Peptic ulcer in children

With the combination of the ulcerative process in the esophagus, stomach and duodenum, the course of ulcers is identical, and the healing time coincides.

Clinic and Diagnosis

The main clinical symptoms are heartburn and chest pain. Heartburn, according to the stories of the patients, is almost constant, with short interruptions, painful. Pain behind the breastbone occurs, as a rule, during eating and is strengthened in a horizontal position. Non-persistent symptoms include eructations, vomiting and dysphagia. Even more rarely there are signs of obvious or latent bleeding. If the establishment of obvious bleeding from the esophagus does not present great difficulties( an admixture of scarlet blood in the vomit masses), then the latent bleeding of their upper gastrointestinal tract is difficult to recognize.

It is generally believed that the likelihood of bleeding from the upper gastrointestinal tract increases with a combination of increasing anemia with gastroenterological complaints. If you suspect a bleeding peptic ulcer of the esophagus, in addition to examining the mucosa of the esophagus, tests for latent blood in the stool are conducted. It should be remembered that, firstly, the blood volume of less than 50 ml, trapped in the lumen of the digestive tube during bleeding from the upper gastrointestinal tract, in particular from the esophagus, may not be determined by modern methods of stool examination;Secondly, a number of food products and food colors can stimulate the presence of blood decay products in the feces.

The clinical course of the peptic ulcer of the esophagus is long, wavy. Seasonality of exacerbations is noted, as well as with duodenal ulcer.

Clinical diagnosis of this disease of the esophagus is extremely difficult. Therefore, the diagnosis is established using radiological and endoscopic methods.

X-ray examination reveals signs of an ulcer in the form of a niche in the wall of the esophagus, sometimes surrounded by the esophagus. However, due to the fact that ulcers in the esophagus are shallow, the diagnosis of them even with the help of a contrast method presents significant difficulties. An indirect radiographic evidence is narrowing of the esophagus - spastic in inflammation around the ulcer and scarring - with long-term ulcers.

A crucial role in the diagnosis is played by esophagofibroscopy, in which ulceration of the esophagus mucosa is usually found on the posterior or lateral wall, in the lower third, with uneven margins slightly protruding above the level of the mucosa. The surface of the ulcer is covered with a whitish or gray coating.

Treatment

Treatment is carried out with the obligatory observance of measures to prevent gastroesophageal reflux. With an uncomplicated ulcer, conservative treatment is indicated. Nutrition of the patient during the "acute" ulcer or exacerbation in the case of its chronic course is fractional - 6-8 times a day, in small portions. For the purpose of maximum shading of the mucous membrane, the mashed food is prescribed. It is advisable to give the patient a half-spoonful of vegetable oil before eating. The temperature of food should not exceed body temperature, i.e.36.8 degrees. Avoid saturated bouillons, extractives, acidic products. With severe pain behind the breastbone, it is recommended to take a small sip of 0.25% solution of novocaine in a warm form.

Prescribe course treatment for 6-8 weeks enveloping and antacid preparations( bismuth nitrate base, vikalin, vicair, Almagel A, phosphalugel, etc.).It is desirable to systematically consume alkaline mineral waters such as Borjomi. The means enhancing the reparative processes in the field of ulcers, such as methyluracil, trichopolum, solcoseryl, are shown. These same drugs to some extent stimulate and local immunity.

Spasmodic phenomena in the esophagus, especially if they are accompanied by pain, are eliminated by antispasmodic and anticholinergic drugs.

As the process of stamping the ulcerative process into a set of therapeutic measures includes physiotherapy - Novocaine or magnesium sulfate electrophoresis on the region of the cervical lymph nodes, the collar zone.

In recent years, methods for directly affecting the ulcer with the use of endoscopic equipment have been widely used: electrocoagulation with ulcers of high frequency, photocoagulation with a laser beam, application of polymer pastes to the ulcer surface, introduction of tissue surrounding the ulcer, vasoconstrictor. These methods should be used after mandatory complete sanation of teeth, oral cavity and nasopharynx. When treating ulcers of the esophagus, you must strictly follow the constant, regular cleansing of the intestine, prevent constipation.

The occurrence of complications such as esophageal stenosis or intensive bleeding requires the use of surgical methods of treatment.

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