Ulcers disease stomach and duodenal ulcer

Proper and timely treatment of ulcers stomach and duodenal ulcer is of great importance: this disease is very common, affects people in their most productive period, is a frequent cause temporary or persistent loss of capacity and is often severe, sometimes life-threatening complications. In the course of chronic ulcers S. O. Bazilikas distinguishes three stages. The first stage is the initial period of the disease when the recurrences are still rare (not every year), of short duration. In this stage the disease is relatively easy, not reflected significantly on the health of the patient. In the second stage of the disease there are frequent, lengthy and rather severe relapses, the disease takes a progressive course. In the third stage of the disease join such complications, as expressed adhesions and scar processes, motor failure of the stomach, bleeding, penetration and other
In the course of peptic ulcer decided to allocate the phase of deterioration, decaying exacerbation and remission.
Comprehensive treatment at the resort in General and internal use of mineral waters are particularly indicated in patients with stomach ulcer and duodenal ulcer predominantly in the first and second stage in remission. Often, however, practitioners have to solve the questions of construction of medical facilities in the resort and for heavier groups of patients suffering from ulcerative disease of the third stage or arrive to the resort in the phase of exacerbation and decaying exacerbation. In these cases treatment success depends on the correctness of the medical factors, including drinking mineral waters.
Comprehensive Spa treatment of patients with peptic ulcer of stomach and duodenal ulcers include internal reception of mineral water, a shared baths, health food, in the absence of contraindications - local mud. In the third stage of the disease and in acute phase widely used drugs include antacids, anti-inflammatory, anti-spastic, cortical and other stimulants
In the appointment of drinking mineral waters, one should bear in mind that saying disease stomach and duodenal ulcer develops mainly in the high-anxiety main functions of the stomach - salootdelenie, acid-forming, enzyme and motor. Pathology of these functions, especially peptic factor that plays an important role in the Genesis of the disease and its relapses. Therefore, when ulcers stomach and duodenal ulcer recommended mineral water providing relatively benign influence on mechanical-, chemo - and thermoreceptors of the stomach and with a quite distinct duodenal gliding action. These are the waters of low mineralization zero-carbon or low carbon dominated hydrocarbonate and sulfate ions, with slightly acidic, neutral or slightly alkaline.
Mineral waters are applied only warm (38-45 degrees), with more pronounced them antispastic effect; moreover, in the process of heating up of mineral water in them significantly reduces the concentration of free carbonic acid.
When ulcers stomach and duodenal ulcers first and second stage in the acute phase of treatment at the resort begins with a short (5-7 days) strictly anti-ulcer treatment on the scheme of the nutrition Institute of the AMS of the USSR: bed rest, diet 1A, 16, medications, compresses on her stomach, etc. Actually resort factors, including drinking treatment in this period is not applied. Using the above mineral water is allowed only in the form of absorption mikroklizm or drip enemas. Microclysters particularly effective when expressed pain syndrome and persistent heartburn, absorption drip enema is recommended for frequent vomiting, in order to combat dehydration. In these cases, the necessary and prevention of possible loropeni, one of the methods which is rectal introduction of slightly mineralized water with a predominance of chlorine ions. Drinking cure patients of the group under consideration is prescribed only after a strict anti-ulcer course (in 6-7 days) and spend on a gentle method: 100 ml for the 1 - 1.5 hours before eating 1-2 times a day with the subsequent increase in a single dose to 150 - 200 ml and number of techniques to 2-3 times a day.
Gastric lavage if there floridnas ulcers are not recommended because they are unsafe in terms of possible complications (perforation, ulcers, bleeding). From these considerations are not shown and the methods rectal insertion of mineral waters, which significantly increased intra-abdominal pressure, especially underwater intestinal. When deep ulcer process and sharply expressed painful syndrome should not be used even intestinal and soul siphon of enema. If the disease is accompanied by a dyskinesia of intestines with persistent constipation and there is a need in the intestinal procedures, in the period of exacerbation best to restrict enemas from 300-500 ml of mineral water temperature 38-39 degree or even a micro.
Ulcers in the first and second stage in the phase of decaying exacerbation drinking treatment prescribed at the beginning of the course, but hold on a delicate method with a gradual increase in a single dose of mineral water from 100 to 200 ml and number of techniques from 1 to 3 times a day. Gastric lavage in most cases are not shown. From rectally methods of introduction of mineral water (if indicated) valid along with the micro and purifying enemas intestinal and soul siphon of enema, but under low pressure and only in the second half of the course after the relief of pain. Underwater intestines washing is not recommended.
Ulcers in the first and second stage in the phase of remission, along with poorly carbonate water of low mineralization acceptable for use and water with less gentle action - hydrocarbonate, sulphate or chloride water of medium mineralization (up to 15 g/l), containing carbonic acid in high concentrations (up to 2.5 g) and having a pH level of 5.5 to 8.5. When carrying out drinking treatment in most cases there is no reason to limit the dose and frequency methods of mineral water. Studies have shown B. N. Papkov with co-authors (1957), the most optimal is the drinking of mineral water 200 ml 3 times a day. The increase of single doses of 400 ml or decrease in the number of techniques to 1-2 times a day, according to the observations of the authors reduced the efficiency of complex Spa treatment of patients with peptic ulcer. In the phase of remission and healed ulcer (no symptom of a niche), you can apply gastric lavage with mineral water, if they have evidence, such as diffuse inflammation in the lining of the stomach with severe diarrheal manifestations.
In secondary infections of the intestines (dyskinesia, colitis) shall apply, microclysters and cleansing enema of mineral water, intestinal and soul siphon of enema. Underwater intestines washing is valid only when burdened history, in the absence of niche symptom, in the phase of remission. Treatment gentle introduction to mineral water temperature 37-39 degrees and in quantity from 0,5 up to 1 liter simultaneously, only 5-6 times, while total water consumption from 3 to 5 l of the procedure (not more than 2 times per week).
When ulcers stomach and duodenal ulcers in the third stage in resort practice more common and have the greatest value two complications: a tendency to gastrointestinal bleeding and cicatricoadhesive process with the phenomena of motor failure of the stomach. With a history of instructions on previous profuse gastric bleeding and perforation, ulcers and subsequent surgery (its the suturing) internal use of mineral waters is carried out only in the form of drinking water treatment and most environmentally friendly rectally methods-mikroklizm, cleansing enemas. Drinking water treatment is on a gentle method, about the same as in ulcerative disease of the first and second stage in the phase of decaying exacerbation. Used predominantly above the water of low mineralization, with no carbon dioxide or carbon dioxide poor concentration, with a predominance of hydrocarbonate and sulfate ions. Stomach and intestinal soul and especially underwater washing intestines are excluded. In case of persistent indications (resistant, not be affected by other means constipation) with great caution, you can apply a siphon of enema 1-2 times a week but a negative reaction of fecal blood.
If the patient has in the past not been profuse bleeding, but has a tendency to so-called hidden bleeding in the resort needed re-examination of stool for blood not less than 1 time in 5 to 7 days during the whole course. When negative and weak positive reaction, and in most cases also with the positive response of the internal use of mineral waters is carried out mainly by the method recommended in patients with peptic ulcer disease first and second stage in the phase of decaying exacerbation. In stark positive reaction of fecal blood shows a strict anti-ulcer treatment, during which the internal use of mineral waters limit the micro and later appointed drinking treatment in a gentle method is similar to that recommended in ulcerative disease of the first and second stage in the phase of deterioration.
Breach motor (evacuation) function of the stomach on the ground cicatricial stenosis pyloric or duodenal ulcers require strictly differentiated approach to the construction of a medical complex, depending on the severity of these violations. In clinical practice it is accepted to distinguish three stages piloroduodenalnoy stenosis: compensation and subcompensation decompensation. Compensation stage is characterized by the fact that as a result of the working of hypertrophy and increased peristalsis stomach muscles evacuation of food does not significantly disturbed, despite the narrowing of the output from the stomach. In this stage Spa treatment is indicated, in particular widely used and internal use of mineral waters. However, when you assign drinking cure should be borne in mind that in these patients it is possible longer than usual, stay mineral water in the stomach, thus creating conditions for unwanted gain pyloric effect. So would recommend drinking of mineral water in a dose of not more than 150 ml per reception 2-3 times a day and not for 1 - 1.5 hours before eating, and 1 hour 45 minutes or even 2 hours before eating.
In the lavage of the stomach for the most part not necessary. In cases of pronounced inflammation of the mucous membrane of the stomach and significant diarrheal illness in longer healed ulcer of the stomach are used on a regular basis. Rectal administration of mineral water is used if there is evidence from the intestines in accordance with the above recommendations, depending on the phase of the disease.
On the pyloric stenosis in the stage of subcompensation can speak in cases where long working hypertrophy and reinforced gastro muscles give way to its gradual depletion, resulting in hypotension stomach and the slow evacuation of stomach contents. Clinically, this stage is characterized by periodic emergence of a "rotten" burps, feeling of heaviness and completeness in the epigastric region, sometimes vomiting food. In such cases, Spa treatment is carried out on a delicate technique. If there floridna ulcer, narrowing piloroduodenalnoy region (scar nature) is complicated by additional factors - inflammatory infiltration of the mucous membrane and a tendency to spasm privratnika. Therefore treatment at the resort is recommended to start with a 6-7 days strict antiulcer course without drinking mineral waters. Widely shown absorption microclysters, therapeutic effect which is when pyloric stenosis impact reflex reduction spasms gatekeeper and gastric hypersecretion, improved bowel function, and partly in preventing dehydration. With the appearance of premonitory signs of dehydration and chloropinae particularly direct signs of these complications (thirst and dry mouth, dry skin, reducing body weight, increased neuromuscular excitability and others) should, in addition to micro enemas, apply absorption drip enema of mineral water 1-1,5 l 1-2 times a day. The total number of introduced into the body through the intestinal fluid should be at least 1.5-2 litres per day. Most suitable for absorption mikroklizm and drip enemas in such cases are water of low mineralization, with a predominance of chlorine ions.


Drinking treatment is prescribed after strict antiulcer rate (i.e. not earlier than the 6-7th day) and spend on a gentle method: mineral water is used in the amount of 50 to 100 ml per reception 1-2 times a day for 1 hour 45 minutes or 2 hours before meals with a gradual increase in a single dose to 150 ml and number of techniques to 2-3 times a day. With the resumption of clinical signs of motor failure of the stomach, especially vomiting, decrease the dose of mineral water or to take a break in the treatment of drinking water.
Used mainly poorly carbon (or carbon dioxide) water of low mineralization, mainly dominated chlorine ions with neutral or slightly alkaline (Crimea Seltzer, Karachinsky, Mirgorod, Minsk, pärnu, Saki, Grozny, Dagi, pauzhetsk, Tbilisi, hot beach), and the water of low mineralization dominated hydrocarbonate and sulfate ions.
In the absence floridnas ulcers and guidance on former stomach bleeding and perforation, ulcers one of the most effective treatments for the given group of patients are gastric lavage with mineral water. The latest in a greater degree than other curative factors, increase vitality and peristaltic function of stomach muscles and thereby contribute to the restoration of state compensation.
When stenoses privratnika and duodenal ulcer is preferable to conduct stomach before going to sleep - in 2-2,5 hours after dinner 3 times a week amount 6-8-10 procedures per course. Drinking cure prescribed not at the beginning of the year, and after 5-7 days - after a noticeable improvement in the evacuation function of the stomach and stop vomiting. Methodology drinking treatment sparing - similar to the one used in the presence floridnas ulcers after strict antiulcer course.
With the growing depletion of the stomach muscles stenoses privratnika go on the stage of decompensation. Thus the stomach dramatically expanded omitted, sluggish will peristaltie, radiographically detected characteristic symptom of a bowl with a long delay barium in the stomach. Clinical symptomatology is composed mainly of significant violations of the General condition of the organism is not the progressive depletion of the soil, dehydration, development loropeni, chloroprene azotemii, etc. In this stage Spa treatment may not be effective, patients need immediate interventions, mainly in the form of a gastrectomy. Under relatively mild conditions sick sometimes leave the resort for conducting nutritional, medical and restorative treatment in order to prepare them for subsequent operation. Drinking treatment in such cases is contraindicated, since the reception of mineral water even in small doses can increase hypersecretion, overflow and expansion of the stomach. If there are no contraindications (the risk of bleeding or perforation, ulcers, pronounced pain syndrome), when pyloric stenosis in the stage of decompensation used gastric lavage with mineral water at night before going to sleep through the day, sometimes every day in the amount 8-12 procedures of treatment. Widely shown absorption micro and drip enema of the waters of low mineralization, with a predominance of chlorine ions. When inclination to diarrhea, which in patients with decompensated pyloric stenosis is associated mainly with the arrival of the fermentation products from the stomach into the intestine, can be a useful means of enema, in non-severe cases of intestinal soul and irrigation under low pressure. Underwater intestines washing is not recommended, as they are too much stress to the body, weakened by frequent vomiting on the grounds of pyloric stenosis.
Set forth in this section basic guidelines for the differentiated use of mineral waters for when ulcers stomach and duodenal ulcers schematically shown in table. 6. Use this table can facilitate the choice of therapeutic complexes for different groups of patients in everyday practice resort.
In the treatment at the resort ulcer patients after resection of the stomach or the imposition of gastrojejunostomy method in internal use of mineral waters make some adjustments. First of all it is necessary to take into account such features of the functions of the digestive tract after operations on the stomach as fast evacuation of stomach contents and the volatility of the activity of the intestines, the tendency to diarrhea. In this regard, the internal use of mineral waters is carried out by sparing method. Used mainly poorly carbon (or carbon dioxide) water of low mineralization in a relatively small dose of 100 ml 2-3 times a day for 30 to 45 minutes before a meal. Gastric lavage assigned limited only in the presence of obvious gastritis (without floridnas ulcers), and in sparing the form of: a one-time introduction of no more than 250-300 ml of water under low pressure of 5 to 6 times (total water 1,5-2 l), 1-2 times a week is just 3-4 procedures per course. In violation of the functions of the anastomosis drinking treatment is contraindicated. In such cases can be used stomach, absorption micro and drip enemas, but with a significant delay evacuation these methods are ineffective; patients should be advised treatment is stationary.
At the pathology of a biliary system, often developing after operations on stomach (disruption of normal flow of bile, dyskinesia, secondary inflammatory process), in connection with the undesirability and sometimes impossibility of carrying out duodenal intubation widely shown tyubazhi with taking 200-300 ml of mineral water, often without the addition of magnesium sulfate. Tubage usually spend 1 time in 5-7 days. In secondary infections of the intestines - dyskinesia it, enterocolitis and colitis - used rectally methods of introduction of mineral water, microclysters, cleansing enema, a siphon of enema, intestinal soul and irrigation. The purpose of underwater intestinal requires caution, especially after surgery overlay gastrojejunostomy. When this state is saved pathogenetic mechanisms and morphological manifestations of peptic ulcer disease and, therefore, the same possible complications that occur in unoperated patients of acute bleeding, perforation.

Table 6. The scheme differentiated use of mineral waters for when ulcers stomach and duodenal ulcers
Stage of disease The phase of the disease and the nature of the complications Method internal use of mineral waters
drinking cure gastric lavage rectal methods
The first and second Aggravation Appointed with 5-6-th day (after strict antiulcer course) 100 ml for 1-1,5 hours before meals, 1 - 2 times a day with the subsequent increase of single doses of up to 150-200 ml 2-3 times a day Generally excluded With a significant reduction of pain and heartburn are appointed absorption microclysters, with frequent vomiting-drip enemas, for constipation - cleansing enema. Other methods, especially underwater washing intestines are excluded
Fading aggravation Appointed immediately, but with a gradual increase in a single dose of mineral water from 100 to 200 ml and number of techniques from 1 to 3 times a day In most cases, not shown When readings are appointed microclysters absorption, drip enema enemas. In the second half of the rate valid intestinal and soul siphon of enema under low pressure. Underwater washing intestines are excluded
Remission Appointed immediately 200 ml for 1-1,5 hours before meals 3 times a day Shown at healed ulcer in cases of inflammatory lesions of the gastric mucosa with severe diarrheal illness. Assigned in the morning on an empty stomach through day 5 to 6 procedures for the course According to indications. When healed ulcer valid submarine of enema on a delicate method: introduction simultaneously from 0.5 to 1 l of water 5-6 times with a total consumption of no more than 3-6 l of water on the procedure 1-2 times a week
Third Gastric Profuse (in history) By attenuated method - as ulcers first and second stage in the phase of decaying exacerbation Excluded Mainly micro and cleansing enema. When negative reaction of fecal blood with caution allowed siphon of enema 1-2 times a week. Other methods are excluded
Bleeding Hidden When positive and especially sharply positive reaction of fecal occult blood is in the phase of deterioration, in other cases-as in the phase of decaying exacerbation Excluded The same
Cicatricial stenoses privratnika and duodenal ulcer Compensated Appointed with 1-2-th day of the treatment by 100-150 ml per 1 hour 45 minutes or 2 hours before meals 2-3 times a day Shown at healed ulcer in cases of inflammatory lesions of the gastric mucosa with severe diarrheal illness. Assigned mainly for the night after a day of 5 to 6 procedures for the course According to the testimony given phase of the disease (see above)
Subcompensated Appointed with 5-6-th day of the treatment 50-100 ml per 1 hour 45 minutes or 2 hours before eating 1-2 times a day with the subsequent increase in a single dose to 150 ml of 2-Once a day. With the resumption of vomiting should be reduced dose of water or to take a break in the treatment of drinking water When floridnas ulcers are appointed with great care. When healed ulcer widely shown: appointed, as a rule, on a night through the day in the number 6-8-10 procedures per course From the beginning of the course are appointed absorption microclysters 1-2 times a day, with the appearance of premonitory signs of dehydration - absorption drip enemas from 1-1,5 l of water 1-2 times a day. Other methods is indicated. Underwater washing intestines are only allowed when healed ulcer and gentle method
Asthma Contraindicated In the absence of contraindications (the risk of bleeding, perforation, sharp pains) is most effective. Are assigned for the night after a day or daily with 8-12 procedures per course Widely shown absorption micro and drip enemas. In secondary infections of the intestines - siphon wash in mild cases of intestinal soul and irrigation under low pressure. Underwater intestines washing is not recommended