Changes in the oral mucosa in diseases of the gastrointestinal tract

Stomach ulcer, its types and stages

Gastric ulcer (hereinafter referred to as PUD) is a disease in which a mucosal defect occurs and the submucosal layer may be affected. This is a chronic disease that occurs in waves, with periods of exacerbation and remission.

An ulcer can be localized in different parts of the stomach:

• subcardial and cardiac - in the upper part;
• antrum - in the lower section;
• in the body - in the middle part;
• in the pyloric canal - at the transition to the duodenum.

The size of the ulcer is:

• small - up to 5 mm in diameter;
• medium - in diameter 6-19 mm;
• large - 20-30 mm in diameter;
• gigantic - more than 30 mm in diameter.

There are also ulcers associated with the bacterium Helicobacter pylori (hereinafter referred to as HP) and those not associated with it.

The disease occurs in several stages:

• exacerbations - the occurrence of a defect in the mucous membrane;
• scarring - the formation of connective tissue at the site of the ulcer;
• remission - healing of the defect.

The stage of cicatricial and ulcerative deformation of the organ is distinguished separately.

Iron and iron health: what role does the microelement play in our body?

Iron is part of hemoglobin. In turn, the protein hemoglobin is a building material for erythrocytes - red blood cells that carry oxygen from the lungs to the organs, and on the way back rid them of carbon dioxide. Actually, this process is called cellular respiration. Without iron it is impossible. And since every cell in our body needs oxygen, iron can be called one of the most important elements.

The synthesis of hemoglobin takes 60–70% of all iron entering the body. The remaining 30–40% is deposited in tissues and spent on solving other problems - metabolic processes, regulation of the thyroid gland, maintaining the body's defense system and connective tissue synthesis.

As you can see, the functions of iron are varied and numerous, but oxygen transport is the most important of them.

Iron is poorly absorbed even with ideal health and proper diet - the human body is able to absorb up to 10% of the iron supplied with food.

Main causes

The cause of a defect in the gastric mucosa is considered to be an imbalance between the aggressive secretions of the stomach and the protective qualities of the mucous membrane. To digest food, the stomach secretes pepsin and hydrochloric acid. To prevent them from destroying the stomach, mucus forms on its surface, protecting the organ. If more acid is produced and less mucus is produced, an ulcer may form. The background for such a pathology may be a decrease in gastric motility, a violation of the regenerative - restorative properties of the mucous membrane against the background of certain diseases.

The main etiological cause of ulcer formation is damage to the mucous membrane of the HP. This bacterium successfully survives in an acidic environment and produces an enzyme that causes an inflammatory reaction with subsequent formation of a defect. Helicobacter pylori is detected in 82% of patients suffering from gastric ulcers.

Another reason may be uncontrolled use of anti-inflammatory non-steroidal drugs, such as aspirin.

Provoking factors may be:

• smoking and alcohol abuse;
• constant consumption of spicy food;
• stressful situations;
• hereditary predisposition;
• dry food;
• eating disorder.

Gastric ulcers often develop against the background of certain diseases, such as atrophic gastritis and hormonal pathologies.

Symptoms of the disease

Peptic ulcer usually manifests itself more often in spring and autumn, during the period of exacerbation of the disease. The first sign of the disease is pain that occurs immediately after eating. This is due to the fact that pepsin and hydrochloric acid released during meals aggressively affect the defect unprotected by mucus. Moreover, the manifestations of pain symptoms increase within an hour after eating. The pain is localized in the epigastric region, in the region of the heart, and can radiate - radiate under the scapula, as in a heart attack. At the height of the pain syndrome, nausea often occurs, which can result in vomiting, which brings relief.

Other dyspeptic manifestations and signs of illness: heartburn, loss of appetite, constipation. A coated tongue may indicate stomach problems. Against this background, the patient quickly loses weight.

Daily iron requirement in healthy people

Iron requirements vary depending on age and health status.

Infants under six months of age have little need for iron, since they are born with a fair supply of this element. Newborns only need 0.27 mg of iron per day. Children from six months to a year require 11 mg, children from 1-3 years old - 7 mg, children aged 4-8 years - 10 mg, 9-13 years old - 8 mg.

Adolescents 14–18 years old should receive 11–15 mg daily, with girls having a higher need for iron due to monthly blood loss during menstruation.

Men require about 10 mg of iron per day, women - 15-18 mg. During pregnancy, the norm increases to 25–35 mg, and during breastfeeding - to 25 mg.

After about 50 years, the iron requirement for men and women becomes the same - about 10 mg per day.

These are average figures, but in some cases the need for iron may be slightly higher than the statistical average. Athletes and people engaged in heavy physical labor require more iron. The need for iron also increases during recovery from operations and injuries (especially if they were accompanied by blood loss), infectious diseases, as well as for those who suffer from constant bleeding (hemorrhoids, stomach ulcers, nosebleeds, heavy menstruation, etc.).

Treatment of the disease

Gastric ulcers are well treated with conservative methods, which include pharmacotherapy and physiotherapeutic procedures. In emergency and some other cases, surgical intervention is indicated.

Drug treatment

The treatment of gastric ulcers uses complex pharmacotherapy, including medications aimed at the root cause of the pathology, relieving irritation of the mucous membrane and creating a protective barrier for gastric juice and relieving pain. The main group of drugs includes:

1. Proton pump inhibitors are long-acting drugs that reduce gastric secretory activity.
2. Antacids - envelop the mucous membrane, protecting it from the aggressive effects of gastric juice, and reduce its acidity.
3. Antibacterial drugs are aimed at eradication (destruction) of Helicobacter pylori. The best effect is achieved when antibiotics are combined. For peptic ulcers, macrolides, antiprotozoal drugs, penicillin and tetracycline antibiotics are prescribed.
4. Bismuth preparations relieve inflammation and form an insoluble colloid that creates a protective film when combined with protein.
5. Vitamin B5 (Pantothenate) - normalizes the production of hydrochloric acid, stimulates the regeneration of the mucous membrane.
6. Methylmethionine sulfonium chloride, also called vitamin U, acts as a cytoprotector that helps reduce gastric secretion and heal gastric ulcers.

Treatment can be supplemented with other drugs aimed at eliminating the causes of ulcerative pathology.

Physiotherapy

Physiotherapy helps ulcer healing and can be used in complex therapy. The mechanisms of self-regulation and adaptation are beneficially affected by:

• laser puncture - exposure of bioactive points with a laser beam;
• EHF therapy - the influence of electromagnetic waves in the millimeter range;
• magnetotherapy - exposure to low-frequency magnetic fields.

Ultrasound therapy is used to improve gastric motility in case of gastric atony. This procedure also improves blood supply to the organ, reduces the number of bacteria and relieves inflammation.

Surgery

Emergency surgery is performed in case of massive bleeding and perforated gastric ulcer. Surgical intervention is also indicated for complicated forms of ulcers in the case of a non-healing ulcer, as well as for malignancy, when the pathology becomes malignant. In some cases, gentle methods are used: laparoscopy or endoscopy.

specialist

Our doctors will answer any questions you may have

Tumasova Anna Valerievna Gastroenterologist

Diet and bad habits for stomach ulcers

Diet for gastrointestinal ulcers is an essential part of treatment. During the acute period, nutrition should be as gentle as possible, gentle on the mucous membrane and not stimulating the secretory activity of the stomach. In the first two days, preference is given to slimy soups with rice water without vegetables and meat, jelly or warm tea with sugar and crackers. In the next 6 days, table No. 1 is used in therapeutic nutrition.

Authorized Products

General nutrition rules:

• include easily digestible foods in the diet;
• food should be warm
• Do not eat cold or hot foods;
• you need to eat slowly, in small portions
• products need to be crushed and ground;
• Baking, boiling, stewing is allowed;
• fried foods and spices are excluded;
• the break in eating should not be more than 3 hours;
• food must be chewed thoroughly.

The following foods and dishes are allowed for stomach ulcers:

1. Slimy soups: with the addition of rice, semolina, oatmeal, you can add cream or butter;
2. Slimy porridges: with water or milk from the same cereal, you can add cream;
3. Fish and meat: lean beef, veal, turkey, rabbit, chicken. To prepare the meat, you need to boil it, pass it through a meat grinder, add butter, bake it into a soufflé puree, you can cook steamed cutlets, meatballs, meatballs;
4. Eggs: soft-boiled, or steam omelet;
5. Berries and fruits: baked unsweetened fruits, dried fruit compotes;
6. Dairy products: milk, steamed pureed cottage cheese soufflé, cream.
7. Drinks: weak tea with added cream or milk, rosehip decoction, milk or fruit jelly.

You can add refined vegetable oil or unsalted butter to dishes.

Prohibited Products

During an exacerbation, foods that irritate the gastric mucosa and increase the production of gastric juice are excluded: fatty meat, baked goods, preserves, canned and smoked foods, confectionery with cream, dishes with vinegar and spices, garlic.

Do not include vegetables with coarse fiber in the diet, as well as radishes, radishes, daikon, cabbage, tomatoes, turnips, and mushrooms.

It is necessary to avoid foods that cause fermentation processes: legumes, sweet fruits and juices, carbonated drinks.

During the treatment period, you are strictly prohibited from smoking and drinking alcohol.

Foods High in Iron

Our body cannot synthesize iron; it only processes this element, extracting it from worn-out red blood cells. “Fresh” iron comes from food. However, even if you eat foods containing iron, this does not mean that you have enough. The thing is that there are two types of iron.

Iron can be heme (divalent) or non-heme (trivalent). The first is found in products of animal origin and is easily digestible (about 25%), the second is part of plants and is absorbed by only 8–10% maximum[3]. This is why vegans and vegetarians often lack this element, even if they eat foods rich in iron.

And yet, it is the right diet that is considered the main way to prevent iron deficiency. Iron is found in significant doses in the following foods:

Animal products:

• pork liver - 29 mg (hereinafter the figure is given per 100 g of product);
• hard cheese - 19 mg;
• beef liver - 9 mg;
• egg yolk - 6 mg;
• beef tongue - 5 mg;
• turkey - 4 mg;
• beef - 2.8 mg;
• chicken - 2.5 mg;
• mackerel - 2.5 mg;
• pork - 1.6 mg;
• herring - 1 mg;
• cottage cheese - 0.4 mg.

Products of plant origin:

• beans - 72 mg;
• hazelnuts - 51 mg;
• oat flakes - 45 mg;
• fresh forest mushrooms - 35 mg;
• millet - 31 mg;
• peas - 20 mg;
• seaweed - 16 mg;
• prunes - 13 mg;
• dried apricots - 12 mg;
• buckwheat - 8 mg;
• tofu - 5.5 mg;
• peaches - 4.1 mg.

Although the iron content of some plant foods is high, the non-heme form of iron is poorly absorbed. Therefore, it is important for those following a plant-based diet to check their iron levels and, if necessary, take dietary supplements that contain this element.

Our body perceives iron best from meat (on average 20% is absorbed), a little worse from fish and seafood (about 11%), legumes (7%) and nuts (6%). Only 1-3% of iron is absorbed from fruits, vegetables and cereals.

To improve the absorption of iron, it is also important to receive the right amounts of vitamins and minerals, which play the role of catalysts and help this element to be absorbed. These include:

• Vitamin C. Iron is almost not absorbed without ascorbic acid, so the menu must include foods rich in ascorbic acid - berries, oranges and grapefruits, cabbage, red peppers.
• Vitamin A. If a person lacks vitamin A, then iron will not be absorbed and used to “build” new red blood cells. Many orange and yellow fruits and vegetables are rich in vitamin A - it is this substance that gives them their cheerful colors. To replenish vitamin A reserves, you need to eat more dried apricots, carrots and pumpkin. However, it's important to know that fats are needed for this vitamin to be absorbed, so don't ignore sources of retinol like butter, fish oil, and egg yolks.
• Folic acid (vitamin B9). It helps absorb iron and normalizes the digestive tract, and healthy digestion is extremely important for the absorption of this element. Sources of folic acid are eggs, soybeans, yeast, green leafy vegetables, dill, eggplant, tomatoes, chicken liver.
• Copper. Sources of copper are offal, fish and seafood (shrimp, oysters, etc.), cabbage.

Prevention of peptic ulcers

Stomach ulcers can be avoided if you follow some rules. First of all, give up bad habits, since ethyl alcohol and tobacco reduce the protective properties of the mucous membrane and irritate it.

Diet is no less important in prevention: you need to eat at a certain time, the interval between meals should not exceed 4 hours. You cannot eat dry food, as dry rough food injures the walls of the stomach.

For those who work at night, it is recommended to change jobs to work only during the daytime. It is necessary to avoid stress, treat inflammation of the stomach, hormonal diseases, and visit a gastroenterologist at least once every six months.