DEFINITION

An ulcer gastroduodenal is an ulcer in the revetment of the stomach or of the duodenum, which is a mucous layer that covers these organs inside to prevent from injuring for effect of the digestive juices with which they are in permanent contact. It is a question of a very frequent illness that produces a typical pain and changes of the quality of life in the affected persons.

SYMPTOMS

The most typical of the ulcer gastroduodenal is the appearance of the pain or of uncomfortable sensations in the abdominal region, which can present one or several of the following characteristics:

• Pain in the high part of the abdomen (epigastrio) that appears to the 30 to 60 minutes after eating.
• Pain of night appearance (when the stomach is empty).
• The dull pain that is not radiated.
• Periods of pain of weeks, with free symptoms periods.
• Pain on having pressed in the epigastrio.
• Other symptoms consequence of the previous ones would be a loss of weight, loss of appetite, abdominal distension, eructations, morning sickness or vomiting, although the above mentioned are slightly frequent.

This pain can collaborate to pirosis or acidity in the esophagus (behind the breastbone) since often it collaborates to an ebb of the gastric acids towards the esophagus, which can turn out to be damaged by effect of the above mentioned acidity causing esofagitis.

CAUSES

In numerous studies it has been observed that there are no exactly the same causes those that lead to a gastric ulcer or to a duodenal. In fact, it seems that the stomach ulcer is related to the presence in the duodenum of a bacterium named Helicobacter pylori, and the ulcer duodenal is related to an excessive acidity in the stomach, although it could seem paradoxical.

HELICOBACTER PYLORI

As it was possible to have determined, there dye diverse effects on the infected persons:

INCREASE OF THE ACIDIC SECRETION

The increase of the acidic secretion seems that there is the prime mover of the injuries of the peptic ulcer a duodenal. The mucous membrane duodenal answers to the acidity increase with changes in the structure of the mucous membrane, which tries to make more resistant to itself to the aggression that the acid supposes him; it is changing his structure and looking alike increasingly to the gastric mucous membrane, more prepared to resist the acidic attack; finally, trasforma completely in gastric mucous membrane, which is called metaplasia gastric of the duodenum, which in turn becomes infected for the H. pylori with appearance of duodenitis and ulcer duodenal.

I CONSUME OF ANTI-INFLAMMATORY

The anti-inflammatory ones realize his action across numerous and complicated chemical reactions, it enters which there is the regulation of a few molecules named prostaglandin, which the defenses of the stomach favor against the gastric acid.
The anti-inflammatory ones (to see in the figure, B) inhibit the synthesis of prostaglandin PGs (to see in the figure G), for which the stomach loses part of his aptitude to defend itself, up to the point of that these medicines taken of continued form, without gastric protection and without control, lead very often to the appearance of digestive ulcers, or minor declarations of the same etiology.

In the stomach the mucous membrane is prepared to resist perfectly a pH <2,5.

For it it is provided with several defense lines: snot - bicarbonate layer (to see in the figure C), which supports a pH gradient from 2,5 to 7,0 between the surface and the deep layer. the proper phenomena of intercellular cohesion exercise of mechanical barrier (to see in the figure D). the microcirculation is regulated also by the prostagladinas PGs. (to see in the figure G). if this mucous membrane is adapted to the acidic way it means that so that they appear you injure in the mucous membrane (to see in the figure E) there must falter some of these defensive mechanisms. ULCER duodenal (F): The injury mechanisms to produce a gastric ulcer are: The anti-inflammatory medicines (B): so much for oral route since for another route they come to the gastric mucous membrane and make to lose the exterior protection recoverings (C). The infection for the bacterium Helicobacter Pylori (A) that is stationed in the gastric mucous membrane.

DIAGNOSIS

The typical symptoms courtship is quite diagnostic. It usually complement by means of the achievement of a gastroscopia, to see the injuries, to take a biopsy of the injuries for his analysis and a cultivation for Helicobacter Pylori.

The control of the infection for Helicobacter Pylori can be realized by a simple test that the CO₂ measures in the breath. Urea is realized by means of the administration by mouth of Carbono*-Mark / and mixed with citric acid, if the patient has Helicobacter Pylori, by means of the Ureasa produced by this one bacterium, trasformará in CO₂ and ammonia.

Carbono*-marcado/Urea + Ureasa = C0₂ + NH₃

The CO₂ liberated across the blood will appear in the breath across the lung. The measurement of the pronounced CO₂ is realized in two captures, basal and to the half an hour of taking the Carbono*-Urea. The sensibility of the test is 90 % and it is specific in more than 95 % of the cases. By means of this analysis it is possible to give for the infection controlled or to continue with a more long treatment.

GENERALITIES ON THE TREATMENT OF THE ULCER GASTRODUODENAL

• The treatment with antibiotics is indicated in all the patients with infection by Helicobacter pylori (85 % of the patients with gastric ulcer presents it).

• An ideal antibiotic therapy does not exist, there are several options.

• The antiulcer therapy (AntiH₂-Omeprazol) is recommended to relieve symptoms and to facilitate the healing.

• The rebellious ulcers are necessary an association of inhibiting of secretion with antibiotics.

• The maintenance treatment is indicated in these rebellious ulcers.

• In all the ulcerous patients there must be investigated the consumption of AINEs (anti-inflammatory not esteroideos).

• In the ulcers associated with the administration of AINEs (anti-inflammatory not esteroideos) these must be interrupted, if it is possible, and eradicate the Helicobacter pylori, if it is present.

TO SEE ALSO

• Gastritis
• Diet for the gastritis
• Gastroscopia
• Stomach acidity
• Antacid medicines

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