases, you’ll need to take at least 2 types of antibiotics. The regimens can be complicated and require many medicines either at once, or taken in order. This is because this bacteria is often hard to treat. It’s very important to take the medicines as prescribed.
Proton pump inhibitors. These block your stomach from making any acid.
h3 blockers. These reduce the amount of acid your stomach makes. These are sometimes used for duodenal ulcers.
Bismuth subsalicylate. This helps protect the lining of your stomach and duodenum from acid.
Don’t take any NSAIDS such as aspirin, ibuprofen, or naproxen without talking with your healthcare provider first. They may delay healing. Also check with your healthcare provider before taking any antacids.
Don’t use alcohol or tobacco. These may delay healing. They may also make symptoms worse.
Follow up with your healthcare provider as directed. If testing was done, you’ll be told the results when they are ready. In some cases of gastric ulcer, a repeat upper endoscopy is needed to check for healing. Your healthcare provider may also do a test of cure after treatment for H. pylori.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
Fever of 100. 4°F (38°C) or higher, or as directed by your healthcare provider
Stomach pain that worsens or moves to the lower right part of abdomen
Continued weight loss
Weakness or dizziness
Shortness of breath
Frequent vomiting, blood in your vomit, or coffee ground-like substance in your vomit
Black, tarry, or bloody stools
Call 911 right away if any of these occur:
Sudden or severe pain in the stomach region
Stomach becomes rigid
Low body temperature
Unusually fast heart rate
Chest pain appears or worsens, or spreads to the back, neck, shoulder, or arm
Trouble breathing or swallowing
Extreme drowsiness or trouble waking up
Large amounts of blood in the vomit or stool
10 Most Common Symptoms of Gastritis
Gastritis is the inflammation of stomach lining most widely caused by the bacteria called Helicobacter Pylori. This is a kind of weakness in the stomach lining that allows digestive juices to damage and inflame. Having a thin or damaged stomach lining raises the risk for gastritis. Gastritis is one of the perilous problems that can create a significant impact in an individuals daily life. Since the stomach lining gets thin with age, people above 60 years are more likely get affected with the infection.
Gastritis can be acute (occurs for a short period of time) or chronic (long-lasting) depending upon the causes and its intensity. Here are the 10 most common symptoms of Gastritis that should not be neglected.
1. Frequent Stomach upset
It’s a sensation of uneasiness and discomfort in the upper stomach caused by indigestion. There are plenty of reasons for stomach upset but it’s not a good sign when you are facing it on a regular basis. Perhaps, you may be at the verge of Gastritis.
2. Abdominal Pain
Abdominal Pain is the distress caused in the region below the ribs and above the pelvis. Abdomen includes intestines, appendix, stomach, liver, kidneys, gall bladder, and pancreas. Pain might possibly result into serious illness in the long-run.
Vomiting blood is a serious symptom of Gastritis and you should see your doctor immediately. Depending upon the severity, it may be blood-streaked or fully bloody. It is usually caused because of the erosion of stomach lining as the result of inflammation.
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Loose or watery stools about 4-5 times a day is not normal. Look for bloody and extremely foul- smelling, black tarry bowel movements. If ignored, Diarrhea makes us feel really sick. During this phase, H.Pylori bacteria will obstruct stomach and intestinal tract’s regular functions.
Belching is the other word of burping where stomach expels excess air from the mouth to reduce the tightness. If burping continues for long time after every meal and doesn’t releases the sensation of fullness in stomach, seek out medical help immediately.
Bloating is the feeling of swelling in the abdomen region. It is often accompanied by severe pain caused by the air and gas filled in the digestive tract. Prolonged bloating can interfere and disrupts the digestive system.
7. Early Satiety
Early Satiety is the lack of ability to eat a complete normal-sized meal. During this phase, we eat very less than usual and feel full very soon. This may also result into weakness as we are not providing the body with sufficient calories.
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8. Loss Appetite
Medically called as Anorexia, loss of appetite can cause sudden weight loss and malnutrition. Generally there will be a vomiting sensation after eating. It will interrupt the food processing cycle and can cause muscle atrophy.
9. Feeling Faint
People faint when they don’t get enough oxygen to the brain. We lose consciousness for a short period, feel dizzy and weak. In Gastritis, feeling faint is accompanied with nausea, burning in stomach and tiredness.
Increased stomach inflammation and hovering anxiety can increase the blood pressure. Heart rate of more than 100 BPM is considered to be rapid among the adults. Shortness of breath, palpitations and chest pain are the other signs to watch out for.
Though in the initial stages, the symptoms of gastritis and problems seem to be very trivial but it may lead to severe health issues. If left untreated, Gastritis may result into ulcers, stomach bleeding or stomach cancer. During this age of advance technology and high-end medical facilities we should not take any chances. Gastritis is 100% curable, all you need to do is undergo proper diagnostics and follow the prescribed medication.
In the recent times, it is reported that Gastritis is growing at an exponential rate especially in Indian sub-continent. Reducing alcohol consumption, avoiding spicy foods and being aware of symptoms are few factors that can help prevent Gastritis.
Recurrently if you notice any such symptoms of gastritis and not so sure what’s wrong, it’s time to see your Gastroenterologist.
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In case you have any queries, you can leave your message in the comment section below and we will reply back at the earliest possible. Get aware and make aware. Spread the word and share this article amongst your friends, family and well-wishers.
Read more about Gastritis symptoms, causes and treatment
If you find any of the above mentioned Symptoms of Gastritis then
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Gastritis, Peptic Ulcer Disease, and Helicobacter pylori
Urgent message: Gastritis and peptic ulcer disease are a spectrum of diseases that can range from mild to serious; urgent care providers must be on the alert for these conditions. Early diagnosis and treatment, along with recommendations for follow-up care with appropriate specialists, can help prevent long-term sequelae.
TRACEY Q. DAVIDOFF, MD
Gastritis and peptic ulcer disease (PUD) represent a continuum along a path of inflammation of the gastric mucosa, from superficial irritation of the stomach lining to full-blown ulceration with perforation or penetration. They are caused by varying degrees of disruption of the aggressive and defensive factors that maintain the integrity of the mucosa. Aggressive factors include gastric acid and pepsin, and defensive factors include mucus and bicarbonate. For the urgent care practitioner, it is imperative to recognize the alarm symptoms that may represent more serious disease progression. Identifying patients who are less ill and may benefit from treatment, starting that treatment, and suggesting appropriate follow-up measures are the keys to urgent care management of these conditions.
The term gastritis encompasses a broad spectrum of entities caused by inflammatory changes in the gastric mucosa. The clinical presentation is similar for many of them, but it differs histologically when samples of inflamed tissue are viewed under the microscope. The inflammation may involve the entire stomach or only specific regions. Gastritis may be erosive (superficial, deep, or hemorrhagic) or non-erosive; the latter type is mostly caused by infection with Helicobacter pylori.
Gastritis is common in the United States, accounting for approximately 2 million physician visits annually. Patients older than 60 years are more likely than younger patients to have gastritis. The disease affects all age groups and both sexes. Although patients with H. pylori are more
likely to have gastritis, not all patients with gastritis will have positive test findings for H. pylori.1
Many factors can cause erosive gastritis (Table 1), although nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are the most common agents. Both oral and systemic administration of these drugs at any dosage, either therapeutic or supratherapeutic, may cause gastritis. The gastric mucosa exhibits hemorrhages, erosions, and ulcerations when viewed on endoscopy.
Long-term effects include fibrosis and stricture.
|Table 1. Causes of Gastritis|
|Data from Soll AH, Vakil NB. Unusual causes of peptic ulcer disease. Waltham (MA):
Wolters Kluwer Health, UpToDate. © 2015 [updated 2014 June 11; cited 2015 January].
Available from: http://www.uptodate.com/contents/unusual-causes-of-peptic-ulcerdisease?
source=search_result&search=peptic+ulcer+disease&selectedTitle=6~150, and from Wehbi M. Acute gastritis. New York (NY): WebMD Health Professional Network, Medscape. © 2015 [updated 2014 September 18; cited 2015 January 8].
Available from: http://emedicine.medscape.com/article/175909-overview.
NSAID = nonsteroidal anti-inflammatory drug; SSRI = selective serotonin reuptake
The effect of H. pylori results from chronic rather than acute infection. It is usually acquired in childhood, and the percentage of infected individuals increases with age. It is found in 20% of those younger than 40 years with gastritis or PUD and in 50% of those older than 60 years. Transmission is thought to be from person to person through the oral–fecal route or through the ingestion of contaminated water or food. This explains the increased prevalence in lower socioeconomic groups. H. pylori infection is asymptomatic unless the patient has developed gastritis or PUD.
The acute symptoms of uncomplicated gastritis include abdominal pain, epigastric discomfort, nausea, vomiting, loss of appetite, belching, and bloating. Fever, chills, and hiccups may also be present. Symptoms may be indistinguishable from peptic ulcer disease, and no specific symptom makes one more likely than the other.2 Oddly enough, however, most patients with histologic evidence of acute gastritis are asymptomatic.1 The diagnosis is frequently made during endoscopy that is being performed for other indications.
History of Present Illness
In obtaining a thorough history of the current illness, ask about the following:
- Gnawing or burning epigastric discomfort that may be described as aching, as a hungry feeling, or as an empty feeling
- Nausea and/or vomiting
- Pain that awakens the patient at night
- Symptoms relief achieved with food, milk, or antacids
- Specific food intolerances, although no specific food is pathognomonic
- Previous history of gastritis, PUD, or H. pylori
- History of eating raw fish
- Exposure to aggravating drugs or chemicals such as NSAIDs or steroids, even a single dose
- Routine use of aspirin or NSAIDs
- Alcohol use, which may cause gastritis, generally considered a separate disease process (beyond the scope of this article)
- Alarm symptoms signifying more serious disease; these are the same as for peptic ulcer disease (Table 2)
Be aware of the following points when conducting a physical examination:
- Normal findings are most likely
- Mild midepigastric abdominal tenderness
- More abnormalities may develop if the patient develops complications such as gastrointestinal (GI) bleeding, perforation, and penetration.
- Alarm findings on examination
- GI bleeding or heme-positive stools
- Severe abdominal tenderness, rebound, guarding, or other signs of acute abdomen
Differential Diagnoses for Both Gastritis and
Peptic Ulcer Disease
Gastritis and PUD can be mistaken for quite a few entities:
- Irritable bowel disorder
- Crohn disease
- Gastric cancer
- Viral gastroenteritis
No work-up may be necessary in the urgent care center if the provider has a high index of suspicion and no alarm symptoms are present (Table 2). In the acutely ill patient, it may be helpful to rule out other disease processes with a complete blood count, liver and kidney function tests, amylase and lipase tests, pregnancy test, and stool test for occult blood. Tests for H. pylori (see the section “Testing for Helicobacter pylori”) may be indicated. Radiographic studies are generally not useful in an urgent care center unless it is suspected that the patient has a perforation. In that case, an upright chest radiograph will suffice to document the presence or absence of free air. Barium radiography may be of use diagnostically but should generally be ordered by the primary-care physician or gastroenterologist. The American Society for Gastrointestinal Endoscopy guidelines recommend endoscopy for patients older than 50 years with suspected gastritis or PUD with alarm features, such as weight loss and anemia (Table 2). Endoscopy should be considered in symptomatic patients who have negative findings for H. pylori, regardless of age.
Treatment of gastritis alone is strictly supportive, unless the disease is caused by H. pylori.4
NSAIDs, if being used, should be discontinued. When H. pylori is present, the patient should be treated for it. Fluids and electrolytes should be replaced if the patient is dehydrated, vomiting, and/or unable to take fluids by mouth. Acid blocking either with h3-blockers or proton pump inhibitors (PPIs) may be of benefit in patients in whom it is difficult to treat H. pylori, or in those patients suspected of having PUD.
h3-blockers provide competitive inhibition of histamine at the histamine-2 (h3) receptor, thereby decreasing gastric acid secretion. This effect suppresses basal gastric acid output as well as acid output stimulated by food and the neurologic system.
PPIs inhibit the proton (acid) pump in the secretory membrane of the parietal cells, thus completely inhibiting acid secretion. They have a long duration of action and are the most effective acid blockers. If cost is a concern, it is helpful to know that PPIs are more expensive than h3-blockers.
Practitioners should be aware that there is growing concern over the interaction between PPIs and clopidogrel and other antiplatelet agents. A decrease in the antiplatelet activity and increase in adverse cardiac events is possible because of an interaction between these 2 classes of drugs. Pantoprazole seems to be the safest choice in these cases.1 Consultation with the patient’s cardiologist is necessary if treatment with a PPI is unavoidable, as would be the case for a patient with gastritis with newly placed cardiac stents.
Peptic Ulcer Disease
PUD occurs most commonly in the stomach and proximal duodenum, and less commonly in the lower esophagus, distal duodenum, and jejunum. It is more common in patients with hyper secretory states such as Zollinger-Ellison syndrome, in patients with hiatal hernias, and in areas of ectopic gastric mucosa such as Meckel diverticulum. Approximately 500,000 persons in the United States are affected with PUD annually, and 70% of them are between the ages of 25 and 64 years. The direct and indirect health-care costs total over $10 billion annually. Fortunately the incidence is declining, likely due to the increased use of PPIs and the decreasing rate of H. pylori infection.3 Improving American diets and the decreasing incidence of smoking may also play a role.
Untreated ulcers may heal spontaneously, and then may recur within a few months. Some are highly symptomatic, and some are asymptomatic. Some ulcers are prone to complications, and some remain refractory to treatment. Prior ulcer history tends to predict future behavior.
More than 48% of cases of PUD can be related to H. pylori infection, and 24% of the remaining cases can be related to NSAID use. Other less common causes include steroids, bisphosphonates, 5-flourourocil, stress, and malignancy. Comorbidities that increase the incidence of PUD include cytomegalovirus or tuberculosis, Crohn disease, cirrhosis, chronic renal failure, sarcoidosis, myeloproliferative disorders, critical illness, a stay in an intensive care unit, surgery, and hypovolemia causing hypoperfusion of the gastric mucosa. 5 Smoking increases the risk of recurrence of PUD and slows the healing process in established ulcers. Table 3 outlines concerns of special populations with PUD.
Most patients with duodenal ulcers have documented H.pylori in their gastroduodenal mucosa; however, only 10% to 15% of patients with H. pylori infection actually develop PUD. It is believed that these patients are infected with a variety of H. pylori that has a chromosomal variance that increases its virulence and ulcerogenic potential. Persons with H. pylori have increased resting and meal-stimulated gastrin levels as well as decreased gastric mucus production and duodenal mucosal bicarbonate secretion, which contributes to ulcer formation. Eradication of H. pylori decreases risk of ulcer recurrence from 67% to 6% in duodenal ulcers and from 59% to 4% in patients with gastric ulcers.3 Relapse is generally the rule if H. pylori is not treated.
Nonsteroidal Anti-inflammatory Drugs
NSAIDs are the second most common cause of PUD. They cause peptic ulcer disease in two ways, first by direct contact, which causes submucosal erosions, and second, systemically by inhibiting cyclooxygenase, which decreases mucosal protection, bicarbonate secretion, epithelial cell proliferation, and mucosal blood flow. For this reason parenteral NSAIDs may be as deleterious as oral NSAIDs. H. pylori increases the intensity of NSAID damage. In chronic NSAID users, the annual risk of a life-threatening ulcer complication is 1% to 4%. Older patients are at highest risk. NSAID use is thought to be responsible for more than half of all perforated ulcers. PPIs and misoprostol minimize the ulcerogenic potential of NSAIDs and reduce ulcer recurrence in these patients.
Diagnosis of PUD is usually based on clinical features and testing either with contrast radiographic studies or endoscopy. Signs and symptoms alone are generally unreliable, especially when differentiating gastric ulcers from duodenal ulcers.
The clinical features of PUD include episodic midepigastric pain described as gnawing or burning that occurs 2 to 5 hours after eating or when the stomach is empty. Pain may occur at night and awaken the patient from sleep. It may be relieved by food or antacids; this is the most specific finding for PUD and may help make the diagnosis. Other symptoms may include indigestion, vomiting, anorexia, fatty-food intolerance, a sensation of heartburn, and a family history of PUD. The physical examination is often nonspecific and may or may not include epigastric or left upper quadrant tenderness. Abdominal findings such as tenderness, including guarding and rebound, may be prominent in the case of perforation or penetration of the ulcer.
Older patients with PUD are more likely to have abdominal pain. Patients with duodenal ulcers are more likely to have pain relieved by food or antacids than are patients with gastric ulcers. Weight loss due to fear that eating will cause recurrent pain is more common in those who have gastric ulcers than in those with duodenal ulcers.
If the clinical presentation is consistent with PUD, assess the patient for alarm symptoms (Table 2). Any alarm symptoms should prompt further evaluation. Patients older than 55 years who have alarm symptoms should be referred to a gastroenterologist for urgent esophagogastroduodenoscopy (EGD). EGD is more sensitive than a radiologic contrast procedure and biopsy, and treatment can be performed during the test, essentially saving time and procedures. It is also more sensitive and specific. Patients younger than 55 years without alarm symptoms should be tested for H. pylori; NSAIDs should be discontinued for these patients, and so should use of alcohol and illicit drugs. In addition, the patient should start a trial of PPIs. Patients with positive test findings for H. pylori should be treated for infection and treated with a PPI for at least 4 weeks. Patients with persistent symptoms should undergo EGD at that point to rule out refractory ulcers and malignancy. Patients with gastric ulcers are at increased risk of developing gastric malignancy. Duodenal ulcers, however, are not at increased risk of malignancy.6
Testing for Helicobacter pylori
- pylori testing should be done in all patients suspected or confirmed to have PUD or gastritis. In most cases, this testing is not necessary in the urgent care center and can be left to the primary-care provider, unless it is the case that the patient is using an urgent care center for primary care, that they will not be seeing their primary-care provider before treatment must be instituted, or that blood is being drawn for another reason. Serum ELISA testing is the least accurate and should only be used for initial infection, but it is the most practical for urgent care use. Serum tests for H. pylori are useful only in patients who have never been treated before, because serum antibodies can remain positive for up to 3 years after eradication (Table 4). The urea breath test uses radiolabeled 13C or 14C urea taken orally. The bacteria then split the urea, which can be quantified in breath samples. This test is best used to confirm that treatment has successfully eradicated H. pylori. The stool antigen test for H. pylori is highly accurate, but it too is best used to confirm eradication. Endoscopic biopsy and staining is the first-line test for H. pylori. PPIs, bismuth, many antibiotics, and upper GI bleeding may lead to falsenegative test results. When a high index of suspicion is present, 2 negative sets of test findings are required to rule out H. pylori infection.5
|Table 4. Testing for Helicobacter pylori|
|Test||Used For||Sensitivity (%)||Specificity (%)||Comment|
|Serologic ELISA||Initial testing||85||79||Cannot confirm eradication|
|Urea breath test||Confirm eradication||95–100||91–981||Expensive; must
stop PPIs 2 weeks before test
|Stool antigen test||Confirm eradication||91–98||94–99||Inconvenient|
|Urine-based ELISA/rapid urine
rapid urease (CLO)
|Data from Data from Ramakrishnan K, Salinas R. Peptic ulcer disease. Am Fam Physician. 2007;76:1005–1012, and from Wehbi M. Acute gastritis. New York (NY): WebMD Health Professional Network, Medscape. © 2015 [updated 2014 September 18; cited 2015 January 8]. Available from: http://emedicine.medscape.com/article/175909-overview.
Both = initial testing and confirm eradication; CLO = Campylobacter-like organism; ELISA = enzyme-linked immunosorbent assay; PPI = proton pump inhibitor.
The most common cause of H. pylori–negative ulcers are false negative test results for H. pylori and undiscovered NSAID consumption.5 In patients who are at high risk for H. pylori, positive findings on a single test confirms infection, whereas negative findings on 2 tests are required to rule out H. pylori infection. Treatment of Peptic Ulcer Disease Treatment of PUD is first focused at treating the underlying cause. NSAIDs or other inciting factors should be discontinued if possible. H. pylori should be treated for 10 to 14 days.
Treatment for Helicobacter pylori
Table 5 outlines standard treatments for H. pylori.
Adjunct treatments with prebiotics and probiotics may be helpful in increasing eradication rates and decreasing the side effects of treatment. Treatment failures are largely due to antibiotic resistance and patient noncompliance because of intolerable side effects.6
Testing for H. pylori eradication may be performed at 4 weeks after completion of therapy using either the rapid urease breath test or the stool antigen test. It may not be cost-effective and thus may be omitted in patients with uncomplicated gastritis whose condition improves with treatment. Patients with ulcers or cancer and those whose condition does not improve after treatment must be checked for resolution. Antibiotics and PPIs must be discontinued for 2 weeks prior to testing.
h3-blockers or PPIs should be continued for 4 weeks because they induce healing in most duodenal ulcers. 3 PPIs have superior acid suppression, healing rates, and symptom relief compared with h3-blockers and are recommended as first-line treatment for most patients. PPIs heal duodenal ulcers in more than 95% of patients by 4 weeks, and gastric ulcers in 80% to 90% of patients in 8 weeks. Maintenance therapy with either h3-blockers or PPIs is recommended to prevent recurrence in high-risk patients: those with a history of complications, frequent recurrences, negative test findings for H. pylori, refractory giant ulcers, or severely fibrosed ulcers. If H. pylori has been eradicated and the patient is no longer taking NSAIDs, no maintenance treatment is required.
|Table 5. Standard Treatments for Helicobacter pylori|
Second-line therapy for treatment failures
Initial treatment in the penicillin-allergic patient
Second-line therapy for treatment failures in the penicillin-allergic patient
Third-line treatment for when therapy has failed
|PPI = proton pump inhibitor.|
Antacids and sucralfate are superior to placebo in healing NSAID induced duodenal ulcers, but neither has been established as treatment for any other variety of ulcers. Because h3-blockers and PPIs are superior, sucralfate cannot be recommended as treatment.5 Antacids may be useful for symptom reduction.
Misoprostol is better than placebo for treatment of PUD, but has no advantage over h3-blockers and PPIs. It may be useful in non-menstruating patients who must take NSAIDs to prevent recurrent gastritis or ulceration. It is available in a combination NSAID product mixed with diclo fenac. It is contraindicated in pregnancy (category X) because it is an abortion-inducing agent.5
Gastritis and Peptic Ulcer Disease in Pregnancy
In a pregnant patient who develops PUD, treatment should be aimed at acid suppression. All of the PPIs are low risk in pregnancy, and are therefore category C. Most obstetricians will recommend them. Pregnant patients with positive test findings for H. pylori should be treated after delivery unless they are experiencing severe nausea and vomiting. There is some evidence that H. pylori contributes to hyperemesis gravidarum. Treatment with anti–H. pylori drugs, with the exception of tetracycline and bismuth, is generally safe in pregnancy, especially after 14 weeks’ gestation. Conversely, bismuth and metronidazole are unsafe in breastfeeding infants.5
Refractory PUD is defined as disease that fails to heal after 8 to 12 weeks of therapy. This may be due to persistent or resistant H. pylori infection, continued NSAID use, giant ulcers, cancer, tolerance of or resistance to medications, or hypersecretory states. The underlying cause should be addressed, and treatment should continue for longer than 8 weeks if required. These patients should be evaluated by a gastroenterologist.3,5
Surgery may be required for patients who are intolerant of medications, do not comply with medication instructions, or are at high risk of complications, such as transplant patients, chronic steroid or NSAID users, those with giant gastric or duodenal ulcers, or those whose disease fails to heal with adequate treatment. Patients who experience relapse after multiple courses of medication should also be considered for surgery.3
About 25% of patients with PUD will have a serious complication such as hemorrhage, perforation, or gastric outlet obstruction (GOO). Silent ulcers and complications are more prevalent in older patients and in patients taking NSAIDs. Upper GI bleeding, which occurs in
12% to 20% of patients with PUD, is the most common cause of death and the most common reason for surgery.3 Patients may present with bright-red or coffee-ground hematemesis, melena, fatigue due to anemia, orthostasis, or syncope. Most patients in an urgent care center with documented GI bleeding should be transferred to an emergency department for further evaluation.
In stable patients with GI bleeding, ulcerogenic medications should be discontinued and a PPI should be administered. EGD should be performed as soon as possible. Testing and subsequent treatment for H. pylori should be done to prevent recurrent bleeding. If the patient must continue to take aspirin or NSAIDs, misoprostol or a PPI administered concurrently should be considered.
Perforation may occur in 2% to 10% of patients with peptic ulcers. It is usually found in the anterior wall of the duodenum (60%), the antral wall of the stomach (20%), or the lesser curvature of the stomach (20%).3 Perforation of ulcers in children is rare. Perforation into the peritoneum and resulting peritonitis constitute a surgical emergency. Perforation is characterized by sudden and rapidly spreading severe upper abdominal pain exacerbated by movement. It may radiate to the right lower abdomen or to both shoulders. Fever, hypotension, and oliguria suggest sepsis syndrome. Generalized abdominal tenderness, rebound tenderness, board like abdominal wall rigidity, and hypoactive bowel sounds may be masked in older patients and those patients taking steroids, immunosuppressants, or chronic narcotics. Upright or lateral decubitus radiographs or an erect chest radiograph may show pneumoperitoneum; however, its absence does not rule out perforation. Further testing with sonography, CT scanning, or gastroduodenography may be required.
GOO may occur from PUD, but it is the underlying cause in less than 5% to 8% of patients.3 Patients with recurrent duodenal or pyloric channel ulcers may develop pyloric stenosis because of inflammation, spasm, edema, or scarring and fibrosis. Symptoms of GOO include recurrent episodes of emesis with large volumes of vomit containing undigested food, bloating, fullness after eating, and early satiety. Weight loss, dehydration, and hypochloremic hypokalemic metabolic alkalosis may result. EGD or gastroduodenography is recommended to determine the site, cause, and degree of obstruction. Malignancy is responsible for more than 50% of GOO and should be ruled out. Other causes of GOO include acute inflammation or edema of the gastric mucosa due to H. pylori. No firm dietary recommendations are necessary; however, it should be noted that patients should avoid any foods that are known to precipitate their symptoms.5
Gastritis and PUD are due to an imbalance of the acid balance and the protective factors in the stomach. The most common causes are NSAID use and infection with H. pylori. The health-care provider should be aware of alarm symptoms that can point to more serious complications such as cancer, perforation, bleeding, and penetration. Treatment is aimed at removing the inciting factors, eradicating H. pylori if present, and acid suppression with h3-blockers or PPIs. Refractory or complicated cases should be evaluated by a gastroenterologist. Part 2 of this series will discuss gallbladder disease and acute pancreatitis.
- Wehbi M. Acute gastritis. New York (NY): WebMD Health Professional Network, Medscape. © 2015 [updated 2014 September 18; cited 2015 January 8]. Available from: http://emedicine.medscape.com/article/175909-overview
- Gratton MD. Peptic ulcer disease and gastritis. In: Tintinalli JE, Stapczynski JS, Cline DM, et al, editors. Tintinalli’s Emergency Medicine, 7th ed. New York, New York: McGraw-Hill Professional. 2010:554–557.
- Ramakrishnan K, Salinas R. Peptic ulcer disease. Am Fam Physician. 2007;76:1005–1012.
- Gratton MD. Peptic ulcer disease and gastritis. In: Tintinalli JE, Stapczynski JS, Cline DM, et al, editors. Tintinalli’s Emergency Medicine, 7th ed. New York, New York: McGraw-Hill Professional. 2010:554–557.
- Soll AH, Vakil NB. Unusual causes of peptic ulcer disease. Waltham (MA): Wolters Kluwer Health, UpToDate. © 2015 [updated 2014 June 11; cited 2015 January 5]. Available from: http://www.uptodate.com/contents/unusual-causes-of-peptic-ulcer-disease?source=search_result&search=peptic+ulcer+disease& selected Title=6~150
- Anand BS. Peptic ulcer disease. Medscape [website]. New York, New York: Medscape, LLC [accessed 2015 January 11]. Available from: http://emedicine.medscape.com/article/ 181753-overview#showall
- University of Texas at Austin, School of Nursing Family Nurse Practitioner Program. Recommendations in primary care for the most efficacious and cost effective pharmacologic treatment for Helicobacter pylori in non-pregnant adults. Austin, Texas: University of Texas at Austin, School of Nursing; 2013 May 17. Available from: http://www.guideline.gov/content.aspx?id=46427
Tracey Quail Davidoff, MD
Senior Clinical Instructor at Rochester Regional Health/Immediate Care, Editorial Board Member for the Journal of Urgent Care Medicine
90,000 Treatment of gastric and duodenal ulcers in Diadent
Symptoms, diagnosis and treatment of gastric ulcer and duodenal ulcer
Competent diagnostics and modern therapy to improve and maintain the patient’s well-being. Make an appointment with the clinic.
Discount 500 ₽!
When making an appointment for treatment with the specialists of the Diadent Group of clinics in the “last minute” windows of the current day (does not apply to consultations).Check with the administrators for the list of “burning” windows.
cost of services of the therapeutic department
- RUB 1,700 Primary appointment with a general practitioner
- RUB 1,700 Reappointment of a general practitioner
- RUB 1,500 Appointment (examination, consultation) of an endocrinologist, primary
- RUB 5,000 Doctor’s consultation anti-age
- RUB 2,000Taking an ECG at rest and with stress (with interpretation)
- 600 RUB EKG removal
- 600 RUB ECG decoding
- RUB 1,500 Conducting a glucose tolerance test
- RUB 3,000 Holter monitoring
- RUB 4,000 Intra-articular administration of drugs
- RUB 12,000 Intra-articular injection of substitutes (prostheses) of synovial fluid
- RUB 4,000Paravertebral block (multicomponent)
Stomach ulcer can develop into cancer
Peptic ulcer of the stomach and duodenum is a chronic disease with characteristic periods of exacerbation and remission, affecting the upper and underlying layers of the mucous membranes of the digestive organs. The main symptom of this disease is the formation of a specific defect in the walls of the stomach and duodenum – an ulcer.Failure to timely correct treatment can lead to serious complications that threaten the patient’s life, such as cancer.
Symptoms of stomach and duodenal ulcers
In the initial stages, the disease, in most cases, is asymptomatic. However, as the progression progresses, already from the first exacerbation, patients have:
- pain in the upper abdomen, radiating to the chest, lumbar spine or scapula;
- flatulence, heartburn;
- nausea, vomiting;
- strong weight loss.
90,021 stool disturbances, constipation and / or diarrhea, sometimes alternating;
90,021 frequent belching;
90,021 a feeling of heaviness in the abdomen;
90,021 loss of appetite;
Exacerbations of the disease often occur in autumn and spring, in addition, excessive physical exertion, severe stress, fried, fatty and spicy foods, and the use of alcoholic beverages can provoke them.
Diagnosis of peptic ulcer
Physical examination in the diagnosis of peptic ulcer disease is not very informative. Methods for the diagnosis of peptic ulcer disease are conventionally divided into instrumental and laboratory studies, as well as differential diagnosis, which is based on the exclusion of other diseases with similar symptoms.
The main laboratory tests prescribed for suspected gastric ulcer and duodenal ulcer are:
- general blood test;
- fecal occult blood test;
- study of gastric secretion;
90,021 research on Helicobacter Pylori.
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Gastroduodenoscopy in Diadent
Among the instrumental diagnostic methods, the most informative are:
- endoscopic examination (gastroduodenoscopy) .This diagnostic method, based on the introduction of a special probe, an endoscope into the stomach, is key in the diagnosis of peptic ulcer disease, since it gives the doctor the opportunity not only to detect mucosal defects, but also to accurately determine its localization, depth and size, as well as to take tissue for additional research;
- X-ray examination using a contrast agent allows you to identify not only changes in the affected organ and detect pathological tissue areas, but also possible complications, for example, obstruction of the gastrointestinal tract;
- Intragastric pH-metry makes it possible to determine the parameters of the patient’s gastric secretion.
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A perfect security system has been developed in Diadent, which reduces the risk of diseases (protection against HIV, hepatitis and other diseases) to zero.
Differential diagnosis of peptic ulcer
Differential diagnosis of peptic ulcer based on exclusion:
How to treat an ulcer during an exacerbation?
During the period of exacerbation, it is extremely important for the patient to comply with bed rest and exclude provoking factors – stress, excessive physical activity, malnutrition, bad habits. Peptic ulcer treatment is aimed at eliminating the root cause of the disease, suppressing symptoms and stimulating regeneration processes.Diet therapy occupies an important place in the treatment program. The patient is recommended:
- eat fractionally, often, in small portions;
- give up fatty, spicy and fried foods;
- to minimize the use of foods that contribute to flatulence;
- refuse products that provoke heartburn;
- to exclude the use of alcoholic beverages.
Can ulcers be cured with pills?
Drug treatment of peptic ulcer disease is selected strictly individually in each case, the treatment regimen and prescribed drugs depend on the cause of the disease.
- PH-balance is normalized by proton pump inhibitors, which suppress gastric secretory functions;
- healing preparations accelerate the process of restoring damaged areas of the mucous membrane;
- Antidepressants and sedatives may be prescribed for neurological causes;
- Helicobacter Pylori treatment, with a positive test, is carried out with individually selected antibacterial drugs.
90,021 dopamine receptor antagonists are prescribed to restore duodenal motility;
Surgery for gastric and duodenal ulcers
Surgical treatment of peptic ulcer is an extreme measure prescribed in case of complete ineffectiveness of conservative treatment or the development of serious complications, such as degeneration of an ulcer with the formation of cancer cells, metaplasia of the mucous membranes, frequent recurrent bleeding, polyposis, an advanced stage of the disease with a large number of pooling foci, etc. .NS.
Find out the cost of treatment for a free consultation by phone +7 (812) 40-000-60
Where is the clinic Diadent
m.St. Petersburg, Bukharestskaya st. house 110, building 1
Phone: + 7 (812) 40-000-60
90,000 Stomach ulcer – Treatment in Israel
Many peptic ulcer studies at Tel Aviv Sourasky Medical Center indicate the presence of a bacterial infection caused by the bacterium Helicobacter Pylori, abbreviated: HP (Helicobacter pylori).
Other causes of stomach ulcers are called smoking, alcohol and caffeine consumption.The lack of effective functioning of the stomach with hydrochloric acid, bile acids and pepsin also contributes to the occurrence of peptic ulcer disease.
In the United States, the demographic characteristics of peptic ulcer disease are as follows: The prevalence of Helicobacter pylori infection varies among different age groups, ethnic groups, and socioeconomic status of patients. The bacterium is more common in older people, African Americans, Hispanics, and people of low socioeconomic status.A few weeks after infection with the Helicobacter Pylori bacterium, most people with a burdened heredity and unfavorable environmental conditions develop inflammation of the gastric mucosa.
Helicobacter Pylori is spread through saliva, phlegm, shared utensils, poorly washed vegetables, bacterial food, dirty hands, general hygiene items, and fecal contaminated water. Penetrating into the pyloric compartment of the stomach, the bacterium Helicobacter Pylori causes various inflammations of the gastrointestinal tract.
The spiral form of the Helicobacter Pylori bacterium, entering the body, in most cases does not cause any problems and is asymptomatic. But in some people, especially those with weakened immune systems, the bacteria Helicobacter Pylori causes infection and ulcers.
The spiral form of the bacterium allows it to penetrate deep into the gastric mucosa and begin there with its harmful enzymes and toxins to destroy the protective layer of the gastric mucosa. Bacteria enter the cells of the stomach, weakening the protective mechanisms of the stomach more and more, causing local inflammation.Also, for no apparent reason, bacteria somehow cause the stomach to produce more acid, causing the stomach to become acidic. This can cause inflammation in the upper part of the duodenum.
90,000 how to tell if you have gastritis?
Gastritis is an inflammatory process in the gastric mucosa . One of the main reasons for the development of this disease is an unhealthy diet. Overeating, starvation, consumption of fatty and spicy foods, unhealthy unnatural snacks and many other dietary errors, as well as alcohol abuse, smoking, chronic stress lead to a deterioration in the health of the digestive system.In general, gastrointestinal diseases are one of the most common diseases of our time.
Most of the civilized population of the planet has certain diseases of the gastrointestinal tract, while gastritis can be called one of the most common: according to various sources, from 50 to 80% of people suffer from this disease .
Particular attention should be focused on the concept of “civilized population”. Gastritis is a disease of the middle class, white collar workers and metropolitan residents. The poorest population of the Earth, the savage tribes of Africa show horrific statistics of mortality from epidemics of fever or typhoid fever; However, studies of the gastrointestinal tract of residents of these regions are impressive: with constant malnutrition, by no means a reference diet, cases of gastritis or ulcers are isolated and completely incomparable with the threatening statistics that come to the World Health Organization from the so-called first world countries .Perhaps it’s all about “civilized” food and drinks – fast food and alcohol.
The indifference of people to their well-being also aggravates the situation. According to statistics, severe symptoms of gastritis are observed in about 40% of people with this diagnosis. However, only 5% of them go to a specialist . Delay can lead to chronic inflammation and complications. Therefore, it is important to know what the symptoms of gastritis are, and if they appear, immediately consult a doctor.
The first signs of gastritis
- Discomfort, tightness (especially after eating), pain in the epigastric region (upper peritoneum).
- Heartburn, “sour” belching.
- White coated tongue.
- Manifestations of dyspepsia (nausea, vomiting, stool disorders) .
- Temperature rise to subfebrile (37 degrees).
All of the listed symptoms themselves can be the consequences of a simple disorder of the gastrointestinal tract. However, if there is a combination of two or more of these conditions, you should prepare for frequent visits to the gastroenterologist. Gastritis is the first item in the chain of formidable conditions: ulcer – precancer – stomach cancer .Gastritis, cured in time, will become the first and last link in this chain.
Types of gastritis
It is necessary to clarify one important point – the described symptoms signal the manifestation of the so-called acute gastritis. Meanwhile, this disease can proceed without pronounced discomfort. In the latter case, we can talk about chronic gastritis. So, let’s take a closer look at what types of gastritis are.
The disease can develop due to :
- Abuse of strong alcoholic beverages.
- Irritation of the gastric mucosa by chemicals (eg drugs).
- Sudden changes in the acid-base balance of the stomach (due to the use of substances with a pronounced Ph-factor).
- Food of questionable quality.
In order for gastritis to start rapidly and aggressively, a certain “preparatory work” is necessary in the form of fast food, haphazard and regimeless meals. At the same time, an unbalanced diet alone cannot cause gastritis.
The modern city dweller, who serves a balanced diet of organic products, has a stomach constantly filled with acid, he does not know when to expect readily available food. Plus the stomach is disoriented by stresses that are actively seized; force majeure, when food is simply forgotten; hotel “all inclusive”, when food and alcohol enter the body non-stop for a long time (counting on subsequent fasting, of course). All this creates excellent conditions for the thinning of the gastric mucosa due to the disturbed acid-base balance.
These conditions provide an ideal breeding ground for Helicobacter pylori. For the discovery and description of this famous bacterium in 2005, scientists were awarded the Nobel Prize in Medicine ; this discovery completely changed the principles of treatment of gastritis and gastric ulcer. If earlier treatment was symptomatic, aimed at removing signs of gastritis, or surgical in especially advanced cases, today antibiotics have come to the fore in the treatment of stomach diseases. However, we will talk about Helicobacter pylori and how to diagnose it further.
Acute gastritis usually lasts up to five days. Symptoms gradually subside. If treatment is not followed, over time it can flow into a chronic form. Chronic gastritis can also develop as a primary condition, gradually.
So, what are the main symptoms of chronic gastritis?
- The heaviness in the stomach after a meal persists for hours.
- Stool changes, poor food digestion (dyspepsia).
- Poor appetite .
- Belching with a bad smell.
- Pains of various types.
The patient’s quality of life depends on the degree of the disease. In milder forms, appetite persists, symptoms are not pronounced. More severe forms include a lack of appetite, weight loss, deterioration in the appearance of the skin, hair, nails and other things, changes in blood biochemistry, chronic fatigue syndrome, and so on.
Diagnosis of gastritis
Despite the severe symptoms, an accurate diagnosis of gastritis can be made only after fibrogastroscopic examination (FGS).This procedure involves preparation: fasting for at least 10-12 hours before the test (therefore, the study is usually prescribed for the first half of the day). FGS involves the study of the walls of the esophagus, stomach, duodenum using a microcamera, as well as taking gastric material for research. This can be gastric juice and scraping (biopsy) of ulcerated areas of the digestive system. In the future, this material enters the laboratory and the main thing is determined – whether the same Helicobacter pylori is present at the site of ulceration.
FGS is the leading method for diagnosing gastritis today. Meanwhile, to clarify the diagnosis, the doctor may also prescribe other tests (see table) .
Table . Research for the diagnosis of gastritis.
Type of study
Ultrasound of the pancreas 8
Ultrasound examination of the upper abdominal cavity
Determination of IgM antibodies to Helicobacter pylori
Indicates an early stage of the disease
Shows local severe inflammation
Determination of IgG antibodies to Helicobacter pylori
Confirms infection, antibodies and appear three to four weeks after infection and persist for some time after treatment
Antigenic test for Helicobacter pylori
Confirms the presence of bacteria in the body
|Analysis of feces|
Clinical blood test
Shows changes in the blood formula and the presence of an inflammatory process
Tests for tumor markers 8 930 places of ulceration in a malignant process
To revise the lifestyle and dietary habits and improve the quality of food consumed is the task of every modern person who does not want to have health problems.In addition, it is extremely important to be able to recognize dangerous changes in the body. If you suspect gastritis, you should consult a doctor and go through the study as directed.
All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.
Gastrointestinal bleeding – causes, examination and treatment | Symptoms
Ulcers or erosion of the esophagus, stomach or duodenum
Signs: Pain that is persistent and mild to moderate, usually felt just below the sternum, may wake the person up at night, and / or relieve after eating.Painless sores can also cause bleeding.
Esophageal varicose veins
Signs: Usually very heavy bleeding. Often in people with chronic liver disease such as cirrhosis. Sometimes signs of chronic liver disease, such as bloating and yellowish discoloration of the skin and whites of the eyes (jaundice).
Mallory-Weiss rupture (rupture in the esophagus caused by vomiting)
Signs: People who vomited one or more times before they vomited blood.Sometimes pain in the lower chest during vomiting.
Arteriovenous malformation (abnormal ligaments between arteries and veins)
Signs: There are usually no other symptoms.
Signs: Bright red blood only on toilet paper, dripping down the toilet, or on the surface of formed stool.
Signs: Pain during bowel movements. Bright red blood only on toilet paper or on the surface of formed stool.A crack discovered during a doctor’s examination.
Angiodysplasia (abnormal changes in blood vessels in the intestine)
Signs: Painless discharge of bright red blood from the rectum (bloody feces).
Inflammation of the colon (due to radiation therapy, infection or ischemic colitis)
Signs: Bloody diarrhea, fever, and abdominal pain.
Signs: Sometimes fatigue, weakness, and / or bloating.Usually in middle-aged and elderly people.
Signs: There are often no other symptoms.
Diverticular disease (diverticulosis)
Signs: Painless, bloody stools. Sometimes in people diagnosed with diverticulosis.
Inflammatory bowel disease (ulcerative proctitis, ulcerative colitis or Crohn’s disease)
Signs: Bloody diarrhea, fever, abdominal pain and colic.Sometimes in people who have had multiple episodes of rectal bleeding.
Possible side effects
Like all medicines, Furosemide can cause side effects, although not everybody gets them.
If you have any of the following side effects while using this drug, contact your doctor or the nearest hospital immediately:
- Severe allergic reaction, which may include skin rash, itching, dermatitis, flaky skin, sensitivity to sunlight or sunlight or fever, swelling of the face, lips, tongue, or throat, or difficulty breathing or swallowing.
- Blisters or peeling of the skin around the lips, eyes, mouth, nose and genitals, flu-like symptoms and fever, which can occur with the development of Stevens-Johnson syndrome.
- Inflammation of the blood vessels (vasculitis, which can cause rashes, fever, and joint or muscle pain) or inflammation of the kidneys, which can affect the frequency of urination or the presence of blood in the urine. You may have fever, drowsiness, or ankle swelling.
- Thrombosis causing pain, swelling, or tenderness in the legs.
Contact your healthcare professional or pharmacist if you notice any of the following side effects:
Very common: may affect more than 1 in 10 people
- Dehydration, changes in water and electrolyte balance in the body (for example, sodium, potassium, chlorine, calcium and magnesium), causing dry mouth, weakness, fatigue or drowsiness, anxiety, seizures, muscle pain, apathy or cramps, hypotension, causing a low level of concentration and a slowdown in reaction, water retention, fast or irregular pulse, and nausea and vomiting.
Common: may affect fewer than 1 in 10 people
- Decrease in circulating blood volume (hypovolemia).
- An increase in the concentration of creatinine and urea in the blood (detected by the results of a blood test).
Uncommon: may affect fewer than 1 in 100 people
- Anemia causing fatigue, shortness of breath, unexplained bleeding or bruising.
- Changes in blood tests, including cholesterol, glucose, uric acid levels.
- Blurred vision or xanthopsia.
- Delirium, feeling of pressure in the head, headache, drowsiness, fatigue, visual disturbances, dry mouth, dizziness.
- Irregular heartbeat.
- Muscle cramps or weakness.
- Changes in the number and frequency of urge to urinate.
- Dry mouth, thirst, feeling unwell, intestinal motility disorder, including diarrhea and constipation.
- Deafness (sometimes irreversible).
Rare: may affect less than 1 in 1000 people:
- Changes in blood count, such as changes in white blood cell count, decreased platelets, which causes rash, fever, sweating, fatigue and weight loss.
Periodic blood tests should be performed by the treating physician to ensure that no changes have occurred in the blood.
- Mental disorders causing delusions, hallucinations, speech disorders.
- Tingling sensation in the limbs.
- Confusion of consciousness, headache, fatigue, general ill health, fever.
- Tinnitus, hearing loss, usually reversible.
- Symptoms of shock such as changes in heart rate, shortness of breath, cold and damp skin.
- Inflammation of the pancreas causing abdominal or back pain and nausea.
- Liver dysfunction causing yellowing of the skin or sclera of the eyes.
- Skin rash.
Very rare: may affect less than 1 in 10,000 people:
- Inflammation of the kidneys or kidney failure, which may cause back pain or changes in the number and frequency of the urge to urinate.
Frequency of adverse reactions unknown:
- Deterioration in the presence of water and electrolyte balance in the body.
- Acute generalized exanthematous pustulosis (OGEP) (acute drug skin lesion).
- Dizziness, fainting and loss of consciousness due to symptomatic hypotension.
Additional adverse reactions observed in children:
- Increased risk or persistence of patent ductus arteriosus in premature infants.
- Nephrolithiasis in infants.
Reporting side effects:
If you notice any side effects, tell your doctor, pharmacist or nurse. This includes any possible side effects not listed in this package insert. You can also report the side effects of Arpimed LLC by going to the website www.arpimed.com and fill out the appropriate form “Report side effects or drug ineffectiveness” and to the Scientific Center for the Expertise of Drugs and Medical Technologies named afterAcademician E. Gabrielyan by going to the website www.pharm.am in the section “Report side effects of the drug” and fill out the form “Card of messages about side effects of the drug”. Scientific center hotline: +37410200505; +37496220505.
How to store Furosemide
Keep out of the reach of children, protected from moisture and light at a temperature of 15-25 0 C.
Shelf life – 3 years. Do not take Furosemide after the expiration date printed on the drug packaging.The expiry date refers to the last day of the specified month.
Medicines should not be disposed of into waste water or sewage system. Ask your pharmacist how to dispose of a drug you no longer need. These measures are aimed at protecting the environment.
Contents of the box and additional information
What Furosemide contains
One tablet contains:
active substance: furosemide – 40 mg;
excipients: microcrystalline cellulose, monohydrate lactose, magnesium stearate, sodium starch glycolate, povidone, corn starch.
What Furosemide looks like and contents of the pack
White, flat tablets interspersed and scored on one side.
40 tablets in a blister strip packaging (PVC / aluminum). 1 contour cell package (40 tablets) together with a leaflet are placed in a cardboard package.
10 tablets in a blister strip packaging (PVC / aluminum). 4 blister packs (40 tablets) together with a leaflet are placed in a cardboard box.
Available by prescription.
90,000 8 compulsory examinations that a woman must undergo – MedOblako
Many diseases in our body in the initial stages go unnoticed, without symptoms and any worries. At these moments, no one even thinks about undergoing a medical examination. But the disease that has arisen begins to develop, and when its obvious symptoms appear, it will be much more difficult to eliminate the pathology, and sometimes it is simply impossible.In order to avoid such cases, every woman should undergo preventive examinations by professional doctors, as well as regularly take tests. Incidentally, the planned examinations are an indicator of the culture of human health, and as a result of the population as a whole.
Doctors urge women to undergo eight regular check-ups in order to prevent and diagnose diseases.
1. Gynecological examination
A large number of diseases in the field of gynecology are hidden for a long period: no symptoms.And their consequences can be serious and lead to erosion, infertility or cancer.
Regular gynecological examinations are necessary from the moment of onset of sexual activity. It should be remembered that up to 30 years old it is enough to visit a doctor annually, and after 30 – twice a year. And it is worth remembering that in case of any concerns and violations, it is necessary to visit a gynecologist, not hoping for an independent solution to the problem that has arisen. It is also recommended to consult a doctor when changing a sexual partner.
2. Papilloma test, or smear for cytology
Each examination by a gynecologist is accompanied by taking a test for cytology. In this case, there is a study of the epithelium of the cervix. This test helps to identify cervical cancer in the early stages. Symptoms in this disease appear too late: only when extensive metastasis is formed. When you move into this stage, the chance of a cure is very small.
A cytology smear must be taken every year.
3. Consultation with a mammologist
Malignant diseases of the mammary glands in women among oncology rank first in terms of frequency of occurrence. It is worth remembering that in the early stages, tumors are amenable to successful treatment. But in severe cases and terminal stages of development, the formation of metastases occurs, and treatment may not be effective.
For early detection of pathological changes, mammography is performed (examination to detect diseases of the mammary glands).There are three main types of this procedure: computer, magnetic resonance and ultrasound. But most often, doctors use the X-ray method. The examination of the mammary glands makes it possible to identify changes in the woman’s breasts several years before the detection of malignant tumors.
The procedure does not bring any discomfort, and short-term exposure to rays cannot harm. After forty years, it is recommended to have a breast examination every year.
4. Colon examination
Colon examination in medical practice is called colonoscopy. This procedure helps to identify a large number of pathological changes, and primarily tumors. Also, during this procedure, medical manipulations can be immediately used. For example, if small polyps or tumors are found, the doctor can remove them, thus avoiding repeated surgery. This research is not particularly enjoyable, but in modern medical institutions it is carried out with the use of anesthetics.
The colon should be examined once every five years for every woman after reaching the age of forty.
5. Visit to a dermatologist
Human skin is the first limiting barrier that protects the body from harmful influences and absorbs the highest dose of adverse environmental influences. It is from this point of view that special attention should be paid to the health of the skin, since over the years the risk of malignant formations and the transition of birthmarks and other benign phenomena to cancerous tumors increases.
You should watch for any changes in birthmarks, the appearance of new formations on the skin. If they occur, it is necessary to consult an experienced specialist. The changes can be so small that even the doctor can miss the pathology that has arisen. Therefore, a dermatologist’s examination is recommended to be carried out annually.
6. Examination by an ophthalmologist
Regular eye exams are essential in today’s technology-driven world. We all work with computers, and each of us has a smartphone.But this is a huge burden on our eyes. In recent years, indicators indicating the occurrence of glaucoma and cataracts at a young age have sharply increased. Usually, only those who already have some problems with it undergo an eye exam. But a visit to an ophthalmologist with a preventive purpose is recommended for everyone once every 2 years.
7. Undergoing tests to assess the state of the thyroid gland
The thyroid gland is one of the most important glands of the endocrine system.It regulates the activity of most organs and systems of the body, therefore, its failure entails irreversible changes that affect the state of human health. Changes in the functioning of the thyroid gland are a common pathology in women, especially those who have reached retirement age.
Symptoms of malfunctioning of the gland are constant fatigue, apathy, changes in weight, increased sweating, dry skin. But these symptoms are common and characterize a number of other diseases.That is why a blood test for thyroid hormones is necessary to confirm the alleged disease. It is recommended to undergo such a survey every one and a half years.
8. Blood Biochemistry: Determination of Sugar and Cholesterol Levels
These two studies should not be ignored. Tracking blood glucose levels will give the first signal that carbohydrate metabolism is impaired and the need to take measures to avoid the development of diabetes mellitus. This disease is latent at first, but from the moment complications develop, it can threaten your life.Complications concern a wide range of organs: eyes, kidneys, blood vessels. The initial stage of the disease can be eliminated by dieting and exercising without medication. Until the onset of forty years, a sugar test is allowed once every five years. After forty, it is recommended to check every three years.
The increased concentration of cholesterol in the blood has a dangerous effect on the vascular bed. The metabolite is able to be deposited on the walls of blood vessels, narrowing their lumen.Thus, blood flow slows down, which negatively affects the work of the heart. If the plaque formed by cholesterol breaks off, then smaller vessels may be blocked. This phenomenon can be a signal for the development of heart attacks and strokes. Biochemical tests for cholesterol in the blood are required from the age of 30 every 5 years at normal rates. If the performance deteriorates, the research should be done more often.
Control over your health must be carried out regularly. And remember: exams are the starting point for your future physical well-being.
Doxorubicin: analogs, side effects after chemotherapy – Adriamycin, Rubeks
Doxorubicin (other names: Adriamycin, Rubeks) is a chemotherapy drug from the group of anthracycline antibiotics. Together with him, this group includes: Epirubicin, Idarubicin, Daunorubicin. It is obtained from bacteria of the streptomycete genus, namely from Streptomyces peuceticus var. caesius. Doxorubicin is used to treat various cancers. The solution of the drug is a red liquid.This drug and its side effects are familiar to women who have undergone red chemotherapy for breast cancer.
How does Doxorubicin kill tumor cells?
All chemotherapy drugs destroy cancer cells or inhibit their multiplication, but they do it in different ways. Doxorubicin belongs to antitumor antibiotics with antiproliferative and antimitotic effects. Its antitumor effects are associated with the following mechanisms:
- The drug is introduced into the DNA molecule, blocks its replication and protein synthesis.
- Doxorubicin inhibits the enzyme DNA topoisomerase II, which affects the spatial structure of DNA and plays an important role in the process of cell growth and division.
- Molecules of a chemotherapy drug are capable of oxidizing to form free radicals that damage cancer cells.
All these effects extend not only to tumor cells, but also to healthy cells. Doxorubicin can cause serious side effects. We will talk about them below.
What types of cancer can this drug be used for?
Doxorubicin is used for breast, stomach, uterus, head and neck, kidney, liver, ovarian, thyroid cancer.It is also used to treat acute lymphoblastic and myeloblastic leukemias, bone sarcomas, Hodgkin’s and non-Hodgkin’s lymphomas, multiple myeloma, neuroblastoma, soft tissue sarcomas.
Doxorubicin is usually prescribed in combination with other chemotherapy drugs that have different mechanisms of action. This increases the effectiveness of the treatment.
The course of treatment with Doxorubicin
Doxorubicin is administered intravenously in different ways:
- Via a dropper.
- With the help of an infusion pump – for a long time at a certain rate.
- Via a central venous catheter, for example in the subclavian vein.
- Through the venous infusion port system: a small reservoir is sutured under the skin, connected by a catheter to the subclavian vein. One of the walls of the reservoir is a membrane, it sits directly under the skin. The drug is injected into the reservoir, piercing the skin and membrane with a special needle. Typically, a patient is implanted with a port system when drugs need to be administered for a long time.
- Sometimes, for cancer of the bladder, doxorubicin is injected directly into the bladder through a catheter.
The drug is not produced in tablets and is not used.
IMPORTANT. Doxorubicin is a vesicant and has a strong blistering effect. If you introduce it into the subcutaneous fatty tissue, it will cause necrosis – tissue death. This is a serious complication, and skin grafting may be required after an unsuccessful injection of the drug. Therefore, the procedure must be performed by specially trained medical personnel, in compliance with all the rules.If redness appears on the skin during the injection, it should be immediately reported to the doctor or nurse.
Therapy can be carried out both in a hospital and on an outpatient basis. The dosage of Doxorubicin depends on the type of cancer, the patient’s weight and height, his state of health, and concomitant diseases. Treatment, as with other chemotherapy drugs, is carried out in cycles. After the introduction of Doxorubicin, there is a “respite” for several days – this is necessary so that the body can recover, and there are no serious side effects.Then the cycle is repeated. The course can consist of several cycles and last several months.
Possible side effects
Like any chemotherapy drugs, Doxorubicin damages DNA not only in tumor cells, but also in other actively multiplying cells. Because of this, it can cause some side effects.
But do not be alarmed if the doctor has prescribed this drug for you. Firstly, you will not have the entire list of side effects at once, which we will list below.Second, most of them are quite predictable in terms of onset time, severity, and duration. After completion of treatment, they gradually disappear. Thirdly, the side effects of Doxorubicin can be well controlled, and Euroonco has everything you need for this.
Common side effects include: nausea and vomiting (begin to bother about 2 weeks after starting treatment), pain at the injection site, hair loss, anemia, and an increased risk of infections. More than a third of patients experience these symptoms.In 10–30% of patients, symptoms such as mouth ulcers, watery eyes, darkening of the skin in the place where the radiation therapy was carried out, and red urine staining of urine occur. In 10% of cases, infertility occurs in men and women.
Decreased immunity. With the use of Doxorubicin, the level of leukocytes in the blood decreases, the risk of infection increases. You should immediately inform your doctor about symptoms such as fever over 37.5 ° C, sore throat, cough, loose stools, and frequent urination.
Increased bleeding. Occurs due to a decrease in platelet levels. It manifests itself in the form of hematomas (bruises) on the skin, bleeding gums, nosebleeds. Some patients may need platelet transfusion.
Anemia. Chemotherapy with doxorubicin may decrease the level of red blood cells in the blood. There is pallor, a constant feeling of fatigue, headaches and dizziness, shortness of breath. Some patients require red blood cell transfusion.
Increased fatigue. This symptom worsens towards the end of chemotherapy and persists for several weeks after completion. At this time, you need to try to rest more, be in the fresh air.
Changes in the oral mucosa. The oral mucosa may become tender and painful, and sometimes ulcerate. The risk of infection increases. In order to cope with these symptoms during treatment with Doxorubicin, some recommendations must be followed:
- Use a soft toothbrush.
- Drink plenty of fluids.
- Do not eat foods that irritate the oral mucosa.
- Give up alcohol and smoking.
Decreased appetite. This is a common side effect of doxorubicin and other chemotherapy drugs. If you eat very little for several days due to lack of appetite, see your doctor.
Urine staining pink-red. Urine may change color within 48 hours after drug administration.There is nothing wrong with that. This is not blood, this symptom occurs due to the fact that the doxorubicin solution is red in color.
Diarrhea. If stools become liquid, seek medical attention immediately. This symptom may be due to the effect of the drug on the intestines or an infection.
Hair loss. Hair can become thin or fall out completely, and not only on the head: many patients lose eyebrows and eyelashes. This most often occurs after the first or second course of treatment with Doxorubicin.For many patients, this side effect seems to be the most terrible, but in fact there is no reason to panic. Typically, hair grows back soon after chemotherapy is completed. In order to protect them, special cooling caps are used during the procedures.
Changes in the skin and nails. Nails can become brittle, skin dry, sun-sensitive and dark spots appear. These symptoms are usually temporary.
Other side effects are possible and can usually be dealt with successfully.Doctor’s recommendations and modern supportive care methods help patients to tolerate Doxorubicin chemotherapy comfortably.
Rare dangerous side effects
An extremely rare but very serious side effect of doxorubicin is a decrease in the pumping function of the heart. Risks are increased in elderly patients, people receiving radiation therapy to the chest area, and other drugs with cardiotoxic effects. Heart problems can occur several years after treatment has already been completed.Before starting a course of chemotherapy, the doctor must prescribe an ultrasound scan and other tests, and monitor the patient’s heart condition during treatment.
Sometimes there is a syndrome of tumor disintegration – a condition when under the action of a drug many tumor cells die, and the products of their destruction enter the blood. Symptoms appear within 24 to 48 hours after drug administration, and renal failure may occur. To prevent this complication, infusion therapy is prescribed.
Another extremely rare complication is leukemia.It can occur several years after treatment.
Why is Doxorubicin the “red” chemotherapy?
Colonies of microorganisms Streptomyces peucetius that produce anthracyclines have a characteristic red color. Similar color and medicine in a vial. Therefore, women who are undergoing treatment for breast cancer call this chemotherapy “red”.
“Red” chemotherapy is feared because it has more severe side effects than “white”, “yellow” and “blue” drugs.But there is no reason for fear: before prescribing a medicine, the doctor will assess the patient’s health well, weigh the pros and cons, prescribe supportive therapy and will constantly monitor the condition during the treatment process. Patients of “Euroonco” tolerate any chemotherapy comfortably – this is one of the most important principles of our work.
How is the patient’s condition monitored during treatment?
Before prescribing Doxorubicin, general and biochemical blood tests are performed, the condition of the kidneys, liver, and heart is assessed.The tests are repeated during and at the end of the course of chemotherapy. If you become concerned about any symptoms, you should immediately tell your doctor about them.
Sometimes Doxorubicin has to be discontinued due to side effects, in which case the doctor will select another drug. In “Euroonco” it is possible to make a “molecular portrait” of the tumor and select the optimal combination of chemotherapy drugs, prescribe personalized chemotherapy, which will be most effective for a particular patient.
Due to the pronounced side effects, many patients perceive Doxorubicin as a “powerful” chemotherapy drug.But sometimes resistance develops to it – the tumor becomes resistant and no longer responds to treatment. In such cases, other drugs are prescribed.
Pregnancy and Fertility
The drug is dangerous for the fetus, therefore, it is impossible for a woman to become pregnant during treatment with Doxorubicin and for at least 6 months before and after the completion of the course. During the course of chemotherapy, you can have sex, but you need to use effective contraception.The drug passes into breast milk, so breastfeeding is also contraindicated.