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Gastric ulcer and duodenal ulcer : Causes, Symptoms , Diagnosis, Treatment Gastroenterology / / May 12, 2016 Gastric ulcer and duodenal ulcer video What is plague? ulcer formation mechanism Causes of stomach and duodenal ulcers factors that cause ulcers in carriers H. Pylori Symptoms of gastric ulcer and duodenal ulcer Diagnosis of gastric and duodenal ulcers treatment of gastric and duodenal ulcers Antibiotics and combined schemes ulcer treatmentstomach and duodenum Surgical treatment of gastric and duodenal ulcers What can replace aspirin for gastric Meals for gastric Physical activity and exercise for gastric Complications of gastric ulcers Peptic ulcer - an open wound or wetareas, with a tendency to develop in one of two places: - in the mucous membrane of the stomach (gastric ulcer); - in the upper part of the small intestine - the duodenum (duodenal ulcers). Duodenal ulcer occurs three times more often than gastric ulcer. Ulcers develop when the stomach, intestine, digestive glands appear digestive juices, and damaged gastric mucosa or duodenal ulcer. ulcers may be an averag Peptic ulcer disease affects all age groups, but rarely in children. In men, the risk of ulcer twice higher than in women. The risk of duodenal ulcer disease is on the rise, since 25 years and continues to 75 years. The risk of most of its peaks - from 55 to 65 years. mechanism of formation of ulcers Two important component of digestive juices - hydrochloric acid and pepsin enzyme. Both substances are crucial to the destruction and digestion of starches, proteins and fats in the food. They play different roles in the sores. - Hydrochloric acid. is common erroneous assumption that an excess of hydrochloric acid, which is released in the stomach, is solely responsible for the production of ulcers. Patients with duodenal ulcer, tend to have higher than normal levels of hydrochloric acid, but the majority of patients with stomach ulcer have an acid level of normal or below normal. The presence of gastric acid, in fact, it is important to protect against H. Pylori - bacteria, which in most cases causes a peptic ulcer. Exceptions are ulcers that occur on the Zollinger-Ellison syndrome - a rare genetic condition in which tumors in the pancreas or duodenum identifies very high levels of gastrin - a hormone that stimulates the secretion of hydrochloric acid. - Pepsin. This enzyme breaks down proteins in food. It is also an important factor in the formation of ulcers. Since the stomach and duodenum are composed of proteins that are sensitive to the action of pepsin. However, the body has a defense system to protect the stomach and intestines against these two potent substances: - a layer of mucus that covers the stomach and duodenum (the first line of defense); - bicarbonate, releasing mucus layer, which neutralizes the digestive acids; - prostaglandins hormone-like substances that help dilate blood vessels in the stomach to assure good blood flow and to protect against injury. Prostaglandins can also stimulate action of bicarbonate and mucus. destruction of these defense mechanisms makes the mucous membrane of the stomach and intestines susceptible to the action of acid and pepsin, increasing the risk of ulcers. reasons gastric ulcer and duodenal ulcer In 1982, two Australian scientists have identified Helicobacter pylori (Helicobacter Pylori, or H. Pylori) as the main cause of stomach ulcers. They showed that the inflammation of the stomach and stomach ulcers result from gastric infection caused by the bacteria H. Pylori. Bacteria appear to cause ulcers thus: Helicobacter Pylori corkscrew shape allows them to penetrate into the mucous layer of the stomach or duodenum, so that they can be attached to the lining. The surfaces of cells lining the stomach, contain protein. Acceleration factor of the breakdown of proteins acts as a receptor for the bacteria. Pylori survive in a highly acidic environment. Pylori and stimulates an increase in the release of gastrin. Higher levels of gastrin sodeystvovuyut increase acid secretion. Increasing the acid damages the intestinal mucosa, that certain individuals leads to ulcers. Pylori also modifies certain immune factors that allow these bacteria to avoid detection by the immune system and lead to frequent inflammation, even without invasion of the mucosa. Even if not develop ulcers are believed bacterium Helicobacter pylori is the main cause of chronic inflammation of the active in the stomach - gastritis, and in the upper small intestine - duodenitis. Pylori also closely related to gastric cancer and possibly other extraintestinal problems. Bacteria H. Pylori, likely transmitted directly from person to person. However, little is known how these bacteria are transmitted. About 50% of the world's population are infected with H. Pylori. The bacteria are almost always acquired in childhood and persist throughout life if the person is not treated. The prevalence of this bacterium in children is about 0.5% in industrialized countries. But even there, in regions with critical unhygienic conditions, infection conditions are equal to those in developing countries. It is not entirely clear how these bacteria are transmitted. Perhaps transmission methods include: - intimate contact, including contact with the liquid through the mouth; - diseases of the gastrointestinal tract (especially with vomiting); - contact with the feces (fecal matter); - contaminated wastewater. Although Helicobacter pylori are fairly common, ulcers in children are very rare - only 5-10% of the H. Pylori-infected adults. Several factors may explain why some patients get infected ulcers: - smoking; - alcohol intake; - the presence of family members in dealing with peptic ulcer disease; - the male sex; - infecting bacterial strain which contains a cytotoxin associated gene. When bacterium Helicobacter Pylori were first identified as a major cause of peptic ulcer disease, were detected in 90% of people with the duodenum and about 80% of people with stomach ulcers. As more and more people are now tested and treated for the bacteria, the rate of H. Pylori-induced ulcers decreased. Currently H. Pylori are about 50% of people with peptic ulcer disease; factors that cause ulcers in carriers H. Pylori Certain factors may increase the risk of ulcers in NSAID: - age 65 years and older; - history of peptic ulcer or gastrointestinal-bleeding; - other serious diseases - such as congestive heart failure; - the use of such drugs as anticoagulant warfarin (Coumadin), corticosteroids, osteoporosis drug alendronate (Fosamax), etc .; - alcohol abuse; - infection of helicobacter pylori; - other risk factors for ulcer from H. Pylori or NSAIDs; - stress and psychological factors; - bacterial or viral infection; - bodily injury; - radiation therapy; - smoking. Smoking increases the secretion of acid, bicarbonate and prostaglandin decreases and reduces the flow of blood. However, the actual results of smoking research ulcers different. have only 10-15% of people infected with Helicobacter Pylori, developing peptic ulcer. Infections H. Pylori, especially in the elderly, may not always lead to peptic ulcer disease. Also to be present, and other factors in order to actually cause ulcers: - genetic factors. Some people have strains of H. Pylori genes that make bacteria more dangerous and increases the risk of ulcers; - immune disorders. Some people have a violation of the intestinal immune response, which allows bacteria to injure the intestinal mucosa; - lifestyle factors. Although lifestyle factors such as chronic stress, coffee and smoking has long been considered the main causes of ulcers, is now considered that they only increase susceptibility to ulcers, some carriers H. Pylori - and no more; - stress. Although stress is no longer believed to cause ulcers, some studies show that stress can predispose a person to ulcers or prevent healing of existing ulcers; - shift work and interrupted sleep. People who work night shifts have a significantly higher incidence of ulcers than day workers. Researchers suspect that the frequent interruptions of sleep can weaken the immune system's ability to protect against harmful bacteria. - non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use of NSAIDs such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Alevi, Naprosyn) - the second most common cause of ulcers.NSAIDs also increase the risk of gastrointestinal bleeding. The risk of bleeding continues for as long as the patient is taking the drugs, and it can last for about 1 year after the break. Short courses of NSAIDs for the temporary relief of pain should not cause serious problems, because the stomach has time to recover and fix any occurring damage. Patients with ulcers from NSAIDs, stop taking these drugs. However, patients who need these drugs for the long term, can reduce the risk of ulcer drug administration group PPI - proton pump inhibitor - such as omeprazole (Prilosec), famotidine (Pepsid - blocker H2), etc. in 15.-25% of patients taking NSAIDs regularly are evidence of one or more ulcers, but in most cases, these ulcers are very small. Long-term use of NSAIDs can damage, perhaps the small intestine. Even low doses of aspirin (81 mg) may be a risk, although the risk is lower than at higher doses. The greatest risk from the use of very high doses of NSAIDs for a long period of time, particularly in patients with rheumatoid arthritis. - Medications. ulcers can exacerbate some other drugs, in addition to NSAIDs. These include: Warfarin (Coumadin) - anticoagulant, which increases the risk of bleeding, oral corticosteroids, some chemotherapy drugs - spironolactone and Niacin. Bevacizumab - for the treatment of colorectal cancer, may increase the risk of gastrointestinal perforation (perforation or perforation of ulcers - a breakthrough ulcer outside of the stomach or duodenum with the release of their contents). While the benefits of bevacizumab outweigh the risks, gastrointestinal perforation are very serious. If they occur, patients should stop taking the drug. - Zollinger-Ellison syndrome (ZES) syndrome.. Another cause of ulcers, although much lower than H. Pylori or NSAID is Zollinger-Ellison syndrome. A large amount of acid produced in response to an overproduction of hormone gastrin, which in turn causes tumor pancreas or duodenum. These tumors generally cancerous and should be removed.acid production must also be suppressed to prevent new ulcers. ZES should be suspected in patients with ulcers that are not infected with H. Pylori and have no history of NSAID. Diarrhea may occur before the ulcer symptoms. Ulcers occurring in the second, third or fourth parts of the duodenum or jejunum (the middle part of the small intestine) - signs of ZES. Gastroesophageal reflux disease (GERD) is a common and often more severe in patients with ZES. Complications of GERD include ulcers and narrowing (stricture) of the esophagus. ulcers associated with ZES usually resistant and difficult to treat. The treatment is to remove the tumor and acid suppression with special drugs. In the past, removal of the stomach was the only treatment option. Experts do not know what factors actually increase the risk of ulcers. Symptoms of gastric ulcer and duodenal ulcer and - Dyspepsia. The most common symptoms of peptic ulcer disease are collectively known as "indigestion". However, peptic ulcer dyspepsia may occur without, or any other gastrointestinal symptoms, particularly if they are caused by NSAIDs. main symptoms of dyspepsia: - bloating; - feeling of fullness; - hunger and the feeling of emptiness in the stomach, often after 1-3 hours after eating; - burping. - Heartburn and belching. The most common symptoms of peptic ulcer are abdominal pain, heartburn, belching, perhaps a feeling of acid in the throat. Many patients with these symptoms do not have a peptic ulcer. Most of them have what is called "functional dyspepsia." Elderly patients are less likely to have symptoms than younger. No symptoms may delay diagnosis, which may lead to an elderly patient at greater risk of serious complications. - Recurrent abdominal pain. Recurrent abdominal pain and other gastrointestinal symptoms, often found in children. It is becoming the norm for pediatricians with Helicobacter pylori infection in children identify with these symptoms. However, the researchers were unable to confirm a clear connection between regular abdominal pain and H. pylori infection in children. - Pain ulcer. ulcers pain can be localized to one place, or may be throughout the abdominal cavity. Pain can be a burning or aching in the upper abdomen, or as stitching, penetrating through the intestines. Symptoms may vary depending on the location of the ulcer: - in the duodenum often ache after a few hours after eating, and then patients can relieve pain meal. Many also happens heartburn; - dull, aching pain in the stomach, often immediately after a meal. Eating does not relieve pain, and may even enhance it. The pain may also come in the night; - ulcer pain can be especially confusing when it gives on the back or on the chest, behind the breastbone. In such cases, it can be confused with other diseases - such as heart attack; - due to the fact that the ulcer can cause hidden bleeding, patients may experience symptoms of anemia, including fatigue and shortness of breath. - extremely dangerous symptoms. Severe symptoms that begin suddenly may indicate a blockage in the intestines, bleeding or perforation, and all that - emergencies. Symptoms may include: - black or bloody stools; - severe vomiting, which may include blood substance like coffee grounds (a sign of a serious hemorrhage), or all of the contents of the stomach (a sign of bowel obstruction); - severe abdominal pain with vomiting or without, with blood. ulcer can lead to emergency situations. Severe abdominal pain, sometimes with signs of bleeding, may indicate that the perforated ulcer of the stomach or duodenum. Vomiting substances that resemble coffee grounds, or the presence of black tarry stools may indicate a severe bleeding in the digestive tract. Diagnosis of gastric and duodenal ulcers ulcer always suspected in patients with persistent dyspepsia. Symptoms of dyspepsia occur in 20-25% of people who live in industrialized countries, but only about 15-25% of patients with dyspepsia in fact have an ulcer. It should take a few steps to accurately diagnose ulcers: - Medical and family history. doctor will ask questions about the dyspepsia for expanded patient's response, as well as check: - other important symptoms - such as weight loss or fatigue;
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Čira na želucu i dvanaesniku : uzroci, simptomi , dijagnoza , liječenje Gastroenterologija / / August 12, 2017 čira na želucu i dvanaesniku Video Što je kuga? čir mehanizam formiranja Uzroci želuca i dvanaesnika faktori koji uzrokuju čireve u nositelja H. pylori Simptomi čira na želucu i na dvanaesniku Dijagnoza ulkusa želuca i dvanaesnika liječenje ulkusa želuca i dvanaesnika Antibiotici i kombinirane sheme liječenja čiraželucu ili dvanaesniku, Kirurško liječenje ulkusa želuca i dvanaesnika Što može zamijeniti aspirin za želučane prehrana za želučane Fizička aktivnost i vježbe za želučane Komplikacije želučanog ulkusa peptički ulkus - otvorenu ranu ili mokropodručjima, s tendencijom da se razvije u jednom od dva mjesta: - u sluznici želuca (čir na želucu); - u gornjem dijelu tankog crijeva - dvanaesterac (duodenalnog ulcera). duodenalni ulkus javlja tri puta više od čira na želucu često. ČIR razvijati kada je želudac, crijeva, probavne žlijezde se pojaviti probavne sokove, a oštećena želučane sluznice ili čirom na dvanaestercu. ulkusi mogu biti u prosjeku od 0,62 cm do 1,25 cm u pr peptički ulkus bolest pogađa sve dobne skupine, ali rijetko u djece.Kod muškaraca, rizik od čira dva puta više nego u žena.Rizik od dvanaesnika ulkusne bolesti je u porastu, jer 25 godina i dalje je 75 godina.Rizik od većine svojih vrhova - od 55 do 65 godina. mehanizam formiranja čirevi dva važna komponenta probavnih sokova - klorovodične kiselina i pepsin enzima.Obje supstance su od ključne važnosti za uništenje i probavu škroba, proteina i masti u hrani.Oni igraju različite uloge u čireve. - solna kiselina. je uobičajena pogrešna pretpostavka da je višak solne kiseline, koji se oslobađa u želucu, sam je odgovoran za proizvodnju čireva.Bolesnici s čir na dvanaestercu, imaju tendenciju da imaju više od normalne razine solne kiseline, ali većina bolesnika s čira na želucu ima kiselinski stupanj normalno ili ispod normale.Prisutnost želučane kiseline, u stvari, potrebno je zaštititi protiv H. pylori - bakterije, koje u većini slučajeva izaziva peptički ulkus.Iznimke su čirevi koji se pojavljuju na Zollinger-- rijetka genska bolest u kojoj tumora na gušterači ili dvanaesniku identificira vrlo visoke razine gastrina - hormon koji stimulira lučenje solne kiseline. - pepsinom. Taj enzim razgrađuje proteine u hrani.Također je važan faktor u formiranju ulkusa.Budući da je želudac i dvanaesniku se sastoji od proteina koji su osjetljivi na djelovanje pepsina.Međutim, tijelo ima obrambeni sustav za zaštitu želuca i crijeva protiv tih dviju moćnih tvari: - sloj sluzi koja pokriva želuca i dvanaesnika (prva linija obrane); - bikarbonat, oslobađajući sluzi sloj, koji neutralizira probavne kiseline; - prostaglandini hormoni kao tvari koje pomažu rastegnuti krvne žile u želucu kako bi se osiguralo dobru cirkulaciju i štiti od povrede.Prostaglandini također može potaknuti djelovanje bikarbonata i sluzi. uništavanje tih obrambenih mehanizama čini sluznicu želuca i crijeva osjetljivih na djelovanje kiseline i pepsina, povećava rizik od čireva. razloga čira na želucu i dvanaesniku 1982., dvije Australski znanstvenici su identificirali Helicobacter pylori (Helicobacter pylori ili H. pylori) kao glavni uzrok želučanih čireva.Oni su pokazali da je upala želuca i čireva na želucu proizlaze iz želuca infekcije uzrokovane bakterijom H. pylori. čini se da bakterije uzrokuju čireve ovako: Helicobacter pylori vadičep oblik omogućuje im da prodre u sluzav sloj želuca ili dvanaesnika, tako da oni mogu biti priključeni na obloge.Površine stanica sluznice želuca, sadrže proteine.Ubrzanje faktor razgradnju proteina djeluje kao receptor za bakterije. H. pylori preživjeti u vrlo kiseloj sredini.H. pylori i potiče povećanje oslobađanje gastrina.Viša razina gastrina sodeystvovuyut povećavaju sekreciju kiseline.Povećanje Kiselina oštećuje crijevnu sluznicu, da određene osobe dovodi do čira na želucu.H. pylori također modificira određene imunološke faktore koji omogućuju te bakterije kako bi se izbjeglo otkrivanje od strane imunološkog sustava i dovesti do česte upale, čak i bez invazije sluznice.Čak i ako se ne razvije čir Vjeruje bakterija Helicobacter pylori je glavni uzrok kroničnih upala aktivni u želucu - gastritis, te u gornjem tankom crijevu - duodcnitisa.H. pylori također usko povezana s rakom želuca i eventualno drugih extraintestinal problema.Bakterije H. pylori, vjerojatno prenosi izravno od osobe do osobe.Međutim, malo je poznato kako su ove bakterije prenose. Oko 50% svjetske populacije zaraženo je s H. pylori.Bakterije su gotovo uvijek stečene u djetinjstvu i trajati tijekom cijelog života, ako osoba ne liječi.Prevalencija ove bakterije kod djece iznosi oko 0,5% u razvijenim zemljama.No, čak i tamo, u područjima s kritičnim nehigijenskim uvjetima, uvjetima infekcije su jednaki onima u zemljama u razvoju. To nije posve jasno kako su ove bakterije prenose.Možda Metoda prijenosa uključuju: - intimni kontakt, uključujući kontaktu s tekućinom kroz usta; - bolesti gastrointestinalnog trakta (posebno s povraćanjem); - kontakt s izmetom (fekalne materije); - zagađena voda. Iako Helicobacter pylori su česti, čirevi u djece vrlo su rijetki - samo 5-10% od H. Pylori zaraženih odraslih.Nekoliko čimbenika može objasniti zašto neki pacijenti dobili zaražene čireve: - Pušenje; - konzumacija alkohola; - prisutnost članova obitelji koje se bave peptičkog ulkusa; - muški spolni; - zaraza bakterijski soj koji sadrži citotoksin povezana gen. Kada bakterija Helicobacter pylori prvi identificirani su kao glavni uzrok peptičkog ulkusa, otkrivene su u 90% osoba s duodenuma i oko 80% ljudi s ulkusa želuca.Kako sve više i više ljudi sada su testirani i liječene od bakterija, stopa uzrokovane s H. pylori ulkusa smanjuje.Trenutno H. pylori su oko 50% ljudi s peptičkog ulkusa; faktori koji uzrokuju čireve u nositelja H. pylori Određeni čimbenici mogu povećati rizik od čireva u NSAID: - dob od 65 godina i stariji; - povijest peptički ulkus ili gastrointestinalnog krvarenja-; - druge ozbiljne bolesti - kao što kongestivnog zatajenja srca; - korištenje takvih lijekova kao protukoagulacijskih varfarina (coumadin), kortikosteroidi, osteoporoze lijeka alendronat (Fosamax), itd,. - zlouporaba alkohola; - infekcija Helicobacter pylori; - ostali faktori rizika za čir na želucu od H. pylori ili NSAID; - stres i psihološki faktori; - bakterijske ili virusne infekcije; - tjelesna ozljeda; - radioterapija; - pušenje.Pušenje povećava izlučivanje kiseline, bikarbonata i prostaglandina smanji i smanjuje protok krvi.Međutim, stvarni rezultati istraživanja pušenja ulkusa drugačije. imaju samo 10-15% ljudi zaraženih s Helicobacter pylori, razvoju peptički ulkus.Infekcije H. pylori, osobito u starijih osoba, ne mora uvijek dovesti do peptičkog ulkusa.Isto tako da bude prisutan, i drugih čimbenika, kako bi zapravo uzrokovati čireve: - genetski čimbenici.Neki ljudi su sojeva H. pylori gena koji čine bakterije opasniji i povećava rizik od čireva; - imunološki poremećaji. Neki ljudi imaju povredu crijevnog imunološkog odgovora, što omogućuje bakterijama da ozlijediti crijevnu sluznicu; - životne navike. Iako životne navike kao što su kronični stres, kave i pušenje je odavno smatra glavni uzroci ulkusa, danas se smatra da su oni samo povećavaju osjetljivost na čireva, neki prijevoznici H. Pylori - i ništa više; - stres. Iako stres više ne vjeruje da uzrokuje čir, neka istraživanja pokazuju da stres može biti preduvjet za ulkusa ili spriječiti ozdravljenje postojećih čireva; - rad u smjenama i prekinut san. Ljudi koji rade noćne smjene imaju značajno veću učestalost ulkusa nego dan radnika.Znanstvenici sumnjaju da su česti prekidi sna može oslabiti sposobnost imunološkog sustava da se zaštiti od štetnih bakterija. - nesteroidni protuupalni lijekovi (NSAID-i). Dugotrajna upotreba nesteroidnih protuupalnih lijekova poput aspirina, ibuprofena (advil, motrin) i naproksen (Alevi, naprosyn) - drugi najčešći uzrok čira na želucu.NSAR također povećati rizik od gastrointestinalnog krvarenja.Rizik od krvarenja potraje sve dok se bolesnik uzima drogu, a to može trajati oko 1 godinu nakon pauze.Kratki tečajevi NSAR za privremeno olakšanje od bolova ne bi trebalo uzrokovati ozbiljne probleme, jer želudac ima vremena da se oporavi i popraviti štetu događa. Pacijenti s čireva iz NSAR, prestati uzimati ove lijekove.Međutim, bolesnici koji trebaju te lijekove za dugoročno, može smanjiti rizik od čira Drug Administration grupe PPI - inhibitora protonske pumpe - kao što je omeprazol (Prilosec), famotidin (Pepsid - blokator H2), itd u 15.-25% pacijenata koji uzimaju NSAR redovito su dokaz jednog ili više čireva, ali u većini slučajeva, ovi čirevi su vrlo male.Dugotrajno korištenje nesteroidnih protuupalnih lijekova mogu oštetiti, možda u tanko crijevo.Čak i niske doze aspirina (81 mg), može biti rizika, no rizik je manji nego pri višim dozama.Najveći rizik od uporabe vrlo visokih doza NSAID za dugo vremensko razdoblje, naročito u bolesnika s reumatoidnim artritisom. - Lijekovi. ulkusi mogu pogoršati neke druge lijekove, uz NSAR.To su: varfarina (coumadin) - antikoagulans, što povećava rizik od krvarenja, oralnih kortikosteroida, neke kemoterapijskih lijekova - spironolakton i niacin.Bevacizumab - za liječenje raka debelog crijeva, može povećati rizik od gastrointestinalnog perforacije (perforacije ili perforacije ulkusa - proboj čir izvan želuca i dvanaesnika s izdavanjem njihova sadržaja).Dok su prednosti bevacizumab nadmašuju rizike, gastrointestinalne perforacije su vrlo ozbiljne.Ako se dogodi, bolesnici bi trebali prestati uzimati lijek. - sindroma Zollinger-Ellison (ZES) sindrom..Drugi uzrok ulkusa, iako znatno manji od H.Pylori ili NSAID je Zollinger-.Velika količina kiseline proizvedene kao odgovor na hiperprodukcija hormona gastrina, koji pak uzrokuje tumor gušterače i dvanaesnika.Ovi tumori općenito kancerogeni i treba biti uklonjen.kiselina proizvodnja mora biti potisnut spriječiti nove čireva. ZES treba posumnjati u bolesnika s čireva koje nisu zaražene s H. pylori i nemaju povijest NSAID.Proljev se može dogoditi prije simptoma čira.Čir se javljaju u drugoj, trećoj ili četvrtoj dijelovima dvanaesnika ili jejunuma (srednji dio tankog crijeva) - znakovi ZES.Gastroezofagealna refluksna bolest (GERB) je česta i često teža u bolesnika s ZES.Komplikacije GERB uključuju čireve i sužavanje (suženje) u jednjaku. ulkusa povezanih s ZES obično su otporne i teško liječiti.Tretman je ukloniti tumor i kiseline potiskivanje s posebnim lijekovima.U prošlosti, uklanjanje želuca je jedina opcija liječenja. Stručnjaci ne znaju što čimbenici zapravo povećati rizik od čireva. Simptomi čira na želucu i čir na dvanaestercu i - dispepsija. Najčešći simptomi peptičkog ulkusa kolektivno su poznati kao "probavne smetnje".Međutim, peptički ulkus dispepsija može dogoditi bez, ili bilo koji drugi gastrointestinalni simptomi, posebno ako su uzrokovane NSAR. glavni simptomi dispepsije: - nadutost; - osjećaj punoće; - glad, a osjećaj praznine u želucu, često nakon 1-3 sata nakon jela; - podrigivanja. - Žgaravica i podrigivanje. Najčešći simptomi peptički ulkus su bolovi u trbuhu, žgaravica, podrigivanje, možda osjećaj kiseline u grlo. Mnogi pacijenti s tim simptomima nemaju peptički ulkus.Većina njih ima ono što se naziva "funkcionalna dispepsija."Starije osobe su manje vjerojatno da će imati simptome nego mlađi.Nema simptomi mogu odgoditi dijagnozu, što može dovesti do starijih bolesnika veći rizik od ozbiljnih komplikacija. - Ponavljanje bolova u trbuhu. Ponavljanje bolovi u trbuhu i drugih gastrointestinalnih simptoma, često naći u djece.To postaje norma za pedijatre s Helicobacter pylori infekcije u djece identificirati s tim simptomima.Međutim, znanstvenici su uspjeli utvrditi jasnu vezu između redovitog bolovi u trbuhu i H. pylori infekcije u djece. - Bol čira. ulkusi bol može biti lokaliziran na jedno mjesto, ili može biti u cijelom trbušne šupljine.Bol može biti gori ili bolovi u gornjem dijelu trbuha, ili vezenje, prodire kroz crijeva. Simptomi mogu varirati ovisno o lokaciji ulkusa: - u dvanaesniku često boljeti nakon nekoliko sati nakon jela, a onda pacijenti mogu olakšati bol obrok.Također, mnogi se događa žgaravicu; - tupa, probadajuća bol u želucu, često neposredno nakon obroka.Jelo ne oslobađa boli, a može čak i poboljšati ga.Bol također može doći u noći; - bol u želucu mogu biti osobito zbunjujući kada se daje na leđima ili na prsima, iza prsne.U takvim slučajevima, može se pomiješati s drugim bolestima - poput srčanog udara; - s obzirom na činjenicu da se čir može izazvati krvarenje skriven, bolesnici mogu osjetiti simptome anemije, uključujući umor i otežano disanje. - iznimno opasni simptomi. Teški simptomi koji počinju iznenada mogu ukazivati na začepljenje u crijevima, krvarenje ili perforacija, a sve to - hitne slučajeve.Simptomi mogu uključivati: - crne ili krvave stolice; - žestoko povraćanje, što može uključivati krvni tvar poput kave (znak ozbiljnog krvarenja), ili sav sadržaj želuca (znak crijeva opstrukcije); - jaka bol u trbuhu s povraćanjem ili bez, s krvlju. ulkus može dovesti do izvanrednih situacija.Teška bol u trbuhu, ponekad i sa znakovima krvarenja, može značiti da perforiranog ulkusa želuca i dvanaesnika.Povraćanje tvari koje nalikuju kave ili prisustvo crne katrana stolice može ukazivati na ozbiljne krvarenje u probavnom traktu. Dijagnoza ulkusa želuca i dvanaesnika čira uvijek sumnja u bolesnika s perzistentnom čirom.Simptomi dispepsija pojaviti u 20-25% ljudi koji žive u industrijaliziranim zemljama, ali samo oko 15-25% pacijenata s čirom u stvari imaju čir.To bi trebalo poduzeti nekoliko koraka kako bi se točno utvrdili čireva: - medicinski i obiteljske povijesti. liječnik će postaviti pitanja o dispepsija za odgovor proširio pacijenta, kao i provjera: - druge važne simptome - kao što su gubitak težine ili umor;