An ulcer refers to an ulcer. The ulcer diseases include both gastric ulcers and duodenal ulcers. Treatment can usually take place on an outpatient basis. In addition, no bed rest is necessary. Nevertheless, serious complications can occur in the treatment of ulcer disease.
Complications of ulcer disease
Possible complications in treating ulcers are:
- Bleeding with shock (bleeding ulcer)
- Perforation (breakthrough of the ulcer)
- Penetration (collapse of the ulcer into adjacent organs)
- Pyloric stenosis (scarred narrowing of the stomach outlet)
- Malignant degeneration
Gastric and duodenal ulcers may bleed on their first appearance, but also as recurrent ulcers in the context of chronic peptic ulcer disease. Therapy with certain analgesics alone or in combination with cortisone is the most important risk factor. Male sex, older age (older than 60 years), previous ulcer complications and diameter of the ulcer over two centimeters increase the risk of ulcer bleeding. About 10 percent of all ulcers bleed, 10 percent of the bleeding ends fatally.
Behind the exit of the stomach are large blood vessels, which are attacked by a bleeding ulcer and can bleed themselves. There is a danger to life, because you get very bad at this emergency area in the emergency area and there is a risk that the very heavy bleeding can not be stopped in time. Chronic ulcer bleeding often goes unnoticed for a long time and often only occurs during a routine checkup by the anemia. Acute ulcer bleeding, however, can be highly dramatic.
Symptoms are sometimes massive blood loss (light red blood is eliminated with bowel movements, vomiting blood and shock). If there is a suspicion of ulcer bleeding, the patient must be referred to the nearest hospital as soon as possible and examined there! If it has already come to a heavy bleeding, as a first measure the circulation must be stabilized by blood and sugar solutions.
After or parallel to circulatory stabilization, the source of bleeding is localized endoscopically and breast-fed by injection with suprarenin and / or fibrin glue. If the endoscopic techniques fail, emergency surgical hemostasis is indicated. This requires opening the abdomen, locating the source of bleeding and removing the ulcer. In addition, the bleeding vessel is stopped with a thread. A stomach (partial) removal is nowadays only necessary in the very rare cases.
Breaching (perforating) ulcer
Perforations are more likely to result from duodenal than gastric ulcers. They create a connection between the duodenum or stomach and the neighboring organs (pancreas, transverse colon) or the free abdominal cavity. The most important risk factor is the use of certain pain medications. Typical are suddenly onset violent upper abdominal pain with radiation in the back.
The X-ray of the chest shows air under the diaphragmatic domes when perforated, which is normally not found there. If the surgeon sees this x-ray, he will immediately initiate the emergency procedure. In addition, highly effective antibiotics are given, because even today, a strong peritonitis is life-threatening. As a rule, there is a suturing or excision of the ulcer. Rare are stomach part distances.
Stomach outlet stenosis (narrowing of the stomach outlet)
Gastric outlet obstruction is caused by ulcer in certain areas of the stomach. They may be the result of gastric mucosal inflammation around acute ulcers or have developed due to scarred shrinkage after ulcer healing. Patients only consume small portions of food. As a result, and due to frequent vomiting, they lose weight.
The diagnosis is made by a reflection of the gastrointestinal area. If the gastritis has caused gastritis around an acute ulcer, the likelihood of a narrowing after treatment is very high. The situation is different with chronic gastric outlet obstruction. This is due to a shrinkage of the scars left by each ulcer. These do not heal spontaneously, but must be reopened by a so-called endoscopic balloon dilatation.
The danger that the constriction sets in again, is also very large with medication. In this case, an operation is necessary. The passage is restored by a so-called pyloroplasty.
Reconsider taking painkillers
Smoking, alcohol and caffeine intake lead to irritation of the gastric mucosa and contribute to the damage of the gastric mucosa. For pain in the pit of the stomach should not be resorted to pain medication immediately. Although these can lead to a short-term pain relief, but also attack the mucosa in the small intestine. Pain medications should only be taken in consultation with the doctor.
In chronic diseases that require permanent pain therapy (for example, chronic rheumatoid arthritis), a waiver of these analgesic and anti-inflammatory drugs is usually limited or not possible. Here it must be checked whether newer stomach-compatible substances can be used.