Treatment and care

The treatment of uncomplicated peptic ulcer should be conservative. To surgical treatment of ulcers use only on strict conditions (see below), and the problem of surgical treatment of ulcer disease surgeon discusses together with the therapist.
In the period of exacerbation most correct is six-, eight-week course of treatment in the hospital. The main types of treatment used in the hospital: in bed, the implementation of which should follow the nurses; health food, drugs - holinoliticescoe funds (see), antacids (see), sedatives (see), thermal procedures. Strict bed rest, which must comply with the patient in the first three weeks of treatment, then gradually expand. Smoking is strictly prohibited. The building of the diet should come from the principles of the so-called mechanical and chemical sparing, i.e. do not initiate secretory function of stomach, reducing motor activity and not to irritate the mucous membrane of the stomach and duodenum. These requirements are met by anti-ulcer diet, worked out in the clinic of medical nutrition. It consists of three diets - diet-1, 1-6 1 (see clinical nutrition). Each of the first two diets are prescribed for 10-14 days early in the course of anti-ulcer treatment. Great importance is adherence to the rhythm (power break from eating no more than 3-4 hours.
To restore the normal functional state of the nervous system to assign different tranquilizers. One of them is widespread tincture of Valerian root (10-12 g / 300 ml of water to drink during the day). Poor sleep appoint diphenhydramine, pipolfen (1/2 -1 tablet at night).
From holinoliticakih designate atropine 0.5 ml of 0.1% solution 2-3 times a day subcutaneously or inside 5-8 drops of 0.1% solution for 30-40 minutes before meals 2-3 times a day; platifillin 0.5 ml of 0.2% solution 2-3 times a day subcutaneously or inside of 10 drops 0.5% solution. Apply also kvataron (inside of 30 mg per day for 3 days; with good endurance of the drug increase the dose up to 180 mg per day, i.e. 60 mg 3 times; treatment 25-30 days). Contraindications to the use holinoliticakih serve glaucoma, organic stenoses privratnika, hypertrophy of the prostate gland.
Widely used in the treatment of peptic ulcer antacids; they have the ability to neutralize acidic gastric content, contribute to the disclosure of the pylorus and accelerate the speed of gastric emptying. The most widely combination of alkalis in the form of a mixture Bourges: sodium sulphate 6 g, sodium phosphate 8 g and sodium bicarbonate 4 g, which dissolve in 1 liter of water. To take should 1/2 Cup for 30 minutes before meals 2-3 times a day. Assign sodium bicarbonate (baking soda) separately does not follow, as the second phase of its actions it enhances the secretory capacity of the stomach. In addition, appoint bismuth 0.5 - 1 g 3 times a day, usually 1-2 tablets after 30 minutes after a meal 3 times a day (to drink warm water). The course of treatment vikalin 2 months. with the subsequent month break and additional course in 4-6 weeks.
Shown by appointment of vitamins in higher dosages (ascorbic acid 300 mg daily inside, thiamine-bromide 50 mg, pyridoxine 50 mg intramuscularly), alternating these injections after 1 day during the course of anti-ulcer treatment.
Blood transfusion is prescribed by the doctor for uncomplicated form of peptic ulcer with indolent course and the General loss of power (75-100 ml of blood with intervals 2-5 days, 3-5 times per course).
From thermal processes often apply compresses, paraffin baths in the epigastric area. Heat therapy is contraindicated in 2-3 months after profuse gastro-duodenal bleeding and absolutely contraindicated for suspected cancer.
At impossibility to place the patient in the hospital should ensure a course of anti-ulcer treatment at home for 4-5 weeks and then switch to a so-called half-antiulcer treatment - patient after the usual working day of the rest of the day staying in bed at home or in the night sanatorium.
Sanatorium-resort treatment are subject to patients with peptic ulcer disease in the stage of remission or damped recrudescence in the absence of pyloric stenosis, penetration, and the inclination to bleeding and suspected malignant degeneration. Following resorts: Zheleznovodsk, Essentuki, Morshyn, Borjomi, Jermuk, Druskininkai, Krainka, Izhevsk Mineral Water, Darasun.

Conservative treatment. Comprehensive pathogenetic therapy of ulcer disease cannot be made, because the mechanism of the disease is not fully disclosed. In the modern view, violation of the nervous, hormonal and local mechanisms of digestion in the gastro-duodenal system play a role in the occurrence of peptic ulcer disease, so when you build a rational therapy should be reported these violations and breaches of other systems. Consequently, two principles should be based on the treatment of peptic ulcer: the complexity and individualization. It is recognized that the treatment of uncomplicated peptic ulcer should be conservative, but in various periods of exacerbation and remission.
In the period of exacerbation of ulcer disease is the most rational 6-8-week course of treatment in the hospital. The main medicinal products used in the hospital: bed rest, healthy food, drugs (tranquilizers, holinoliticescoe, hormonal drugs, antacids, thermal procedures). The first 3 weeks appoint strict bed rest, then it is gradually expanding. Smoking is strictly prohibited.
The diet should be based on the principle of so-called mechanical and chemical sparing (see Dietotherapy): not to initiate secretory function of stomach, reducing motor activity of the gastro-duodenal system, have buffer properties, and to spare the mucous membrane of the stomach and duodenum.
Physiological effect of the main nutrients on the secretory and motor functions of stomach and duodenal ulcers, studied in the laboratory I. P. Pavlov, should be considered when building an anti-ulcer diet. So, unrefined carbohydrates and especially fats inhibit, and proteins stimulate gastric secretion. However, proteins are the most buffer action. Fat reduces motor activity of the stomach, but at long stay in it enhances it. Thus, diet ulcers should include adequate protein, moderate - refined carbohydrates and fats. Now the use of vegetable oil in the amount of 25-40 g for 30 - 40 minutes prior to meal. Shown vitamins (s - 300 mg, B1-50 mg; B6-50 mg / day, And in the average daily dose of 5-10 mg of fish oil). All vitamins in higher doses prescribed for 6-8 weeks, and then move to smaller, preventive doses. Vitamin a increases the protective function of mucous membranes. Vitamin B1 analgesic effect. In addition, it regulates the function of the nervous system, adrenal glands, motility and secretion of a stomach. Salt is limited to 3-5 g at the beginning of treatment. To ensure the buffer steps food shows and certain rhythm in the meal a little after every 3-4 hours. Between meals justified the appointment hourly 1/2 Cup of warm milk or butter-milk mixture (2/3 of milk and 1/3 20% cream).
In the USSR became widespread anti-ulcer diet, consisting of three diets - tables 1A, 16 and 1 (see Tables therapeutic feeding). Each of the first two diets are appointed for 10 - 14 days. The diet of the patient with peptic ulcer disease should be excluded strong tea, coffee and cocoa on the water. You can enable them in low concentrations with sugar, milk and cream. Fast analgesic effect is achieved by timely appointing a doctor and a strict observance of patients ulcer diet.
Effects on the nervous and hormonal systems. The sedative therapy, including tranquilizers, aimed at restoring or reduction of violations of the functional state of the higher brain centres of the brain. Of tranquilizers the most widely chlorpromazine, meprobamate, Elenium and other
Aminazin used courses (2-3 weeks) parenteral 0.5 ml of 2.5% solution before going to sleep in combination with atropine. Meprobamate in the dose of 0.2 g appoint 2 times a day (morning and night) for 10-15 days, in the future only in the morning for 10-15 days, then every other day for weeks and finally 2 receiving the drug during the week. The course of treatment is 4-6 weeks. Fairly widespread ulcers of sedatives received bromine. It is expedient only intravenous its introduction (10% solution in the amount of 5-10 ml within 3-4 weeks), because the intake stimulates gastric secretion. The great value has to be out of alignment night of sleep in patients with peptic ulcer. For these purposes, you can assign a Dimedrol, pipolfen (1/2-1 tablet), tincture of Valerian root (10-12 g / 300 ml), small doses of phenobarbital (0.02 g) in combination with ascorbic acid (0.2 g), and thiamin (0,005 grams).
The complex anti-ulcer treatment play an important role holinoliticescoe funds. To assign for 30-40 minutes before meals and at bedtime. Group m-cholinolytics appoint atropine injection of 0.1% solution of 0.5 ml 2-3 times a day or on the inside of 5-8 drops of 0.1% solution for 30-40 minutes before meals 2-3 times a day; platifillin - 0.2% 0.5 ml solution for injection 2-3 times a day or on the inside of 10-15 drops 0.5% solution. From gangliosidoses means the most widely benzogeksony (0.1-0.2 g inside 2-3 times or subcutaneously 1-2 ml of 2% solution 2-3 times a day for 20-30 days). After injections of the drug, the patient should be in a horizontal position for 30-40 minutes due to the possible occurrence of ortostaticski collapse.
Among n-holinolitikov best action has kvataron (inside of 30 mg per day for 3 days; with good endurance of the drug increase the dose up to 180 mg per day, i.e. 60 mg 3 times; treatment 25-30 days). The drug almost no have side effects. Of the Central anticholinergic action of the most "soft" acts gangleronum. Applied subcutaneously to 2 ml of 1.5% solution 3 times a day, as well as inside of 0.04 g capsules, 1 capsule 3-4 times a day. The course is 3-4 weeks.
Justified the simultaneous appointment of ulcers of ganglionitis and holinolitikov Central action (PP Denysenko).
At repeated courses of treatment with anticholinergic should change as separate products and their combination (due to habituation to them of the body). Contraindications to the use holinolitikov serve glaucoma, organic pyloric stenosis, hypertrophy of the prostate.
DOKSA (desoxycorticosterone) and preparations of liquorice (import bigastro and domestic - liquidicon) have mineralokortikoidna function. Their use is justified by the assumption that the reduction of this function napochechnikov ulcers [Banovic (K. Bojanowicz)]. 3. I. Anushkevichus and Y. M. Alekseenko used 0,5% oil solution DOKSA 2 ml intramuscularly, beginning 1 time a day (5 days), and further through the day. The course of treatment is 20 - 25 injection. The drug dose should be reduced gradually to prevent "withdrawal syndrome". Bigastro and liquidicon appointed dose of 100 mg 3 times for 30 minutes before meals; treatment for 3 weeks. In some patients bigastro causes swelling and other symptoms of heart failure, headaches, heartburn. Drugs mineralokortikoidne functions more shows with a stomach ulcer.
Impacts on local arrangements. Antacids widely used in the treatment of peptic ulcer. They have the ability to neutralize acidic gastric content, contribute to the disclosure of the pylorus and accelerate the speed of gastric emptying. All together leads to a good analgesic effect with ulcers. Antacids are divided into absorbed (absorbable) and nevsasavatmisa (absorbent). The former include sodium bicarbonate (baking soda), calcium carbonate and magnesium oxide (burnt magnesia).
Assign each drug alone is impractical because they have short-term effect; in addition, sodium bicarbonate in subsequent increases secretornuu the stomach's ability calcium carbonate cause constipation, and burnt magnesia - diarrhea. It is most expedient to combine them with other alkali, for example in the form of a mixture Bourges: Natrii phosphorici 8,0, Natrii sulfurici 6,0, Natrii bicarbonici 4,0; dissolve in 1 liter of water. To take should 1/2 Cup for 30 minutes before meals 2-3 times a day.
The second group contains aluminium hydroxide, aluminium phosphate, carbon aluminum. They have a slower neutralizing, adsorption and shielding effects. Single dose of 0.5-1 g
To protect mucous membranes from irritating influence of gastric juice appoint bismuth 0.5-1 g 3 times a day. It is almost deprived of antacid properties, but causes increased mucus discharge and adsorbs pepsin.
Vikalin (foreign drug Roter) has antacid, enveloping and laxative effect. It is administered 1 to 2 tablets after 30 minutes after a meal 3 times a day (to drink warm water). The course of treatment for 2 months. with the subsequent month break, and then assign additional course (4-6 weeks).
Observations indicate the feasibility of the simultaneous appointment of antacids and holinolitikov, as the latter increase their neutralizing capacity.


Freezing (hypothermia) is a method of direct influence on the glandular apparatus of the stomach, widely spread in the USA, now finds few supporters in the absence of advantages over other methods of treatment of peptic ulcer disease and complications (collapse, bleeding, ulceration of the stomach).
Radiotherapy. Body irradiation and the fundus of the stomach reduces the activity of glandular apparatus stomach for up to 2 years. The method cannot be recommended in connection with the well-known influence of x-rays on the function of other systems (endocrine disorders).
Non-specific treatment methods. The use of vitamins - see above.
Blood transfusion influence the reactivity of the organism, cell regeneration, disorders of the nervous and hormonal regulation. Shows patients with uncomplicated form of peptic ulcer with a General loss of power, with a sluggish course of peptic ulcer disease. Pour 75-100 ml of blood intervals 2-5 days, 3-5 times per course. Of the many thermal effects of ulcers most often used warmers, heated wraps, mud applications (temperature 42-44°, 20-30 minutes, every other day, 12-14 procedures for the course), paraffin and other applications on the epigastric region. Often used diathermy. In addition to painkillers actions, heat, affecting reflex by, improves blood circulation, has a beneficial effect on the secretory and motor function of the stomach, relaxes the spastic contractions. If in the application of thermal procedures comes exacerbation of pain (usually after 3-4 procedures), it is necessary to reduce the intensity of the applied treatment, or even to interrupt it for a few days. Heat therapy is contraindicated in 2-3 months. after profuse gastro-duodenal bleeding and absolutely contraindicated with suspected cancer. Occult bleeding are not a contraindication to the use of the thermal procedures.
Hydrotherapy can start with 2-3 weeks antiulcer treatment. Different complexes therapeutic exercises should be started in bed after acute nephritis phenomena. Contraindications - acute gastro-duodenal bleeding.
At impossibility to place the patient in the hospital should ensure a course of anti-ulcer treatment at home for 4-5 weeks and then switch to a so-called half-antiulcer treatment - patient after the usual working day of the rest of the day staying in bed at home or in the night sanatorium.
During remission all patients with peptic ulcer disease should be under medical supervision. If after the course of treatment remain functional disorders of the gastro-duodenal system, incomplete scarring of ulcerous defect, then the treatment should be continued until the complete disappearance of these violations. Prohibit Smoking, drinking alcoholic beverages. Treatment of opportunistic diseases, sanitation of the oral cavity.
To prevent recurrence of the disease is set to the correct organization of work and life. Within a year after the exacerbation of ulcer disease the patient should follow a certain diet. The meal should be frequent and fractional (4-5 times a day). Exclude from a diet food substances, mechanical irritant to the stomach and having a strong sokogonnym action (coarse fiber, smoked products, fried foods, strong meat, vegetables, mushroom Navara, coffee, cocoa, made with water, salty foods, onions, garlic). If within 1.5 years after the treatment the patient no complaints and the examination is not detected signs of "irritation" of the stomach or duodenum, conduct a gradual transfer to the usual diet with some restriction rough and having sokogonnym effect of food substances. Interruptions in the food should be not more than 4 hours.
Further, even in the absence of complaints should be re-prophylactic examination of patients: in the first 2 years after the exacerbation - every 6 months, thereafter annually. Increase of motor and secretory activity may be a harbinger of a relapse. In these cases it is a preventive course of treatment lasting up to four weeks. In "critical" for ulcer periods of preventive bed or pruposely treatment for three weeks with a direction of patients in the night dispensaries, diet canteens.
Sanatorium-resort treatment are subject to patients with peptic ulcer disease stomach and duodenal ulcers in remission or fading aggravation in the absence of motor failure of the stomach, the propensity to bleeding, penetration and suspected malignant degeneration. Single profuse bleeding that took place a year ago and more, is not a contraindication for Spa treatment. Following balneological resorts: Zheleznovodsk, Essentuki, Pyatigorsk, Morshyn, Truskavets, Borjomi, Jermuk, Isti-su, Druskininkai, Birstonas, Mardakan, Krainka, Izhevsk Mineral Water, Darasun.
Of physical therapy after the disappearance of the phenomena sharp aggravation recommend galvanic collar on Shcherbakov, promelektroproekt General Vermel, diathermy the cervical sympathetic nodes, ultrasound on the epigastric region through the day, ultraviolet irradiation on his back, starting with 3-4 biodoses in 2-3 days.
Potable mineral water treatment begins with a 1/3-1/2 Cup with increase in the future up to 3/4 - 1 Cup three times a day for 1-1,5 hour. before a meal. During the Spa treatment is not only the mineral water treatment, and the totality of sanatorium-resort factors. Contraindications for referral to the resort are expressed aggravation of the disease, a tendency to massive bleeding, suspected malignant ulcers.
The analysis of remote results of conservative treatment of peptic ulcer shows more or less stable recovery in 35-40% of patients. Early diagnosis and timely initiation of anti-ulcer treatment with the following dispensary observation of patients increase the percentage of good long-term results.