GERD: Esophageal Erosion and Ulcers

Topic Overview

The backup, or reflux, of stomach acids and juices into the esophagus that occurs with gastroesophageal reflux disease (GERD) can wear away (erode) the lining of the esophagus and cause sores, called ulcers.

GERD is caused when stomach acid and juices reflux into the esophagus. This happens when the valve between the lower end of the esophagus and the stomach (the lower esophageal sphincter) does not close tightly. This reflux can cause irritation, inflammation, or wearing away of the lining of the esophagus, which is called esophagitis.

In severe cases, patches of the lining of the esophagus wear away completely, and ulcers may develop. Ulcers can be shallow or deep and can destroy the lining of the esophagus where they develop.

Treatment for ulcers in the esophagus usually means treating the GERD that caused the ulcer in the first place. Treatment for GERD involves lifestyle changes and medicine. Treatment sometimes involves surgery.

Lifestyle changes include the following:

• Change your eating habits.
  • It’s best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down.
  • Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
  • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
• Do not smoke or chew tobacco. Smoking can make GERD worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• If you have GERD symptoms at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Do not wear tight clothing around your middle.
• Lose weight if you need to. Losing just 5 lb (2 kg) to 10 lb (5 kg) can help.

Medicines used to treat GERD include:

• Proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec).
• h3 blockers, such as cimetidine (Tagamet) and famotidine (Pepcid).

The most common surgery to treat GERD is fundoplication surgery. During surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the lower esophageal sphincter, which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.

Credits

Current as of:
April 15, 2020

Author: Healthwise Staff
Medical Review:
Adam Husney MD – Family Medicine
Arvydas D. Vanagunas MD – Gastroenterology

Current as of: April 15, 2020

Picture, Function, Conditions, and More

Image Source

© 2014 WebMD, LLC. All rights reserved.

The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. The esophagus is about 8 inches long, and is lined by moist pink tissue called mucosa. The esophagus runs behind the windpipe (trachea) and heart, and in front of the spine. Just before entering the stomach, the esophagus passes through the diaphragm.

The upper esophageal sphincter (UES) is a bundle of muscles at the top of the esophagus. The muscles of the UES are under conscious control, used when breathing, eating, belching, and vomiting. They keep food and secretions from going down the windpipe.

The lower esophageal sphincter (LES) is a bundle of muscles at the low end of the esophagus, where it meets the stomach. When the LES is closed, it prevents acid and stomach contents from traveling backwards from the stomach. The LES muscles are not under voluntary control.

Esophagus Conditions

• Heartburn: An incompletely closed LES allows acidic stomach contents to back up (reflux) into the esophagus. Reflux can cause heartburn, cough or hoarseness, or no symptoms at all.
• Gastroesophageal reflux disease (GERD): When reflux occurs frequently or is bothersome, it’s called gastroesophageal reflux disease (GERD).
• Esophagitis: Inflammation of the esophagus. Esophagitis can be due to irritation (as from reflux or radiation treatment) or infection.
• Barrett’s esophagus: Regular reflux of stomach acid irritates the esophagus, which may cause the lower part to change its structure. Very infrequently, Barrett’s esophagus progresses to esophageal cancer.
• Esophageal ulcer: An erosion in an area of the lining of the esophagus. This is often caused by chronic reflux.
• Esophageal stricture: A narrowing of the esophagus. Chronic irritation from reflux is the usual cause of esophageal strictures.
• Achalasia: A rare disease in which the lower esophageal sphincter does not relax properly. Difficulty swallowing and regurgitation of food are symptoms.
• Esophageal cancer: Although serious, cancer of the esophagus is uncommon. Risk factors for esophageal cancer include smoking, heavy drinking, and chronic reflux.
• Mallory-Weiss tear: Vomiting or retching creates a tear in the lining of the esophagus. The esophagus bleeds into the stomach, often followed by vomiting blood.
• Esophageal varices: In people with cirrhosis, veins in the esophagus may become engorged and bulge. Called varices, these veins are vulnerable to life-threatening bleeding.
• Esophageal ring (Schatzki’s ring): A common, benign accumulation of tissue in a ring around the low end of the esophagus. Schatzki’s rings usually cause no symptoms, but may cause difficulty swallowing.
• Esophageal web: An accumulation of tissue (similar to an esophageal ring) that usually occurs in the upper esophagus. Like rings, esophageal webs usually cause no symptoms.
• Plummer-Vinson syndrome: A condition including chronic iron-deficiency anemia, esophageal webs, and difficulty swallowing. Iron replacement and dilation of esophageal webs are treatments.
• Esophageal stricture: A narrowing of the esophagus, from a variety of causes, which, if narrow enough, may lead to difficult swallowing.

Esophageal Ulcer

An esophageal ulcer is an open sore in the lining of the esophagus. The esophagus is the tube that carries food and liquid from your mouth to your stomach. This sheet tells you more about esophageal ulcers and how they are treated.

Causes of an esophageal ulcer

Esophageal ulcers can be caused by:

• GERD (gastroesophageal reflux disease or heartburn). This condition occurs when stomach acid flows back into the esophagus. It’s the most common cause of esophageal ulcers.

• Infection of the esophagus. This is caused by certain types of fungus and bacteria. It’s also caused by viruses such as herpes simplex virus 1 (HSV-1) or cytomegalovirus (CMV).

• Irritants that damage the esophagus. These include cigarette smoke, alcohol, lye, and certain medicines.

• Certain types of treatments done on the esophagus. These include chemotherapy and radiation.

• Excessive vomiting.

Symptoms of an esophageal ulcer

Esophageal ulcer symptoms can include:

• Pain when you swallow or trouble swallowing

• Pain behind your breastbone (heartburn)

• Feeling of food sticking in your throat or not going down right

• Upset stomach (nausea) and vomiting 

• Vomiting blood

• Chest pain

Diagnosing an esophageal ulcer

Your provider will ask about your symptoms and health history. He or she will also give you a full exam. Tests will be done as well . These can include:

• Upper endoscopy. This is done to see inside your esophagus. This lets your provider check for ulcers. During the test, an endoscope (scope) is used. This is a thin, flexible tube with a tiny camera and light on the end. The scope is placed into your mouth. It’s then guided down the esophagus. Small brushes may be passed through the scope to loosen cells from the lining of the esophagus. Other tools may also be passed through the scope to remove tiny tissue samples (biopsy). These samples are then sent to a lab for study.

• Barium swallow. This is done to take X-rays of your esophagus. This helps your provider check for ulcers. For this test, you’ll drink a chalky liquid that contains a substance called barium. The barium coats your esophagus so that it will show up clearly on X-rays.

• Blood tests. These check for infection, such as HSV-1 and CMV in the esophagus. For a blood test, a small sample of your blood is taken and sent to a lab.

Treating an esophageal ulcer

Treatment focuses on giving the ulcer time to heal, easing symptoms, and preventing further damage. Treatment may include:

• Medicines to reduce the amount of acid your stomach makes

• Medicines to treat infection

• Quitting smoking and not drinking alcohol

• Not taking irritating medicines such as aspirin, ibuprofen, potassium, tetracyclines, doxycycline, quinidine, iron, and alendronate

Recovery and follow-up

With treatment, an esophageal ulcer takes several weeks or longer to heal. A follow-up endoscopy may be done to check the ulcer’s healing. Let your provider know if your symptoms don’t get better or if they come back again. If you have GERD, work with your provider to manage it. You can take steps to help keep your esophagus healthy and prevent future problems.

When to call your healthcare provider

Call your provider right away if you have any of the following:

• Fever of 100. 4° F ( 38.0°C) or higher, or as advised by your healthcare provider

• Chills

• Continued pain or trouble swallowing

• Coughing up blood

• Frequent nausea or vomiting that looks like bloody coffee grounds

• Dark, tarry, or bloody stools

Esophagus Ulcer – an overview

Esophagitis and Esophageal Ulcers

Esophagitis and esophageal ulcers are most commonly due to gastroesophageal reflux, infections (e.g., herpesvirus, Candida, and cytomegalovirus), drugs, chemical or physical injury from ingestion of toxic substances, or foreign objects. Bleeding from esophagitis is usually occult; thus, patients commonly present with anemia. Bleeding from esophageal ulcers varies in severity depending on the etiology, but it is more often acute. Signs and symptoms include hematemesis, epigastric pain, and odynophagia. The majority of patients with acute bleeding present to the emergency department,¹³ and many of them have significant comorbid conditions. Overall, gastroesophageal reflux disease– associated ulcers are most common, and are seen in all age groups, although they are more prevalent after the age of 40 years. Ulcers due to infections are more likely to occur in immunocompromised patients. However, herpes simplex virus esophagitis has been documented in immunocompetent patients as well. Other causes of esophageal ulcers include Crohn’s disease and use of NSAIDs. Concomitant alcohol use has been reported in a subset of patients with NSAID-induced esophageal ulcers, suggesting that it may have a synergistic effect. Ulcers due to medication injury are common in the elderly, whereas those due to foreign objects are more common in children. Reflux is less likely to be associated with bleeding than use of NSAIDs, which cause injury by direct mucosal contact.¹⁴ Radiation-induced injury is mediated by vascular compromise. Injury from chemical agents, such as lye, is caused by their corrosive effect on the mucosa.

Ulcers due to gastroesophageal reflux disease occur mainly in the distal third of the esophagus. Adjacent mucosal changes typical of reflux, such as squamous hyperplasia with prominent fibrovascular papillae and intraepithelial inflammation (eosinophils, neutrophils, and lymphocytes), are usually present. Herpesvirus inclusions are identified most readily in squamous cells at the edge of herpetic ulcers (Fig. 10-3) In contrast, cytomegalovirus inclusions are most often found in endothelial cells or stromal cells at the ulcer base. Candida should be sought wherever neutrophils accumulate in the surface epithelium, usually associated with superficial desquamation. Morphologic features of radiation injury include dilated and thickened capillaries with deposition of hyaline, prominent endothelial cells, and reactive stroma with atypical stellate fibroblasts. NSAID-induced ulcers are typically large, shallow lesions with a broad base, and are most common in the middle esophagus.¹⁴ Pill esophagitis shows superficial epithelial sloughing, keratinocyte necrosis, spongiosis, and intraepithelial eosinophils. Ulcerating malignant neoplasms may also be a source of bleeding, but this is an unusual presentation of esophageal cancer.¹⁵ However, the most common indication for endoscopy in patients with a secondary malignant neoplasm of the esophagus is GI bleeding.¹⁶ Bleeding from NSAID-induced ulcers is usually active and infrequently complicated by strictures. Rarely, esophageal or gastric ulcers may perforate or penetrate into contiguous vascular organs, such as the heart and aorta, leading to massive bleeding¹⁷ (Fig. 10-4). Ulcers due to foreign bodies are particularly prone to this complication.¹⁸, ¹⁹

The GERD-Esophageal Cancer Connection | Everyday Health

If you suffer from painful and persistent heartburn symptoms, you may have a condition that is more serious than simple indigestion.

Gastroesophageal reflux disease, or GERD, is a common condition in which the primary symptom is frequent heartburn. But with GERD, acids in the stomach move backward, into the esophagus, and cause damage to the cells that line the esophagus. The esophagus can become inflamed and irritated, leading to the formation of ulcers, which increase your risk of developing esophageal cancer.

Esophageal Cancer and GERD: How the Diseases Are Related

Esophageal cancer is thought to be linked to inflammation in the esophagus — it is believed that those irritated cells eventually begin to mutate into cancer cells. Constant exposure of the esophageal lining to stomach acids and bile can also cause serious damage and irritation. This may lead to Barrett’s esophagus, a condition in which the esophageal tissue changes in response to constant irritation and becomes more likely to lead to esophageal cancer.

Even if you don’t develop Barrett’s esophagus because of untreated GERD, your risk of one type of esophageal cancer, called adenocarcinoma, is significantly increased. Here are some facts about heartburn and GERD:

• Twenty percent of Americans suffer from heartburn at least two times a week and 10 to 20 million Americans suffer from GERD.
• Ten to 15 percent of people with GERD will develop Barrett’s esophagus.
• Thirty percent of esophageal cancers are related to GERD.
• GERD can occur in adults, children, and even babies.
• GERD can still be present in people who do not have heartburn. Other symptoms include coughing, asthma-like symptoms, and problems swallowing food.

Reducing Your Risk for Esophageal Cancer

Having GERD doesn’t mean you are destined to develop esophageal cancer. But it can serve as a warning that you need to take care of your body and get the GERD under control to prevent Barrett’s esophagus and, potentially, esophageal cancer.

Controlling GERD means more than popping an antacid when you notice heartburn symptoms. If you experience frequent heartburn, talk to your doctor to see if you might need specific treatments for GERD. There are a number of ways to treat and manage GERD to reduce your risk of developing esophageal cancer. This can include:

• Medication. Your doctor will tell you if you need prescription-strength or over-the-counter (OTC) medications to control your GERD. OTC medications that you may be familiar with include Tagamet HB (cimetidine), Pepcid AC (famotidine), and Zantac 75 (ranitidine). These medications may help limit the amount of acid that your stomach produces and are typically taken before a meal to prevent reflux. Prilosec is also a common medication (both OTC and prescription) used to treat GERD by preventing acids in the stomach from being produced.
• Surgery. While rarely needed, surgery is an option for people with GERD who cannot manage their disease with medications or if complications arise. Surgery is typically laparoscopic (done through small incisions with the assistance of a lighted scope), and there a number of different types of surgery that can be used to correct the issue. All basically work to make the lower esophageal sphincter stronger (the muscle that is supposed to keep stomach acids out of the esophagus).
• Weight loss. Just being overweight can lead to GERD, especially if you have extra pounds around your waistline. A good weight-loss plan to reach and maintain a healthy body weight can be a successful treatment for GERD.
• Avoid foods that cause reflux. Large meals that stretch the stomach, as well as heartburn-causing foods such as onions, tomatoes, citrus fruits and juices, chocolate, and peppermint, can trigger reflux. Cigarette smoking should be avoided if you have GERD. It’s also best to avoid alcohol and caffeine, and choose low-fat food choices whenever possible.
• Pay attention to your stomach after a meal. If you suffer from GERD, skip the tight pants and belt: Wear loose clothing that doesn’t constrict your waist, and let gravity help stomach acid stay where it belongs by staying upright after a meal. That means no lying down or bending over until a few hours after you’ve eaten.

Nipping GERD in the Bud

Your best method of reducing the risk for esophageal cancer as a complication of GERD is to get your GERD under control, and quickly. The longer it persists, the more damage it can do to your esophagus — damage that could potentially lead to Barrett’s esophagus and even esophageal cancer. So consider GERD your earliest warning sign for esophageal cancer and get the treatment you need today.

Esophagitis – El Atlas Gastrointestinal

Infectious Esophagitis | Johns Hopkins Medicine

Esophagitis is swelling and irritation of your esophagus. The esophagus is the tube you use to swallow. It connects the back of your throat to your stomach. The most common cause of swelling and irritation of the esophagus is stomach acid that flows back into your esophagus.

But infections can also cause this swelling and irritation. Fungi, yeast, viruses, and bacteria can all set off the condition, called infectious esophagitis. Anyone can get it, but you are more likely to develop it if your immune system is weakened.

Causes

Infectious esophagitis can be caused by fungi, yeast, viruses, and bacteria.

Symptoms

These are symptoms of infectious esophagitis:

• Pain when swallowing

• Difficulty swallowing

• Mouth pain

• Chest pain

• Nausea or vomiting

• Chills or fever

Risk factors

People with a normal immune system are unlikely to get infectious esophagitis. If you have a medical condition or are undergoing treatment that weakens your immune system, you could be at risk. These conditions put you at risk:

• HIV/AIDS

• Cancer treatments, including chemotherapy and radiation treatments

• Diabetes

• Bone marrow or stem-cell transplant treatment

• Medicines that depress the immune system, such as steroids or medicines taken after an organ transplant

• Long-term antibiotic use

• Medicines that limit how much stomach acid you produce

• Alcohol abuse

Advanced age can also make you more likely to get it.

Diagnosis

Your healthcare provider may suspect infectious esophagitis if you have symptoms of esophagitis along with a condition that weakens the immune system.

To make a diagnosis, your healthcare provider may order certain tests:

• Endoscopy. During this outpatient procedure, the gastroenterologist passes a thin, flexible scope through your mouth to examine your esophagus. He or she might take swabs and scrapings to find the cause of an infection if he or she sees signs, such as white patches, fluid-filled blisters, or sores in your esophagus.

• Blood work. Your healthcare provider may test your blood for viruses that can cause infectious esophagitis, such as herpes simplex virus.

Treatment

If you have a healthy immune system, your infection may clear on its own without treatment. How infectious esophagitis is treated often depends on the cause:

• Esophagitis caused by a fungus called Candida. This fungus may be treated with an antifungal medicine called fluconazole or other similar medicines.

• Viral esophagitis may be treated with antiviral medicines, such as acyclovir.

• Bacterial esophagitis may be treated with broad-spectrum antibiotics. These are medicines that work against many types of bacteria.

• Sometimes acid blockers are used along with other treatments.

Complications

Complications are unusual unless you have a condition or disease that weakens your immune system. Complications may include:

• Infection that spreads to other parts of your body

• Scar tissue that forms in the esophagus and causes a narrowing

• Ulcers in the esophagus that lead to bleeding

• A hole in the esophagus called a perforation or fistula

When to call the healthcare provider

Call your healthcare provider if you have any questions about your medicines or any other aspect of your treatment. Let your healthcare provider know right away if you have:

• Increased difficulty swallowing

• Pain with swallowing

• Symptoms of infection, such as chills or fever

• Chest pain or difficulty breathing

Living with infectious esophagitis

While you are recovering from infectious esophagitis, work closely with your healthcare provider and keep all your follow-up appointments.

If you have ongoing symptoms of painful or difficult swallowing, your healthcare provider may suggest that you take these steps:

• Stop smoking.

• Avoid alcohol and caffeine.

• Avoid over-the-counter medicines that may irritate your esophagus, such as aspirin or ibuprofen.

• Avoid foods or beverages that give you heartburn.

• Lose weight if you are overweight.

• Eat smaller meals more often.

• Avoid eating for 3 hours before you go to bed.

• Avoid sleeping in a flat position. Elevate the head of your bed several inches.

Esophageal ulcer, symptoms, diagnosis and treatment | Alpha

Esophageal ulcer: symptoms and treatment

An esophageal ulcer is an area of ​​mucous membrane damaged by ingestion of gastric juice. Ulceration can be acute or chronic. A mucosal defect occurs as a result of gastroesophageal reflux, therefore, treatment is aimed at eliminating the causes of gastric acid reflux into the esophagus. Sometimes the disease can also be associated with the pathology of the vessels of the esophagus.

The prognosis for maintaining the ability to work is favorable, the disease does not pose a threat to the patient’s life, but reduces its quality. Esophageal ulcers are treated by a gastroenterologist or therapist.

Causes of the disease

Distinguish between symptomatic and peptic (true) ulcers.

Causes of peptic pathology:

• Gastroesophageal reflux disease (GERD).
• Diaphragmatic hernia of the esophagus.
• Stomach operations.
• Systemic scleroderma.
• Insufficiency of the cardiac stomach.

Diseases of the digestive tract, leading to a decrease in the tone of the gastric wall.

Symptomatic ulcers are less common than peptic ulcers and are diagnosed in the absence of GERD. Possible causes of pathology:

• Viral infection (tuberculosis, HIV, cytomegalovirus, herpes, etc.)etc.).
• Tumor of the esophagus, causing mechanical compression of the organ.
• Autoimmune processes (Behcet’s syndrome, Sjogren’s disease).
• Deep burns of the mucous membrane, sepsis.
• Long-term use of a gastric tube.

The causes of acute ulcers of the esophagus are most often operations and diseases with profuse vomiting. Chronic pathology develops against the background of other systemic health problems.

Symptoms of an esophageal ulcer

The disease has a characteristic clinical picture. Symptoms of an esophageal ulcer are chest pain, heartburn, impaired swallowing function, nausea. As a result of insufficient nutrition, the patient loses weight. When the defect is located near the cardiac sphincter, pain in the esophagus is often confused with symptoms of angina pectoris. If ulceration persists for a long time, narrowing of the lumen and frequent regurgitation of food immediately after eating is possible.

Severe heartburn is one of the characteristic symptoms of an esophageal ulcer in the early stages of development.The intake of acidic gastric juice is high. Many patients experience relief from heartburn only after vomiting.

In the absence of treatment, the defect grows, complications arise. The most dangerous condition is perforation of the esophageal wall into the mediastinum (mediastinitis), into the abdominal cavity (“acute abdomen” state, into the pleural cavity (pleurisy), into the aorta (rarely profuse bleeding).

Diagnosis of esophageal ulcer

You need to see a doctor immediately after the first symptoms appear.Early diagnosis of ulcers is the key to successful treatment.

The patient is prescribed a comprehensive examination:

• Radiography with contrast. The picture shows signs of mucosal ulceration, concomitant pathologies are determined: hiatal hernia, esophagitis.
• Endoscopy. The main method for diagnosing esophageal ulcers. With the help of a video camera, the doctor examines the lining of the esophagus, conducts an edge biopsy for the differential diagnosis of cancer.According to the results of endoscopy, the type of ulcer is determined: focal (up to 10 mm in diameter, without changes in peristalsis and motility), deepened (up to 10 mm, high edges), flat-infiltrative (boundaries are hyperemic, fibrin at the bottom of the defect).
• Daily measurement of acidity. The survey results suggest GERD.
• General blood analysis. Data are needed to determine comorbid conditions.
• Coprogram. A fecal occult blood test is prescribed.

Treatment of esophageal ulcer

Diet

The patient’s food should be fractional, in small portions, without overeating. It is recommended to adhere to the therapeutic diet No. 1a or No. 1b according to Pevzner, but the doctor can make adjustments to the menu taking into account the characteristics of a particular clinical case. All food should be boiled or steamed. Exclude spicy, sour, fried foods, any food that can irritate the mucous membrane.

Drug treatment

The patient is prescribed a complex of drugs aimed at protecting and healing the mucous membrane:

• Antacids that reduce the activity of H + ions.
• Drugs that normalize the acidity of gastric juice.
• Prokinetics, which increase the tone of the gastric wall, eliminate congestion.
• Antibacterial drugs (if H. pylori has been detected).
• Vitamins and fortifying agents.

Herbal sedatives if the ulcer is associated with prolonged stress.

Diagnostics and treatment of esophageal ulcers in Nizhny Novgorod

We invite you to undergo a full examination at the modern clinic “Alpha-Health Center”.We use the latest digital equipment and our own laboratory facility for accurate diagnosis of esophageal ulcers. You can make an appointment with a doctor by calling the phone number listed on the website.

Esophageal ulcer (K22.1)> MedElement Disease Handbook> MedElement

Endoscopy
Esophagoscopy is the main method for verifying the diagnosis. However, when prescribing this study to elderly people, contraindications to it should be taken into account: IHD, high arterial hypertension, severe spondylosis Spondylosis is a chronic disease characterized by dystrophic changes in the discs, joints and ligamentous apparatus of the spine with the formation of coracoid and styloid osteophytes (pathological bone growths) along the upper and the lower edges of the vertebral bodies.
thoracic spine and others.

Three forms of esophageal ulcers are described:

1. Focal ulcer – a small ulceration (0.3-1 cm in diameter) with clear, even, not raised edges. Peristalsis preserved, rigidity Rigidity – numbness, stiffness.
walls are missing.

2. A deep ulcer has a larger size (diameter 0.5-3 cm) with clear, even edges, rising above the surrounding tissue, the peristalsis is preserved.

3. Plasoinfiltration ulcer – looks like a flat infiltrate Infiltrate is a tissue site characterized by an accumulation of cellular elements usually not characteristic of it, increased volume and increased density.
0.3-3 cm in diameter with clear boundaries, hyperemic

edges covered with fibrin.

For differential diagnosis with esophageal cancer for all ulcers, a biopsy of the esophageal mucosa with subsequent histological examination is required.

X-ray examination
The main X-ray sign of an esophageal ulcer is a “niche” (ie, a round or triangular protrusion on the contour of the esophageal shadow), and often there is convergence of folds of the esophageal mucosa towards the ulcer. X-ray examination does not always reveal an ulcerative niche, however, when it is carried out, a hernia of the esophageal opening of the diaphragm, gastroesophageal reflux and a complication of an ulcer – esophageal stricture are detected with a high degree of reliability.An indirect sign of an ulcer is a persistent contrast spot on the inner surface of the esophagus after the passage of barium suspension through it.

Peptic ulcer – MC “LOTOS”

Pirogova Irina Yurievna

Deputy chief physician for organizational and methodological work, head of the center of gastroenterology and hepatology, gastroenterologist

What is a peptic ulcer?

A peptic ulcer is a wound in the lining of your stomach or duodenum.The duodenum is the first section of your small intestine. A peptic ulcer located in the stomach is called a stomach ulcer. A peptic ulcer located in the duodenum is called a duodenal ulcer. A peptic ulcer can also develop in the section of your digestive tract just above your stomach – the esophagus, which is the tube that connects your mouth and stomach. However, most peptic ulcers form in the stomach or duodenum.

Many people have peptic ulcers. You may have a stomach ulcer and a duodenal ulcer at the same time, and ulcers may occur more than once in your lifetime.

Peptic ulcers are successfully treated. First, you should see your doctor.

What causes peptic ulcers?

Most peptic ulcers are caused by:

• Helicobacterpylori (H.pylori) – bacteria that cause infection
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen

H. pylori is the most common cause of peptic ulcers. Doctors believe that H. pylori can be spread through dirty food or water, or mouth-to-mouth, such as kissing. Although many people are infected with H. pylori, most never develop an ulcer. NSAID use is the second most common cause of peptic ulcers.But not all people taking NSAIDs develop peptic ulcers. NSAID ulcers are most commonly found in humans

• over 60 years old
• female
• long-term NSAIDs
• who have had an ulcer before

Other causes of peptic ulcers are rare. One of the rare causes is Zollinger-Ellison Syndrome, a condition in which the body produces too much stomach acid, which damages the lining of the stomach or duodenum.

Stress or spicy foods do not cause peptic ulcers, but they can make the ulcers worse or prevent them from healing.

What are the symptoms of peptic ulcers?

A dull or burning pain in the stomach is the most common symptom of peptic ulcers. You can feel pain anywhere from your belly button to your sternum. Pain often

• appears between meals or at night
• stops quickly with food or antacids
• lasts from a few minutes to several hours
• appears and continues for several days or weeks

Other symptoms of peptic ulcers may include

• weight loss
• poor appetite
• bloating
• burp
• vomiting
• stomach discomfort

If you experience even mild symptoms, you may have a peptic ulcer.You should visit your doctor to discuss your symptoms with them. The course of peptic ulcers worsens without treatment.

Call your doctor right now if you have

• sudden sharp pain in the stomach that does not go away
• black or bloody stools
• Bloody or vomit that looks like coffee grounds

These symptoms may be signs that ulcer

• damaged blood vessel
• passed through the wall of your stomach or duodenum, i.e.e. perforated it
• interferes with the passage of food from your stomach into the duodenum

These symptoms must be treated urgently. You may need surgery.

How is peptic ulcer diagnosed?

Tell your doctor about your symptoms and what medications you are taking. Be sure to tell about any drugs you are taking without a prescription, for example, if these drugs are NSAIDs.

Your doctor will test your blood, breath, and stool to find out if you are infected with H. pylori. About half of all people with NSAID ulcers are also infected with H. pylori.

Your doctor may also decide to examine the lining of your stomach and duodenum with an endoscopy or by taking a series of images of the upper gastrointestinal tract (GIT), the latter being a type of x-ray.Both procedures are painless.

During the endoscopy, you will be given a relaxation medication. The doctor will then insert an endoscope – a thin, tube equipped with a light source with a miniature camera – through your mouth and into your stomach and duodenum. Also during the procedure, your doctor may take a small piece of tissue – no larger than a match head – to examine under a microscope. This process is called a biopsy.

To take a series of upper GI images, you will need to drink a liquid suspension called barium.Barium will make your stomach and duodenum visible on x-rays.

How are peptic ulcers treated?

If you have peptic ulcers, they need to be treated. Depending on the cause of the ulcer, your doctor may prescribe one or more of the following medications:

• proton pump inhibitor (PPI) or histamine receptor blocker (h3 blocker) to reduce gastric acid production and protect the mucous membrane of the stomach and duodenum
• One or more antibiotics to kill H.Pylori
• A preparation containing bismuth subsalicylate to coat ulcers and protect them from stomach acid These preparations will relieve pain and promote healing of ulcers.

If your peptic ulcers are caused by taking NSAIDs, your doctor may advise you

• stop taking NSAIDs
• Reduce the dose of NSAIDs you are taking
• take PPI or h3 blocker with NSAID
• switch to another drug that will not cause ulcers

You must take

• only drugs prescribed by a doctor
• all drugs, exactly following the instructions of your doctor, even if the pain has passed

Tell your doctor if any medications cause you nausea, dizziness, diarrhea, or headaches.Your doctor may prescribe other drugs for you.
And if you smoke, then quit smoking. You should also avoid drinking alcohol. Smoking and drinking alcohol slows the healing of ulcers and can make them worse.

Can antacids or milk help heal peptic ulcers?

Neither antacids nor milk can heal peptic ulcers, although any of these can give a feeling of short-term improvement. Talk to your doctor before taking antacids or drinking milk while your ulcers are healing.

Some antibiotics used to eradicate H. pylori may not work well with antacids. Although antacids can temporarily relieve ulcer pain, they cannot kill the H. pylori bacteria. Only antibiotics can do this.

Many people are used to thinking that drinking milk helps heal peptic ulcers. But now, doctors know that while milk can temporarily improve the well-being of ulcers, it also increases the secretion of stomach acid.Excess stomach acid makes the ulcer worse.

What to do if peptic ulcers do not heal?

In most cases, drugs will heal ulcers. If your ulcers are associated with H. pylori infection, you must complete all antibiotic treatment and all other medications prescribed by your doctor. Clearing the infection and healing the ulcers will only happen if you take all your medications as prescribed.

When you are finished taking your medications, your doctor will take a breath or stool test to make sure the H. Pylori infection has been cleared. Sometimes H. pylori bacteria continue to remain in the body even after the patient has taken all the drugs correctly. If this happens, your doctor will prescribe other antibiotics for you to get rid of the infection and heal the ulcers.

In rare cases, surgery is needed to heal ulcers. Surgery may be required if your ulcers

• do not heal
• relapse
• bleed
• Perforate the wall of the stomach or duodenum
• prevent the passage of food from the stomach

Possible during operation

• removal of ulcers
• decrease in the amount of acid produced in your stomach

Can peptic ulcers recur?

Yes.If you smoke or take NSAIDs, your ulcers may recur. If you need NSAIDs, your doctor may prescribe another drug or additionally prescribe drugs to prevent ulcers.

What can I do to prevent peptic ulcers?

To prevent H. pylori ulcers

• Wash your hands with soap and water after using the toilet and before eating
• Eat only clean and properly prepared foods
• Drink only clean water from safe sources

To prevent ulcers caused by NSAIDs

• stop taking NSAIDs if possible
• if you are shown to take NSAIDs, then take NSAIDs with food
• Take lower doses of NSAIDs
• Talk to your doctor about medications that may protect your stomach and duodenum when taking NSAIDs
• Consult your doctor about transferring you to a drug that does not cause ulceration

Things to Remember

• A peptic ulcer is a wound in the lining of the stomach, duodenum or esophagus.
• The bacterium Helicobacterpylori (H. pylori) is the most common cause of peptic ulcers.
• The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen is the second most common cause of peptic ulcers.
• Neither stress nor spicy foods cause peptic ulcers. But, like smoking or drinking alcohol, they can worsen the course of ulcers or prevent them from healing.
• If ulcers are caused by H. pylori, antibiotics are required to eradicate the microorganism.
• If your ulcers are caused by NSAIDs, your doctor may consider prescribing a more appropriate treatment for you.
• Drugs that reduce the production of stomach acid and protect the mucous membrane of the stomach and duodenum, promote the healing of ulcers.

Prevention measures for ulcers due to H. pylori infection include:

• Washing hands after using the toilet and before eating
• eating properly prepared food
• Drinking clean water from safe sources

Prevention measures for ulcers associated with NSAID use include:

• Stop taking NSAIDs, if possible
• taking NSAIDs with food
• taking lower doses of NSAIDs
• Consultation with your doctor about medications that can protect your stomach and duodenum while taking NSAIDs
• Consultation with your doctor regarding transferring you to a drug that does not cause ulceration.

Gastroesophageal reflux disease – causes, symptoms, diagnosis and treatment

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Gastroesophageal reflux disease: causes, symptoms, diagnosis and treatment.

Definition

Gastroesophageal reflux disease (GERD) is a chronic recurrent disease caused by a violation of the motor-evacuation function of the organs of the gastroesophageal (gastroesophageal) zone. It is characterized by the regularly repeated throwing of stomach contents into the esophagus and, in some cases, the contents of the duodenum, which leads to damage to the mucous membrane of the lower esophagus with the development of reflux esophagitis – inflammation of the esophageal mucosa.As a result, in some patients, the normal stratified squamous epithelium of the esophagus is replaced with a columnar epithelium resembling the mucous membrane of the stomach or small intestine (columnar metaplasia, Barrett’s esophagus), which is a precancerous condition and requires careful monitoring and treatment.

Causes of GERD

Gastroesophageal reflux disease is an acid-dependent disease in which hydrochloric acid in the stomach damages the lining of the esophagus.

Normally, the acidity ( pH ) of the stomach is 1-2, and the lower third of the esophagus is 5.5-7.

Pathological reflux – the reflux of the contents from the stomach into the esophagus, at which the pH of the esophagus becomes less than 4, arises from the insufficiency of the lower esophageal sphincter (the locking mechanism, which normally “passes” the contents only from the esophagus into the stomach, and not vice versa).

With GERD, there is a pathologically high frequency and / or duration of episodes of the reflux of stomach contents into the esophagus.The integrity of the esophageal mucosa is due to the balance between the factors of aggression (hydrochloric acid) and the ability of the mucous membrane to resist the damaging effect of the thrown stomach contents during gastroesophageal reflux (GER). Disruption of this balance in a significant proportion of patients is accompanied by a significant slowdown in the recovery of pH in the distal (lower) esophagus after each episode of reflux. Violation of clearance (cleansing) of the esophagus develops as a result of a combination of several factors: weakening of the peristalsis of the thoracic esophagus, decreased secretion of saliva and mucus.The mucus layer is one of the key components of the chemical cleansing of the esophagus and restoring the pH to normal levels.

A significant increase in gastric acid secretion increases the risk of GERD.

In the vast majority of patients, reflux episodes occur mainly during transient relaxation of the lower esophageal sphincter, during which the antireflux barrier between the stomach and the esophagus disappears for 10-15 seconds, regardless of the act of swallowing.

Episodes of gastroesophageal reflux can develop with normal pressure values ​​of the lower esophageal sphincter. The mechanism of GER in these cases is associated with a high pressure gradient between the stomach and the esophagus due to various reasons: impaired evacuation of contents from the stomach, high intra-abdominal pressure (for example, in obesity, pregnancy, especially in the third trimester, constipation, wearing tight belts, belts).

Classification of GERD

Depending on the clinical manifestations GERD , esophageal and extraesophageal manifestations of the disease are distinguished (Montreal classification).

• Esophageal manifestations – heartburn, belching, regurgitation, odinophagia (discomfort, pain behind the breastbone when swallowing, associated with the passage of food through the esophagus), as well as endoscopic manifestations of the disease.
• Extraesophageal manifestations of GERD – chronic cough associated with reflux, sore throat and sore throat, hoarseness due to damage to the vocal cords, bronchial asthma, tooth damage.

However, for the most part, doctors use the endoscopic classifications – Los Angeles and Savary-Miller.

Los Angeles Endoscopic Classification :

Grade A. The endoscopic picture shows one (or more) lesions of the mucous membrane (erosion or ulceration) less than 5 mm long, limited by the fold of the mucous membrane.

Grade B. The endoscopic picture reveals one (or more) lesions of the mucous membrane longer than 5 mm, limited by the folds of the mucous membrane.

Degree C. The endoscopic picture reveals a lesion of the mucous membrane, which extends to two or more folds of the mucous membrane, but occupies less than 75% of the circumference of the esophagus.

Grade D. The endoscopic picture reveals a lesion of the mucous membrane, which extends to 75% or more of the esophagus circumference.

In the Los Angeles classification, erythema and edema of the esophageal mucosa are not considered signs of reflux. More than 80% of patients with GERD have grade A or B esophagitis. Grade D esophagitis occurs only in 5-6% of cases of erosive GERD.

Endoscopic classification of esophagitis by severity according to Savary-Miller :

I degree.There are isolated non-confluent erosion and / or erythema of the distal esophagus.

II degree. Merging erosions are observed that do not capture most of the mucous membrane.

III degree. Erosive lesions of the lower third of the esophagus are observed, merging and covering the entire surface of the esophageal mucosa.

IV degree. There is a chronic ulcer of the esophagus, cylindrical (gastric or intestinal) metaplasia of the mucous membrane of the esophagus (Barrett’s esophagus).

Symptoms of GERD

Patients with gastroesophageal reflux disease are characterized by complaints of heartburn (about 80% of patients), belching (about 50% of patients), discomfort or chest pain (about 20% of patients), which occurs when swallowing food. Symptoms often make themselves felt at night, which significantly reduces the quality of life of patients.

The appearance of heartburn is associated with prolonged contact of acidic gastric contents with the mucous membrane of the esophagus.It is usually exacerbated by inaccuracies in diet, drinking alcohol, carbonated drinks, physical exertion, bending over, and lying down.

Belching may be worse after eating or drinking carbonated drinks.

Difficulty swallowing and chest pain may be caused by hypermotor dyskinesia of the esophagus (esophagospasm) and / or acid irritation of the damaged esophageal mucosa in the presence of erosions or ulcers.

An increase in the risk of the incidence of bronchial asthma, as well as the severity of its course in patients with GERD (gastroesophageal reflux is detected in 30–90% of patients with bronchial asthma).

Aggressive stomach contents can damage tooth enamel. In patients with GERD, caries, dental erosion and even aphthous stomatitis are more often diagnosed.

Diagnosis of GERD

The diagnosis of “Gastroesophageal reflux disease” can be established on the basis of characteristic complaints, history of the disease, as well as the results of instrumental examination: esophagogastroduodenoscopy (EGDS), intraesophageal pH-meter and pH-impedance meter.

EGDS is the main method for instrumental diagnosis of GERD and its complications.In addition, it is possible to identify anatomical features and factors predisposing to the throwing of contents from the stomach into the esophagus: insufficiency of the cardia of the stomach, hernia of the esophageal opening of the diaphragm.

Patients with no effect with adequate therapy, as well as in the presence of complications, undergo a biopsy of the esophagus with a histological examination to clarify the diagnosis.

X-ray examination of the esophagus is not used for the direct diagnosis of GERD, but it can detect hiatal hernia, diffuse esophagospasm, and esophageal strictures.

Daily intraesophageal pH -metry allows you to estimate the cumulative time during which pH is less than 4, the total number of refluxes per day, the number of refluxes lasting more than 5 minutes, the duration of the most prolonged reflux. Daily pH -metry can help in establishing a diagnosis, in the selection and assessment of the effectiveness of drug therapy in a patient with GERD.

pH – impedance measurement – registration of reflux based on the measurement of resistance (impedance), which provides an electric current with the contents that enter the lumen of the esophagus.This method establishes episodes of reflux into the esophagus, regardless of the value of pH of refluctate, and also records the time during which the esophagus is released from the contents that got during reflux. In this case, the acidity of the refluctate (acidic, slightly acidic, slightly alkaline) is determined by pH sensors. The study can be useful for patients with suspected extraesophageal manifestations of GERD, as well as for the selection of drugs, adjusting their dosage and time of administration.

Which doctors should I contact for GERD

General practitioners, general practitioners and gastroenterologists are involved in the examination and treatment of patients with suspected GERD or with a confirmed diagnosis of GERD.

With extraesophageal manifestations of GERD, you may need to consult a cardiologist, pulmonologist, ENT specialist.
With the ineffectiveness of adequate drug therapy, the addition of complications, the question of surgical treatment may arise.

Treatment of GERD

Treatment of GERD involves not only special medical care, but also dietary nutrition, smoking cessation, alcohol abuse. It is important to avoid overeating; refrain from eating at least 3 hours before bedtime.At the same time, it is not recommended to increase the number of meals – it is more correct to observe three or four meals a day without snacks. It is advisable to avoid eating tomatoes in any form, sour fruits and berries, fatty foods, chocolate and coffee. It is worth limiting foods that increase gas formation: whole milk, brown bread, cabbage, legumes, apples, grapes, etc. It is recommended to limit the consumption of very hot or cold food and carbonated drinks as much as possible.

Situations that increase intra-abdominal pressure should be avoided: wearing tight belts and corsets, lifting weights, working in an incline, physical exercises associated with overstraining the abdominal muscles.

Patients who are concerned about heartburn while lying down can be advised to raise the head of the bed by 15-20 cm.

Some cardiac drugs – calcium antagonists of the nifedipine group, nitrates, as well as progesterone, antidepressants reduce the tone of the lower esophageal sphincter and can aggravate gastroesophageal reflux. Non-steroidal anti-inflammatory drugs (pain relievers) can themselves cause inflammation, the formation of erosions and ulcers of the mucous membrane of the esophagus, stomach and duodenum.Patients with comorbid GERD should discuss with their doctor the possibility of discontinuing these drugs.

The most effective drugs for the treatment of GERD today are proton pump inhibitors.

By reducing the production of hydrochloric acid in the stomach, they reduce its aggressive effect on the mucous membrane, thereby helping to reduce inflammation, and heal erosions and ulcers. For complete healing, a course reception of at least 4 weeks is usually required.

In case of rare heartburn and in the absence of esophagitis, the use of drugs from the group of antacids and alginates is sufficient to quickly eliminate symptoms. They neutralize hydrochloric acid, envelop the mucous membrane, forming a film that protects it from damage. Their action is short-lived, so they are used for symptomatic therapy.

Prokinetics enhance the motility of the esophagus and stomach, improve esophageal clearance, increase the tone of the lower esophageal sphincter. Usually used in a course of about 2 weeks in combination with proton pump inhibitors.

With a complicated course of the disease (repeated bleeding, esophageal strictures, in some cases – the development of Barrett’s esophagus), patients may be shown surgical treatment – fundoplication. Its essence lies in strengthening the sphincter, for which part of the stomach is sutured to the esophagus.

Complications

Complications of GERD include ulcers of the esophagus, bleeding caused by erosive and ulcerative lesions of the mucous membrane, as well as peptic stricture (narrowing of the lumen of the esophagus) and Barrett’s esophagus, which increases the risk of developing adenocarcinoma (malignant tumor) of the esophagus.

Therefore, the main role in the prevention and early diagnosis of esophageal cancer is played by the timely diagnosis and effective treatment of Barrett’s esophagus.

Among the risk factors for the development of complications, the most important are the frequency and duration of symptoms, in particular heartburn, the severity of erosive esophagitis, the frequency of its recurrence, the presence of a hiatal hernia, obesity, the presence of nocturnal refluxes.

Prevention of GERD

To prevent the development of GERD, it is recommended to avoid weight gain, quit smoking, alcohol abuse, and adhere to a healthy diet.

Sources:

1. Ivashkin V.T., Maev I.V., Trukhmanov A.S., Lapina T.L. et al. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of gastroesophageal reflux disease. Russian journal of gastroenterology, hepatology, coloproctology. 2020; 30 (4): 70–97. https: // doi.org/10.22416/1382-4376-2020-30-4-70-97.
2. Sereda N.N. Gastroesophageal reflux disease. Siberian Medical Journal. No. 4, 2014. S. 133-139.

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Peptic ulcer: symptoms, causes, diagnosis, treatment

Peptic ulcer: symptoms, causes, diagnosis, treatment

Peptic ulcer is a disease characterized by ulcerative lesions of the mucous membrane of the stomach, duodenum or lower esophagus.In more than 50% of cases, pathology chooses the duodenum.

At first, the patient does not suspect that he is sick, because he does not feel a deterioration in health. Later, symptoms such as hunger pains, a burning sensation in the epigastric region appear. If the ulcer is on the back wall of the duodenum, then the patient complains of pain in the thoracic spine. Typically, the pain becomes more intense between meals or at night. After small portions of food, there is a feeling of overeating.Sometimes vomiting occurs.

The ulcer itself is not dangerous, but it can cause serious consequences. For example, bleeding, damaging blood vessels, resulting in anemia due to iron deficiency. Scars formed at the site of a healed ulcer can interfere with the patency of the duodenum. There are cases, fortunately, they are very rare, when hydrochloric acid eats away at the walls of the stomach thinned by an ulcer (perforated ulcer). As a result, the contents of the stomach enter the abdominal cavity, causing dangerous inflammation.

That is why a patient with a peptic ulcer who has symptoms such as vomiting blood or in the form of “coffee grounds”, black stools, weakness, chills and sweating, low blood pressure, tension in the abdominal muscles, an attack of acute pain, needs to urgently seek medical help.

Causes of peptic ulcer

The stomach produces hydrochloric acid and the enzyme pepsin, which break down protein. Excessive secretion of these substances (especially hydrochloric acid) or insufficient mucosal protection from their effects can provoke the formation of ulcers.Normally, the gastric mucosa is covered with an additional layer of mucus, which neutralizes hydrochloric acid and provides the organ with full-fledged work.
In addition, the formation of ulcers can be the result of prolonged use of drugs. These are mainly non-steroidal anti-inflammatory drugs. But this does not mean that drugs that irritate the gastric mucosa provoke the development of peptic ulcer in every patient taking them.

Until recently, it was believed that stress, smoking, alcohol, hot spices cause pathology.Although all of the above contributes to the development of peptic ulcer disease, the leading role in the emergence of the disease today is attributed to the bacteria Helicobacter Pylori. It has the unique ability to adapt to the extreme conditions of the stomach and duodenum. It is found in almost every patient suffering from duodenal ulcer, and in 80% of cases in patients with stomach ulcers. There is an assumption that it is transmitted by direct contact.

Diagnosis of peptic ulcer

Today, the methods of radiological and contrast examinations of the stomach and duodenum, the essence of which is to swallow a contrast agent filling the esophagus and parts of the gastrointestinal tract, are not used.

Recently, the method of fibrogastroscopy has been used to detect peptic ulcer disease. This method allows not only to consider any changes in the mucous membrane using a special device of the gastroscope, but also to take a tissue sample for further study. With its help, you can identify the bacteria Helicobacter Pylori. The presence of bacteria in the body is also determined using a blood test.

Peptic ulcer treatment

Since the causative agent of the disease is often the bacterium Helicobacter Pylori, the treatment is based on suppressing its vital activity with the help of antibiotic therapy.Treatment, in addition to taking antibiotics, includes the simultaneous use of drugs that reduce the secretion of gastric juice. The duration of the course is only 1-2 weeks.
Patients report significant relief when taking drugs that neutralize the acidity of the stomach.

Advances in the treatment of peptic ulcer with drugs have led to the fact that the surgical method is practically not used. Only in severe cases of the disease is surgery indicated, for example, bleeding, obstruction or perforated ulcer.

Patients are advised to follow a diet. Milk should be excluded from the diet, which, although it relieves an attack of pain for a while, stimulates the production of gastric juice. It is necessary to forget about smoking: ulcers in smokers heal more slowly and are more often exacerbated. Do not overuse non-steroidal anti-inflammatory drugs such as aspirin, which can damage the stomach lining.

Peptic ulcer disease is still considered a serious disease, so it cannot be underestimated and treated on its own.Only the qualified help of a specialist is the key to a complete recovery.

90,000 ᐈ Diagnosis of gastric ulcer in St. Petersburg

Stomach ulcer is one of the most serious diseases of the digestive tract. The prevalence in the population of this pathology is about 2-3%, and among patients of gastroenterological hospitals it accounts for 37-39%. But the true incidence is somewhat higher, because not all patients seek medical help and undergo a full and timely diagnosis of stomach ulcers.

When They Talk About Stomach Ulcer

In medicine, a stomach ulcer is a local defect in the mucous membrane in any part of the stomach. She is prone to a chronic recurrent course with the formation of coarse sclerosing edges. The inflammatory-necrotizing process often spreads to the submucosa and even to the muscle layer, and healing proceeds with scarring of tissues. This is the key difference between ulcers and erosion. Massive and rough post-ulcer scarring can even lead to deformity of the stomach, but characteristic stellate or linear scars are more common.

In most cases, chronic ulcers are found in the lower part of the lesser curvature of the stomach, in the area of ​​the pyloric muscle ring. Sometimes there are “kissing” ulcers. They are located at the same level on the opposite walls of the stomach and touch when it is emptied. Acute multiple defects can occur in any part of the organ.

If the appearance of an ulcer is due to endogenous (internal) factors, they talk about the development of gastric ulcer.Moreover, in this case, concomitant ulcerative defects are often found in the duodenum. If damage to the mucous membrane is associated with the action of a specific factor, we are talking about a symptomatic ulcer. But in everyday clinical practice, such distinctions are rarely used, because in most cases a combination of several unfavorable factors is revealed in one person. It is their combination that often becomes the decisive moment for starting the pathological process in the stomach wall.

Why does a stomach ulcer occur

There are many reasons for the appearance of stomach ulcers.

In more than 1/3 of cases, the main damaging factor is the helical bacterium Helicobacter pylori. Moreover, infection of a person does not mean that he will necessarily develop gastritis or an ulcer. Helicobacter pylori begins to show aggression when the protective and regenerative mechanisms are weakened, the enzymatic activity of the gastric juice changes, and other damaging factors join.Helicobacteriosis is widespread in modern society, but in most people it is asymptomatic.

The second most important etiological factor is the ulcerogenic (ulcerative-provoking) effect of medications. This side effect is most pronounced in non-steroidal anti-inflammatory drugs (NSAIDs), especially in the first generations. Also often there are drug-induced stomach ulcers against the background of the use of corticosteroid and caffeine-containing drugs, reserpine, atophan.Initially, erosive gastritis develops, which is able to quickly transform into ulcerative defects.

A stomach ulcer can also be stressful in nature, develop against the background of shock and pain conditions.

What contributes to the appearance of ulcers

Predisposing factors include:

• irrational and irregular nutrition;
• tumors of various localization;

90,015 smoking and alcohol abuse;

• foreign bodies of the stomach;
• endocrine diseases;
• emotional overload, overwork, chronic stress;
• secondary immunodeficiency states associated with chronic infections.

All this does not lead to direct ulceration of the gastric mucosa, but creates conditions for the activation of Helicobacter pylori infection and reduces the resistance of tissues to the action of gastric juice.

Diagnosis of stomach ulcers: why a competent approach is so important

Diagnosis of stomach ulcers is often limited only to visualization of the existing defect. For this, in many medical institutions, X-rays of the digestive organs and FGS are performed.Indeed, these techniques allow identifying ulceration zones, assessing their number, size and depth of the lesion. But, unfortunately, this is not enough for a full diagnosis of gastric ulcer. After all, the doctor needs other information to select the optimal therapy regimen.

The main tasks of diagnostics for stomach ulcers:

• Ulcer detection. In this case, it is important to identify all defects that may be small (only a few millimeters), located deep in the natural folds of the stomach, or be covered with layers of fibrin.
• Assessment of the state of the rest of the surface of the mucous membrane, because the diagnosis of gastric ulcer does not exclude the presence of other abnormalities.
• Assessment of the morphology of adjacent tissues. In the area of ​​the stomach ulcer, inflammatory and necrotic changes, and sometimes areas of cell metaplasia, can be detected. In this case, we will talk about the malignancy (malignant transformation) of the process. That is why peptic ulcer disease is considered a high risk factor for developing cancer.In addition, there are situations when a stomach ulcer appears when a cancerous tumor is destroyed.
• Identification of complications: bleeding from the bottom or walls of the ulcer, penetration or perforation.
• Identification of Helicobacter pylori infection and assessment of the degree of its activity. Such a diagnosis for stomach ulcers helps the doctor to prescribe etiotropic (directed at the cause) treatment.

Do not forget that in case of a stomach ulcer, the diagnosis should not be a single one.Dynamic observation is recommended for a patient with this disease. Annual prophylactic examinations are monitoring the condition of tissues, early detection of relapses, and prevention of cancer.

What is included in the diagnosis of stomach ulcer

A basic comprehensive examination of patients with suspected gastric ulcer or with an already confirmed disease includes:

If necessary, such basic diagnostics are supplemented by other methods, the examination scheme is drawn up by a doctor.

A high degree of reliability of the research is the most important factor in the complete diagnosis of stomach ulcers. Therefore, it is preferable to choose medical facilities with modern equipment and experienced specialists.

In the ICLINIC Digestive Cancer Prevention Center, all studies are carried out using the most modern and safe equipment, with strict adherence to the rules of asepsis and in a comfortable environment for the patient. High professionalism of specialists, an expert class of used gastroscopes, high-quality materials, our own multidisciplinary laboratory – all this makes the diagnostic results highly informative and reliable.

We recommend:

FGDS

Helicobacter pylori (helpil test)

Taking a biopsy for endoscopic examinations

Appointment of a gastroenterologist

Test for the likelihood of stomach cancer

Are you over 45 years old?

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Have your relatives had cancer?

Not really

Do you have chronic diseases of the gastrointestinal tract:

– chronic gastritis,
– peptic ulcer,
– chronic colitis and other inflammatory bowel diseases, 90 100
– Crohn’s disease,
– ulcerative colitis,
– previously identified polyps of the stomach and intestines,
– identified submucosal epithelial formations of the gastrointestinal tract?

Not really

Have you had stomach and intestinal surgeries?

Not really

Do you have cicatricial adhesive changes in the gastrointestinal tract?

Not really

Do you smoke (more than 1 cigarette per day)?

Not really

Do you allow for errors in your diet (low consumption of fruits and vegetables, high consumption of meat and animal fats)?

Not really

You have at least one of the following symptoms:

– overweight,
– difficulty swallowing,
– irritability,
– pallor of the skin,
– chest pain,
– unmotivated weakness,
– sleep disturbance,
– loss of appetite,
– bad breath,
– belching,
– nausea and / or vomiting,
– feeling of heaviness in the abdomen,
– changes in stool (constipation and / or diarrhea),
– traces of blood in the stool,
– abdominal pain.

Not really

Make an appointment

What are the advantages of ICLINIC?

• The highest level of specialists: among them are doctors of medical sciences and members of the world’s medical communities, and the average length of service of the clinic’s doctors is 16 years of impeccable work.

• Modern expert equipment: diagnostic devices of the medical center were released in 2017 by the world’s leading manufacturers (Pentax and others of the same level).

• Impeccable endoscopic diagnostic accuracy thanks to high image resolution of 1.25 million pixels.

• Unique technologies for early diagnosis of cancer, including i-scan – virtual chromoendoscopy. With the help of this technology, even the smallest, initial tumor changes can be recognized.

• Everything for the patient’s comfort: effective pain relief, including general anesthesia; thin endoscopes less than 10mm in diameter; fast and accurate handling.

• Safety: automated disinfection of equipment with quality control, monitoring of vital functions of the patient during research.

• Narrow specialization: the medical center deals with diseases of the digestive system, constantly improving in its particular field. Our specialists are constantly undergoing advanced training, participate in international conferences, trainings and seminars in Russia and Europe.

• Convenient location: Petrogradskiy district of St. Petersburg is located not far from the center.It is convenient to get here both by car and public transport. Chkalovskaya metro station is located very close to the clinic, and also not far from the medical center of St. Petersburg Sportivnaya, Petrogradskaya and Gorkovskaya stations.

Our professionalism is always on guard for your health.

90,000 Treatment, diseases of the digestive system, Sanatorium Elochki.

Sanatorium “Yolochki” of the Ministry of Finance of the Russian Federation

Treatment of Diseases of the Digestive System

Spa treatment program No. 4

Indications: Diseases of the esophagus: esophagitis, gastroesophageal reflux, achalasia of the cardiac part, ulcer of the esophagus; Diseases of the stomach: stomach ulcer, duodenal ulcer, gastritis and duodenitis;

Bowel diseases: irritable bowel syndrome, constipation, peritoneal adhesions, etc.; Liver diseases: chronic hepatitis, etc.; Diseases of the gallbladder, biliary tract and pancreas:

cholelithiasis, gallbladder stones, cholecystitis, cholangitis, chronic pancreatitis, etc.

Age category: adults

Conditions of provision: sanatorium-resort and outpatient-resort

Contraindications:

1. All diseases of the digestive system in the acute phase.

2. Cicatricial narrowing of the esophagus and intestines with impaired patency; the structure of the common bile duct and the gallbladder duct.

3. Peptic ulcer of the stomach and duodenum in the acute phase, complicated by pyloric stenosis, repeated bleeding that occurred in the previous 8-10 months, ulcer penetration; suspected malignancy of a stomach ulcer, Solinger-Ellison disease.

4. Gastritis: rigid, antral, Menetrie’s disease (hypertrophic gastritis).

5. Complications after surgery on the stomach (non-healing postoperative scar, fistulas, adductor loop syndrome, the so-called vicious circle, severe dumping and hypoglycemic syndromes, atony of the stomach stump, peptic ulcer of the jejunum in the acute phase with a tendency to bleeding and penetration in neighboring organs, exacerbation of chronic postoperative gastritis, pancreatitis, cholecystitis, hepatitis, severe postvagotomy diarrhea).

6. Varicose veins of the esophagus.

7. Enterocolitis with severe malnutrition (depletion).

9. Chronic dysentery, nonspecific ulcerative colitis, chronic colitis with extensive ulcerative or erosive process in the rectum or sigmoid colon, revealed by sigmoidoscopy or colonoscopy, as well as bleeding hemorrhoids.

10. Oncological diseases.

List of medical procedures prescribed for treatment