Treatment of stomach ulcers

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The principle of pathogenetic therapy cannot be fully realized in the treatment of peptic ulcer due to the lack of clarity regarding the nature and causes of this disease. Obviously, given the combined disorders of the nervous, humoral and local mechanisms of digestion in the gastro-duodenal system, therapeutic treatment should be concentrated in the 3 corresponding directions. However, a number of funds simultaneously acts on different pathogenetic mechanisms and thus such a division of the medical factors practically is conditional.
Among therapeutics aimed at aligning mostly local digestive disorders in the gastro-duodenal system include diet and antacids.
In the period of exacerbation most appropriate to hospitalize the patient. It must comply with pruposely the mode with limited physical movements, with the obligatory afternoon refreshment during 1,5 - 2 hours. This mode is necessary for 2-3 weeks and then gradually expand.
The purpose of the diet aims to achieve maximum rest of the stomach in two ways: 1) reduction of the expansionary effects of nutrients on the major glands of the stomach; 2) reducing motor activity and decrease muscle strength gastroduodenal system.
In addition to the secretory and motor effects of food products, it is necessary to take into account the buffer properties of food, i.e., its ability to bind and neutralize hydrochloric acid. All these requirements are satisfied balanced diet that includes sufficient amounts of protein, moderate in carbohydrates and fats. I. C. savoshenko and A. P. Nesterov (1968) is recommended at the beginning of the exacerbation of the most sparing diet with gradual transition to more load diet (1A, 16, I-tables on M. I. Pevzner). The authors consider it expedient to include in the diet of a variety of fats (olive oil, refined sunflower, butter) in the amount of up to 100 g
Diet during exacerbation of the disease must be mechanically and chemically benign, but when flaccid, oligosymptomatic disease I. C. savoshenko and A. P. Nesterov are supporters of the diet without mechanical sparing. At the accompanying pancreatitis amount of protein can increase up to 140 - 150,
G. E. Burchinsky and C. E. Kushnir (1968) believe that the period of appointment of the table 1A in connection with its low calorie content you want to restrict 7-8 days. Whereas the buffer properties of food, nutrition should be a fraction, and frequent (at least 4-6 times), and in the intervals between meals should drink 1/2 Cup of warm milk or butter-milk mixture (2/3 of milk and 1/3 20% cream). Unfortunately, many patients with peptic ulcer disease cannot tolerate milk.
Using radio telemetry were studied antacid properties of various nutrients. It turned out that the food antacids" exceeds in duration of action of known medicinal antacids. The most powerful antacid was milk, several weaker - meat and the bread had a minimal antacid properties (A. S. Belousov and B. G. Abramov, 1970).
FK Menshikov and others (1971) showed that frequent meals with the inclusion of products with active anti-acid properties (buffer activity), can for a few hours to support in a cavity of a stomach condition of averaging and thereby prevent pathological evacuation, the increase in intragastric pressure and the emergence of pain in these patients. According to their data, a fractional power helps to eliminate heartburn and normalization of stool.
The composition of the anti-ulcer diet vegetarian cereals and vegetable pureed soup with milk and cream, meat, chicken, fish (low-fat varieties, in a boiled kind, missed through Mincer or in the form of meat porridge, meat frikadele or chicken and fish quenelles); dairy products: cheese (grated), sweet sour cream (limited), acidophilus milk, curdled milk, kefir (sour), milk, cream, butter; soft-boiled eggs, vegetables boiled mashed, cooked in milk, with the addition of butter; fruit boiled, mashed; raw carrot juice; cereals of rasmani, dairy or with the addition of butter, honey, jam, sugar, fruit candy (individually and limited); white bread, crackers from a white bread, meringue, a dry biscuit, fruit drinks, mashed fresh fruit, jelly (except cranberry), well from dry rose, rhubarb; weak tea (preferably with milk or cream); salt sharply limited.
Broad inclusion of milk and cream in the diet is justified, given their antacid properties.
3-4 weeks diet gradually begins to expand at the expense of transition to meat, chicken and fish with a piece of beef sausages, boiled sausage, scrambled eggs, cereals cereals, boiled vegetables, vegetable salads (without onions!), compote, raw fruits and berries.
In case of stable remission, patients may at some time to move on to a regular diet, eliminating fat soups, borsches and pickle, pork and lamb, duck and goose, smoked and canned in oil and tomato sauce, kvass, beer, sweet or semi-dry wines, vodka. Individually occasionally allowed to resort to dry wines. Caution should be included in the diet of coffee and cocoa with milk, sugar and cream (B. Ya. Persian, 1963).
Timely manner prescribed diet quickly brings relief, pain, reduced diarrhoeal disorders. The therapeutic effect of the diet due to the impact of impaired motor activity of the gastro-duodenal system. Direct examine the effect of diet on kislotoobrazoutei led to negative results (Lennard-Jones, Babouris, 1965).
Tobacco and alcohol should be prohibited patient peptic ulcer disease, and the doctor must not, in this respect, to demonstrate liberalism.
In the foreign literature of the recent years is widely discussed the expediency of application of the diet with ulcers. A number of researchers (Doll, 1964; Buchman, 1969) consider inexpedient the observance of patients ' diet.
Buchman (1969) spent in hospital patients comparative analysis of the effect of "free" and "strict" diets and have not received significant difference in the relief of clinical symptoms in patients of both groups. However, patients in both groups received antacids, milk, and make it difficult for the solution of the question about the benefits of dietary restrictions (Flick, 1969; Stempien, 1969). Patients themselves (respondents 152) and their wives in the survey did not doubt the need for the use of the diet for a long period of time, especially useful for themselves, they believed the milk, boiled eggs, biscuits, butter, baby cereals, cheese (Roth and Caron, 1967).