Recommendations for rehabilitation after peptic ulcer. Rehabilitation for peptic ulcer disease of the gastrointestinal tract. List of used literature

Introduction

Dear readers, We present to your attention a book dedicated to a very relevant disease at present - peptic ulcer of the stomach and duodenum. The relevance of this problem is due to the high incidence of this disease - 5 people per 1000 working-age population, as well as a fairly large number of complications of this disease that are life-threatening. Such a high incidence of the disease is due to a dynamic life, poor diet and frequent and prolonged stress.

It is very important that you, dear readers, know the main manifestations of this disease, learn about its complications and be able to consult a doctor in a timely manner. In addition, the book contains a complete description of methods for treating gastric and duodenal ulcers; the main part of the book is devoted to folk recipes used for rehabilitation after this disease. I hope that this book will help you not only recover from peptic ulcer disease, but also successfully go through the entire rehabilitation period and achieve long-term remission of this disease.

Rehabilitation after peptic ulcer

Peptic ulcer disease is currently very widespread - almost 5 people per thousand of the population suffer from this pathology. The incidence of peptic ulcer disease is not the same in men and women - men get sick 7 times more often than women, a peculiar risk factor in this case is blood group I. This pattern is especially clearly seen in the development of duodenal ulcer. Peptic ulcer disease develops as a result of the action of damaging factors on the mucous membrane of the stomach or duodenum, which, during the development of this disease, many times prevail over protective factors. An ulcer is a small and limited defect in the mucous membrane of the stomach and/or duodenum. The main damaging factors include rough and poorly chewed food, hydrochloric acid, which under normal conditions is neutralized and does not have a damaging effect on the mucous membrane, and pepsin. An important role is played by the reflux of bile into the stomach from the duodenum, which is observed in many diseases of the gastrointestinal tract: impaired motility of the gallbladder and bile ducts, cholecystitis, cholelithiasis. The main protective factor of the gastric mucosa is mucus, which neutralizes the damaging effects of hydrochloric acid and the enzyme pepsin on the mucosa, promotes rapid regeneration of the mucous membrane, and also provides mechanical protection from rough and poorly chewed food. Mucus has an alkaline reaction, and pepsin and hydrochloric acid are acidic, as a result of which the protective effect of mucus occurs.

Predisposing factors The development of gastric and duodenal ulcers is caused by non-compliance with the diet, abuse of salty, spicy, very hot, sour foods, and abuse of alcoholic beverages. Unbalanced food, namely food that does not contain the “reference” amount of fats, carbohydrates, proteins, mineral salts and vitamins, can lead to the development of peptic ulcers. Dry food is also a predisposing factor in the development of peptic ulcer disease - this has a scientifically based opinion: dry food is most often found when eating in a hurry on the go, i.e. in conditions not suitable for this, and all this leads to increased secretion not only hydrochloric acid, but also all digestive enzymes and bile, which during normal nutrition should be diluted with liquid. A very important point in the development of peptic ulcer disease is prolonged psycho-emotional stress, which, dear readers, is far from uncommon in our time of technological progress. During times of stress, many people begin to smoke and drink alcoholic beverages much more often. But smoking not only has an adverse effect on the respiratory system, but also has a fairly large negative effect on the gastrointestinal tract. This is due to the fact that a certain part of the smoke and saliva containing cigarette tar enters the stomach, irritating the mucous membrane. In addition, during smoking, a reflex spasm of blood vessels occurs, including the vessels that supply the wall of the stomach, as a result of which the normal ability of the gastric mucosa to regenerate is disrupted. Drinking strong alcoholic drinks, especially in large quantities, has a powerful damaging effect on the mucous membrane of the stomach and duodenum. The damaging effect of alcohol is especially pronounced when drinking alcohol on an empty stomach. But it is not only human vices and inattention to one’s health that leads to the development of gastric and duodenal ulcers. Many people have a variety of diseases, the treatment of which can lead to the development of peptic ulcers. Drugs that cause the development of peptic ulcers include hormonal drugs, acetylsalicylic acid, butadione, indomethacin and many others.

In addition to the above risk factors, there is a genetic predisposition to this disease. This means that a child born into a family of parents with peptic ulcer disease has a high risk of developing this disease, even if he follows all the rules and tries as much as possible to protect himself from risk factors. The risk decreases if one of the parents is sick, and increases if a sibling has a peptic ulcer. The risk of developing this disease also increases in the presence of other pathologies of the gastrointestinal tract. On average, the hereditary risk of developing peptic ulcers ranges from 20 to 40%. In addition to pathology from the gastrointestinal tract, pathology from other organs and systems: respiratory, endocrine, nervous, cardiovascular systems can lead to the development of peptic ulcers as a result of deterioration of blood supply to the stomach and duodenum, as well as disturbances in nervous regulation.

The most common cause of gastric and duodenal ulcers is the microbe Helicobacter pylori, which is found in a large percentage of cases. The introduction of this microorganism most often occurs when performing invasive measures, for example, the well-known fibrogastroduodenoscopy. Helicobacter pylori provides a source of chronic inflammation in the stomach; in addition, its waste products and the enzymes it secretes have a mutagenic effect on the mucous membrane. Therefore, a peptic ulcer can in a certain percentage of cases become malignant and turn into cancer. Based on these data, along with the treatment of peptic ulcer, eradication therapy for Helicobacter pylori infection is carried out. There are two treatment regimens, and each of them includes an antibacterial drug.

So, dear readers, I have introduced you to the risk factors for developing gastric and duodenal ulcers and I hope that you will try as much as possible to avoid possible risk factors or minimize them.

But if, nevertheless, you were unable to avoid risk factors and you developed the disease, then I will try to simply describe the clinical manifestations of gastric and duodenal ulcers, which differ from each other in some respects.

Stomach ulcer

Gastric ulcer usually develops at a fairly mature age, and the main complaint of patients is pain in the left hypochondrium or epigastric region, which begins on average 30 minutes after eating and lasts up to 1.5 hours, i.e. the time during which food moves from the stomach to the duodenum. At the beginning of the disease, pain occurs only when eating large amounts of spicy, salty, fatty foods, or when overeating, and only when an ulcer has formed does it begin to be permanent after each meal. The nature of the pain can be different: from minor to intense, the pain can radiate to the back, sometimes there is a retrosternal pain. In the background after pain, most patients note dyspeptic disorders, namely: sour belching, heartburn, and in advanced stages of the disease - nausea and vomiting. Vomiting brings relief to patients by reducing the intensity of pain, so in certain cases patients can induce vomiting on their own. When analyzing the acidity of gastric juice, its acidity is revealed to be normal or slightly reduced. Features of the clinical manifestation of duodenal ulcer is its appearance at an early age. In addition, this localization of peptic ulcer is characterized by other patient complaints: pain appears on average 2 hours after eating and is most often localized in the area of the navel projection and in the epigastric region. In addition, the pain is nocturnal, as well as hunger pain. The intensity of pain decreases after eating and taking antacids. Duodenal ulcer is characterized by a kind of vicious circle: pain appears, which is relieved by eating, then pain comes again, etc. When examining gastric juice, an increase in its acidity is noted. The secretion of gastric juice is also often increased. In addition to pain, patients complain of heartburn, which is often burning in nature. Vomiting brings relief to patients, and patients themselves cause it - the vomit is usually copious and has a sour smell.

The course of peptic ulcer disease is characterized by seasonality. For people with a hereditary predisposition to peptic ulcer disease, especially in the presence of chronic bacterial gastritis, during the period of autumn or spring dyshormonal state, hyperplasia and increased function of endocrine cells are observed, which secrete gastrin, histamine, serotonin, etc. The area of the stomach and duodenum is a kind of hypothalamus gastrointestinal tract. -intestinal tract, as it has a large number of cells secreting hormones and various

biologically active substances. Due to this, they participate in the stimulation of gastric secretion and affect the nutrition and proliferation of cells in the gastrointestinal tract. But against the background of active bacterial gastritis and/or duodenitis, the most favorable conditions arise for the formation of an ulcerative defect. And with the formation of a peptic ulcer defect, a decrease in the functional activity of endocrine cells is observed. This leads to a decrease in the production of aggressive factors, improves nutrition of the stomach and duodenum and creates favorable conditions for the healing of the ulcer. In this way, the human body can independently fight this disease. There are statistics that 70% of ulcers heal on their own without any intervention. But it is still necessary to carry out treatment to reduce the recovery time, prevent exacerbations, complications, as well as prevent the malignancy of the process, i.e., the transition of the ulcer to a cancerous process. Dear readers, now you are aware of the main manifestations of gastric and duodenal ulcers, and if you identify similar symptoms in yourself, I strongly recommend that you contact your local gastroenterologist.

Features of the course of peptic ulcer disease

Peptic ulcer is a chronic, constantly relapsing disease. But different people have different periods of time between exacerbations of the disease: from several months to several years. The main goal of treatment is to increase the duration of the period of remission, that is, the period of normal well-being. The period of exacerbation of peptic ulcer disease usually lasts about 1 month. Healing of an ulcer scar occurs in approximately 3–5 weeks. I would like to draw your attention to the fact that as a result of each exacerbation, the ulcerative defect heals with an increasingly rough scar, and the edges of the ulcerative defect become undermined. With adequate treatment, recovery becomes possible in a shorter period of time. It is necessary to remember about the possible serious complications of a peptic ulcer: bleeding (occurs in 22% of cases), germination into neighboring organs (penetration) (occurs in 3% of cases), perforation, narrowing of the gastric outlet (occurs in 10–14% of cases), transition ulcers into a malignant process - malignancy (in 2% of cases).

Based on the modern classification, mild, moderate and severe forms of this disease can be distinguished. At mild flow exacerbation of the disease is observed no more than once a year, scarring ends by 5-6 weeks from the start of therapy. At moderate course the number of exacerbations of the disease is no more than 2 times a year, more pronounced clinical symptoms are noted, scarring begins by the 10th week from the start of therapy. At severe course The disease has more than 3 exacerbations per year, pronounced full clinical symptoms are observed, short periods of remission and scarring occurs within 3 months from the start of therapy, surgical intervention is often required.

According to the variants of the course, a benign, protracted and progressive course is distinguished. These periods are similar to the manifestations of the above-described course of peptic ulcer disease.

In addition to these indicators, the classification includes the state of secretion, motility and evacuation of the gastroduodenal system, which can be normal, slowed down or enhanced.

Complications of peptic ulcer

First, I would like to dwell on the most common complication of peptic ulcer disease, namely bleeding. It is customary to distinguish between small and massive bleeding. Bleeding can sometimes be chronic - patients can lose small amounts of blood for several months, which can result in unusually increased fatigue, weakness, decreased performance, and laboratory tests reveal anemia and low hemoglobin levels. In addition, there are other signs of bleeding that will help you establish its presence: if the blood loss is about 50 ml, then the stool becomes black in color, but in most cases remains formed, and if 100 ml or more of blood is lost, the stool changes its consistency and becomes tarry. In addition to this symptom, vomiting is observed in a fairly large percentage of cases. If the bleeding occurs from an ulcer located in the stomach, then the vomit becomes the color of coffee - the so-called “coffee grounds” vomit. This is explained by the fact that when hemoglobin in the blood interacts with hydrochloric acid, hemoglobin is oxidized and it acquires a dark color. When the ulcer is located in the duodenum, vomiting usually does not occur; vomiting is also rarely observed with minor bleeding, since in the latter case it enters the duodenum from the stomach. A feature of bleeding is the following sign: before bleeding, there is usually a fairly noticeable increase in pain, which ceases to be intense after the end of bleeding. Thus, dear readers, if you have never complained about the gastrointestinal tract, but have begun to notice the appearance of unreasonable weakness, increased fatigue, and pallor, I recommend that you consult a doctor. In addition, it is necessary to undergo annual

endoscopic examination of the stomach, and people at risk for developing peptic ulcers should undergo this examination once every 6 months. If, nevertheless, you find fairly definite signs of bleeding, I strongly recommend that you call an ambulance as soon as possible, and spend the time waiting until the ambulance arrives for the benefit of your health: you need to lie down on the sofa, put a cold object on your stomach - for example a bottle filled with cold water, but under no circumstances should you eat or drink at this time.

The second most common complication is narrowing of the gastric outlet, but this disease only in very rare cases develops acutely and requires emergency care. Most often, this pathology develops gradually - over several months or even years. A peculiar risk factor for the development of narrowing of the gastric outlet is often exacerbating peptic ulcer disease over a fairly long period of time; In addition, the most common location of the ulcer in this case is observed in the outlet section of the stomach. There are three stages during this disease.

Stage 1 diseases - patients feel satisfactory, and they may only be bothered by heaviness in the stomach after a large amount of food eaten, and sometimes vomiting may occur. But the most common complaints are burping and hiccups.

2 stage The disease is characterized by increased heaviness in the epigastric region after a normal meal, rotten belching appears, quite severe abdominal pain appears, and vomiting is often observed. Rotten burps indicate stagnation of food in the stomach and the development of fermentation processes. The vomit contains admixtures of food eaten the day before, namely 2-3 days ago. In addition to complaints, objective changes are also noted: patients note weight loss, general weakness and increased fatigue.

1. stage The disease is characterized by the fact that no matter what the patient eats, heaviness in the stomach develops in any case, and the severity of this heaviness directly depends on the amount of food eaten. This is explained by the fact that there is a pronounced narrowing of the outlet of the stomach and food is not able to move further along the gastrointestinal tract. Stagning in the stomach, food undergoes putrefactive and fermentation processes, as a result of which the vomit has a foul odor. Patients are unable to tolerate constant heaviness in the stomach and can vomit up to several times a day, after which a significant improvement in their condition is noted. In stage 3, patients look very thin; as a result of frequent vomiting, water and minerals are lost, resulting in dehydration.

2. Treatment of narrowing of the gastric outlet can only be treated surgically, therefore, dear readers, if you suffer from this disease, I strongly recommend that you contact your doctor for advice. The sooner you see a qualified doctor and have surgery, the fewer complications you will have in the future.

The next most common complication of gastric ulcer is perforation of the ulcer. Perforation of a duodenal ulcer is many times more common than perforation of a gastric ulcer. In the vast majority of cases, 80–90% of ulcer perforation occurs during the period of exacerbation of peptic ulcer disease. Perforation can occur in people with a long history of peptic ulcer disease, as well as in people in whom the main signs of peptic ulcer disease could be completely absent. Risk factors for ulcer perforation are consumption of rough and poorly chewed food, consumption of strong alcoholic beverages, abuse of spicy and salty foods, and overeating. The defect in the wall of the organ, formed when an ulcer perforates, can have different sizes - from a few millimeters to 2-3 cm. Thus, the contents of a hollow organ - the stomach or duodenum - enter the abdominal cavity, which is a closed space. The contents, entering the abdominal cavity, are a strong irritant - severe pain occurs, which can be compared to scalding with boiling water or a blow from a dagger. Patients immediately take a forced position: on the right side with legs tucked to the stomach and bent at the knees; The skin of patients becomes covered with cold sweat, and sometimes a single vomiting may occur, which does not bring relief. The slightest movement of the patient causes severe pain, which is caused by the spreading of gastrointestinal contents throughout the abdominal cavity. This manifestation occurs in the initial period of the disease. 3–5 hours after the onset of the disease, a period of imaginary well-being begins - a decrease in the intensity of abdominal pain and a slight improvement in well-being are noted. There is bloating, the tongue is covered with a white coating, dry, and there is a rapid heartbeat. But such symptoms are just the calm before the storm. 6 hours after the onset of the disease, an increase in abdominal pain is noted, this complaint again comes to the forefront, and repeated vomiting is noted that does not bring relief. Due to the loss of a large amount of fluid through vomit, dehydration of the body is noted - facial features become sharper, the temperature can rise to 40 °C, and the skin becomes dry. If no measures are taken at this stage, diffuse peritonitis may develop, which threatens a poor prognosis. Already at the first stage of the disease, with the appearance of “dagger pains,” it is necessary to call an ambulance. Before the ambulance arrives, it is necessary to place the patient in a horizontal position; it is strictly forbidden to give the patient anything to drink or eat, or to take analgesics, which smooth out the picture of the disease, as a result of which it becomes more difficult to make a correct diagnosis, but the life of the sick person depends on making the correct diagnosis. .

The next group of complications of peptic ulcer disease will include 2 complications that develop most rarely: penetration, or germination into neighboring organs, and malignancy, or malignancy of the ulcer and its transition to cancer.

A stomach ulcer penetrates into nearby organs: the pancreas, duodenum, lesser omentum, and sometimes the anterior abdominal wall. Penetration of an ulcer is a limited perforation, since in this case the gastric contents are poured into the organ into which germination has occurred. The main manifestations of the disease during penetration will be similar to those during perforation, but will be less severe, but there is a distinctive sign of penetration - the pain becomes constant and loses the daily frequency characteristic of an ulcer. In addition, there is a change in the nature of the pain - it becomes more intense and, depending on the organ being sprouted, begins to radiate to other parts of the body, and not just localized in the epigastric or epigastric region. The main method of treating ulcer penetration is surgery. The earlier the surgical intervention is performed, the better the prognosis and the more effective the recovery period, the fewer postoperative complications there are.

The transition of a peptic ulcer to a malignant process is a fairly rare complication. This complication of peptic ulcer disease is very dangerous, since it is usually not diagnosed in the initial stages, and diagnosis at the later stages of this complication leads to high mortality in the first years after surgery, despite the success of the therapy. This is due to the fact that at the initial stages of the malignant process there are practically no signs of the oncological process. And the first, early clinical symptoms correspond to the already advanced stages of the tumor process. The first clinical symptoms include aversion to meat food, significant, unreasonable weight loss, and general weakness, which are often regarded as simple overwork. It should be noted that the transition of an ulcer to cancer is observed only when it is localized in the stomach; duodenal ulcers practically do not develop into a malignant process. Treatment of stomach cancer is only surgical, and the earlier surgery is performed, the better - the risk of distant metastases is reduced. But, alas, even with a successful operation, the treatment does not end there - patients must undergo chemotherapy and radiation therapy for a long time, which do not have the most favorable effect on the body, but are still an integral part of a full treatment. The only method of prevention and early detection of this disease is annual fibrogastroduodenoscopy with targeted biopsy from suspicious areas and further examination of the biopsy.

Thus, dear readers, I tried to sufficiently familiarize you with the possible complications of peptic ulcer disease. You have seen how dangerous these complications are - after all, they all require surgical intervention. But I hope that you can avoid all these complications and the disease itself if you carefully monitor your health. And remember - it is easier to prevent a disease than to treat it!!!

Having become familiar with the clinical manifestations of peptic ulcer disease, as well as its complications, you have learned a little about this disease. And the more aware you are, the more armed you will be! If you, dear readers, have found signs of a stomach or duodenal ulcer and consulted a doctor, you did absolutely the right thing! The doctor will have to prescribe you certain laboratory diagnostic tests that will help in making a diagnosis of peptic ulcer or refute it. So that these studies and their results are not a mystery to you, this chapter of the book will be devoted to this very issue.

You will need to donate blood for a general analysis. Using this analysis, it will be possible to detect the presence of anemia - a decrease in the number of red blood cells per unit volume of blood, leukocytosis - an increase in the level of leukocytes per unit volume of blood, determine the level of hemoglobin, and the level of ESR. In the presence of leukocytosis and an increase in ESR, an inflammatory process in the body can be suspected, and in the presence of anemia and a decrease in hemoglobin levels, signs of acute and chronic bleeding can be suspected.

An addition to the general blood test is a biochemical blood test, which can be used to determine the presence of acute-phase inflammatory indicators, the presence of which indicates an inflammatory process, to determine the total blood protein and mineral composition of the blood, enzymes.

An important diagnostic method is stool testing for occult blood, or Gregersen's test. But to carry out this test, you must follow certain rules: do not brush your teeth for 2 days, avoid traumatizing the oral cavity.

In addition to laboratory examination methods, there are invasive examination methods that are necessary for an accurate diagnosis of the disease: it is necessary to determine the acidity of gastric juice, in certain cases it is necessary to conduct daily pH measurements, to examine the motor function of the stomach and duodenum, which may be normal, decreased or increased .

The most valuable information about the location of the ulcerative defect can be obtained using the X-ray method and using fibrogastroduodenoscopy.

Before an X-ray examination, the patient is given a radiopaque liquid to drink, after which photographs are taken at certain intervals. On X-ray photographs, a sign of the presence of a peptic ulcer will be the presence of a defect in the wall of the stomach or duodenum filled with a radiopaque substance. In addition, this examination method makes it possible to determine the motor and evacuation function of the stomach, namely the ability of the stomach to conduct a radiopaque substance into the duodenum. This is important to exclude or confirm narrowing of the gastric outlet. The next invasive research method is fibrogastroduodenoscopy, with the help of which the doctor can accurately determine the position of the ulcerative defect. This research method is also used in emergency cases when it is necessary to establish the presence of a source of bleeding. Also, this research method, when the source of bleeding is detected, in certain cases makes it possible to stop the bleeding without resorting to abdominal surgery. Currently, there are many samples and generations of fiber tubes for performing fibrogastroduodenoscopy - their diameter ranges from 6 mm (latest generation) to 17 mm. The smaller the diameter of the tube, the less discomfort you will experience during this procedure. Using fibrogastroduodenoscopy, the doctor can take a small section of the mucous membrane from suspicious areas for histological examination - to exclude malignancy of the process. To detect or exclude the presence of ulcer growth into neighboring organs, an ultrasound method is used. This method is non-invasive and is considered completely safe; thanks to these qualities, it has found wide application in almost all areas of medicine. The reliability of this study is quite high and depends primarily on the qualifications of the doctor, as well as on the generation of the device. To diagnose Helicobacter pylori infection, the following methods are used: microscopy of a biopsy specimen obtained during a biopsy, a respiratory urease test (exhaled air is analyzed), a biochemical urease test when examining a biopsy specimen, as well as a microscopic examination of a biopsy specimen and serological methods, which are highly reliable. Urease is an enzyme that is formed during the life of Helicobacter pylori.

Traditional treatment of gastric and duodenal ulcers

Treatment of gastric and duodenal ulcers must be comprehensive, selected individually depending on the stage of the process, clinical manifestations of the disease, the presence of concomitant diseases and complications, as well as taking into account the degree of impairment of the functional state of the entire gastrointestinal tract.

The general principles of drug treatment of peptic ulcer should be aimed at reducing the increased secretion of hydrochloric acid and pepsin, protecting the mucous membrane of the duodenum and stomach, increasing the speed of reparative processes in the mucous membrane, i.e. promoting its rapid recovery, normalizing the motor and evacuation function of the gastroduodenal systems. The fastest recovery can be achieved with the combined use of drug therapy and dietary nutrition. Suppression of excessive secretion of hydrochloric acid is achieved by using peripheral M-anticholinergic blockers and H2-blockers. The same groups of drugs are used to normalize the motor-evacuation function of the gastrointestinal tract. Adsorbents and antacids are used to bind and neutralize hydrochloric acid. Bismuth preparations are used to protect the mucous membrane of the duodenum and stomach. Since in a large percentage of cases, Helicobacter pylori is detected during biopsy examination, it is necessary to carry out eradication therapy, i.e. treatment aimed at destroying this microorganism. Erradication therapy is carried out according to 2 schemes: the first scheme includes 3 drugs, the second - 4. If treatment according to the first scheme is unsuccessful, they move on to the second. In addition to drug treatment methods and dietary nutrition, hyperbaric oxygen therapy has recently been widely used, especially in the elderly. This method allows you to improve the nutrition of the mucous membrane of the stomach and duodenum. In addition to this method, EHF therapy and irradiation of the ulcer through a fibrogastroduodenoscope are used.

EHF therapy is a method of influencing high-frequency electromagnetic waves on an ulcerative defect. This method has a beneficial effect on the reparative capabilities of the mucous membrane, as a result of which the time for scarring of the ulcer can be significantly reduced. This method has also found wide application not only in treatment, but also in the prevention and rehabilitation of patients. This method has many positive aspects: with a sufficient number and correctly performed procedures, the ulcerative defect heals without scar formation and the period of remission of the disease can increase to several years. In addition, EHF therapy is a non-invasive method, as a result of which it does not cause any discomfort to patients and has virtually no contraindications or side effects.

Laser irradiation of an ulcer is used for poorly healing ulcers. Due to 5–7 such procedures, the well-being of patients significantly improves, and the periods of scarring of the ulcer are reduced.

Dear readers, in order to fully rehabilitate after a peptic ulcer of the stomach and duodenum, along with the main therapy, you must follow a diet. Dietary nutrition is an integral part of any treatment, as it helps the body cope with the disease as soon as possible and speed up the healing process. The main point of dietary nutrition for gastric and duodenal ulcers is mechanical, chemical and thermal sparing of the mucous membrane of the stomach and duodenum, as well as a decrease in the secretory activity of many glands of the gastrointestinal tract. This is necessary so that the mucous membrane recovers faster, since the secretion of the digestive glands has an irritating effect on the damaged mucous membrane and inhibits the process of its recovery. In dietary tables there are restrictions on certain food products: for example, with increased stomach acidity, it is necessary to limit foods with an acidic reaction and consume foods that can bind free hydrochloric acid. Chemical, mechanical and thermal sparing of the mucous membrane consists of excluding very hot, coarse, spicy and salty foods from the diet. It is necessary to prepare foods according to a certain method and serve them warm, not hot, preferably in liquid or pureed form. Fractional meals are recommended - namely, meals should be more frequent, but in smaller portions. Thanks to this diet, a decrease in the production of hydrochloric acid is achieved, the motor function of the stomach is improved, and the secretory function and activity of all digestive glands is normalized. In addition, fractional meals relieve the gastrointestinal tract. In our country and many other countries, diet tables developed by the outstanding nutritionist and scientific mind Pevzner are used.

Next, I will give you examples and a brief description of dietary tables that are used to treat gastric and duodenal ulcers. All tables are numbered with Arabic numerals; some dietary tables may contain a letter of the Russian alphabet after the number, which divides the tables within one group. For peptic ulcers of the stomach and duodenum, dietary tables according to Pevzner No. 1, No. 2 are used. In table No. 1, the following tables are distinguished: No. 1a, No. 16 and No. 1.

Table No. 1a. This table aims to limit the mechanical, chemical and thermal aggression of food on the stomach to the maximum extent possible. This diet is prescribed in the acute stage of gastric and duodenal ulcers, after bleeding, acute gastritis and other diseases that require maximum sparing of the stomach. The chemical composition of this table: 100 g of fat, 80 g of protein and 200 g of carbohydrates. The total calorie content of this table is 2000 Kcal. Products allowed for consumption when prescribing diet No. 1a: fruit and berry juices (not from sour varieties of berries and fruits), slimy milk soups, low-fat milk, jelly, soft-boiled eggs, omelettes, cream, jelly, steam soufflés. The amount of table salt should be limited to 3–4 g per day. Food must be taken in small, fractional portions 6–7 times a day for 14 days. After this you need to go to table number 16.

Table number 16. This table aims to limit the mechanical, chemical and thermal aggression of food on the stomach less sharply than table No. 1a. This diet is indicated for all patients with mild exacerbation of gastric or duodenal ulcers, as well as in the subsiding stage of exacerbation, with chronic gastritis. The total caloric content of this table is 2600 Kcal, the chemical composition of this table is presented: 100 g of proteins, 100 g of fats and 300 g of carbohydrates. Table salt is limited to 5–8 g per day. The diet of this table is presented in the same way as that of 1a, but you can add steamed and meat dishes, soufflé, pureed porridge, wheat crackers up to 100 g per day. Strong tea and coffee should be excluded from the diet. Afterwards they move on to dietary table No. 1.

Table No. 1. This dietary table aims to moderately spare the stomach from mechanical, chemical and thermal aggression of food products and is used in compensated stages of diseases of the stomach and duodenum, as well as in the 3rd decade of the course of treatment for peptic ulcers. Table No. 1 is an almost complete diet. The daily caloric intake of this table is 3200 Kcal, the chemical composition is covered by 100 g of proteins, 200 g of fats and up to 500 g of carbohydrates. Rough plant foods, concentrated meat and fish broths, all fried foods, and fresh bread are prohibited. Allowed: lean meat, steamed fish, boiled meat and fish, pureed vegetables, milk, omelettes, milk sausages, cottage cheese, stale white bread.

So, to summarize the description of dietary table No. 1, I will try to summarize the above data and give a list of foods that are allowed and that should be completely excluded from the daily diet.

The following must be completely excluded from the diet: smoked foods, fatty meats, fish, canned fish, fresh white bread, confectionery, any broths, boiled eggs, any fermented milk products, sharp cheeses, chocolate, ice cream, pasta and many cereals, mushrooms . Pickles are also excluded: tomatoes, cucumbers, cabbage, sauerkraut; onions, spinach, sorrel. Excluded: pepper, mustard, horseradish, limited: cinnamon, vanillin, parsley and dill. It is necessary to completely exclude strong tea and coffee, carbonated drinks, natural juices and compotes from sour varieties of fruits and berries. Products and dishes recommended for consumption include rice, semolina, oatmeal, day-old bread, crackers, first courses are recommended to be consumed pureed. Lean varieties of meat and fish are allowed for consumption, which are best consumed steamed or boiled. Casseroles, puddings and soufflés are allowed. You can eat soft-boiled eggs, but no more than 2 eggs per week. The following sweet dishes are allowed: jam, honey, sweet varieties of fruits and berries. Milk is allowed, but not fermented milk products. The recommended drinks are weak tea and rosehip infusion, which is especially beneficial.

Table No. 2a recommended during the recovery period after acute colitis, enteritis, enterocolitis, gastritis, as well as for chronic gastritis with secretory insufficiency, but preserved secretion. This table is prescribed in the absence of concomitant diseases of the liver, bile ducts, and pancreas. Dietary table No. 2a aims to slightly limit mechanical and chemical irritants that have an irritating effect on the mucous membrane of the gastrointestinal tract. It is not advisable to eat foods that linger in the stomach for a long time. Table No. 2a is an almost complete diet with a normal content of proteins, fats and carbohydrates. It is necessary to limit the daily intake of table salt to 5–8 g, free liquid intake should be about 1.5 liters. The diet of food products allowed for consumption is quite wide, but they must be served boiled or pureed. It is recommended to steam food. It is allowed to eat low-fat varieties of fish and meat, even baked, but without a rough crust. The total calorie content of the dietary table is 3100 Kcal. The diet is split - 5-6 times a day.

Table No. 2 aims to eliminate mechanical irritation of the stomach while maintaining its chemical stimulation to increase the secretory function of the stomach. This table is prescribed for gastritis with low acidity, in the absence of hydrochloric acid, i.e., for anacid conditions, chronic colitis without exacerbations, as well as for recovery from various diseases. The total calorie content of this table is 3000 Kcal, the chemical composition is 100 g of proteins, 100 g of fats and 400 g of carbohydrates. The content of table salt in the daily diet increases to 15 g.

Products prohibited for consumption at dietary table No. 2 are fresh bread, baked goods, various buns, fatty fish and meats; canned food and smoked products are not recommended for consumption. Many vegetables are prohibited for consumption in their whole form, but are allowed pureed. Dairy soups and legume soups are prohibited. Mushrooms, salted and pickled dishes are prohibited, spices are limited. Chocolate, ice cream, red currants, dates, figs, raspberries, gooseberries and some other berries are prohibited. Drinks prohibited: kvass, black coffee, natural grape juice.

The following products are allowed: lean meats and fish, slightly stale wheat bread, preferably coarsely ground, crackers, pasta, vegetables: eggplant, pumpkin, zucchini, turnips, radishes, rutabaga, etc., but in pureed or chopped form, preferably steamed. The following cereals are allowed: semolina and rice. Dairy products: non-acidic sour cream and cottage cheese, and cottage cheese is better in pureed form; from fermented milk products - kefir, mild varieties of cheese. 2 eggs per week are allowed, soft-boiled or in the form of an omelet or scrambled eggs. It is better to limit your potato consumption by using another side dish. The following sweet products are allowed: marmalade, marshmallows, sweet fruits and berries, as well as dried fruits and compotes made from them. Spices are allowed, but not in large quantities. You can eat a variety of dietary foods that meet the above requirements. Rosehip decoction, weak tea, coffee and cocoa are allowed from the liquid, but must be diluted with milk.

Traditional methods of treatment used for a quick period of rehabilitation after peptic ulcer of the stomach and duodenum.

Herbal medicine for the rehabilitation of gastric and duodenal ulcers

Herbal medicine is the science of how to treat a person with the help of plants. The use of medicinal herbs and other natural remedies in the treatment of sick people has attracted people's attention since ancient times. There is evidence that 6 thousand years ago people used plants for medicinal purposes. Knowledge about the effects of medicinal and poisonous plants has accumulated over centuries.

The therapeutic effect of medicinal plants is recognized by folk and scientific medicine, therefore herbal medicine (plant treatment) is widely used today.

Recently, interest in traditional medicine has increased. This is explained by the fact that its arsenal includes a large number of old, tested, accessible means.

As a result of our conversation, you will learn about simple and accessible, ancient and modern health recipes based on natural remedies, as well as recipes for medicinal plants.

Before choosing this or that remedy, I recommend that you read the section that gives a brief description of the most important types of medicinal plants and contains information about them, how to collect, store, and prepare medicinal plants.

From the book Diseases of the stomach and intestines author Yulia Popova

Nutrition for gastric and duodenal ulcers Therapeutic nutrition for peptic ulcers pursues several goals simultaneously. Firstly, nutrition should provide the mucous membrane of the stomach and duodenum with maximum peace. Secondly,

From the book Nutrition for Gastric Ulcers author Ilya Melnikov

Recipes for gastric and duodenal ulcers Cottage cheese soufflé with carrots Cottage cheese – 150 g, carrots – 50 g, semolina – 10 g, granulated sugar – 1 teaspoon, butter – 1 teaspoon, non-acidic sour cream – 2 tablespoons, 1 /2 eggs.Cottage cheese with

From the book Exercises for internal organs for various diseases author Oleg Igorevich Astashenko

From the book Treatment of diseases of the stomach and intestines author Elena Alekseevna Romanova

From the book Surgical Diseases author Alexander Ivanovich Kirienko

Therapeutic movements for gastric and duodenal ulcers Gastric and duodenal ulcers are a chronic disease characterized by the formation of ulcers in the mucous membrane and deeper layers of the walls of the stomach and

author Irina Nikolaevna Makarova

Herbal medicine for peptic ulcers of the stomach and duodenum The goal of herbal medicine for peptic ulcers of the stomach and duodenum is the most complete restoration of the defect of the mucous membrane and the normalization of all abnormalities in the work

From the book Gastric Ulcer. The most effective treatments author Yulia Sergeevna Popova

Collections used for gastric and duodenal ulcers Collection No. 1 Chamomile flowers, fennel fruits, marshmallow roots, wheatgrass rhizome, licorice roots - in equal proportions. 2 tsp. pour 1 cup of boiling water over the mixture. Infuse, wrapped, for 30 minutes, strain.

From the book of 100 cleansing recipes. Ginger, water, Tibetan mushroom, kombucha by Valeria Yanis

Complications of peptic ulcer of the stomach and duodenum You need to know the frequency and place of peptic ulcer of the stomach and duodenum among other chronic diseases of the abdominal organs. Clinical anatomy, morphology and physiology of the stomach and

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From the book Therapeutic nutrition for chronic diseases author Boris Samuilovich Kaganov

Recipes for gastric and duodenal ulcers Appetizers Cottage cheese soufflé with carrots Cottage cheese – 150 g, carrots – 50 g, semolina – 10 g, granulated sugar – 1 teaspoon, butter – 1 teaspoon, non-acidic sour cream – 2 tbsp . spoons, 1/2 egg.Cottage cheese with sugar, semolina and

From the book Longevity Calendar according to Bolotov for 2015 author Boris Vasilievich Bolotov

Cleansing for stomach and duodenal ulcers Ginger root extract is actively used in homeopathy. It is believed to have a beneficial effect on the activity of the gastrointestinal tract, for example, with gastritis, gastric ulcers and

From the author's book

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December 11 Cleansing for gastric and duodenal ulcers When toxic waste accumulates, the gastrointestinal tract becomes sluggish. But the more vigorously it works, the more gastric enzymes it releases, which play a leading role in the destruction

From the author's book

December 12 Cleansing for peptic ulcers of the stomach and duodenum (continued) Take 1 tbsp. spoon with the top of plantain seeds, pour a glass of boiling water. Leave in a thermos overnight. Drink by? glass half an hour before meals 3 times a day (that is, you need 1 tablespoon of seeds per

From the author's book

December 13 Cleansing for peptic ulcers of the stomach and duodenum (end) If pain bothers you, place a hot, damp compress on the stomach area and on the adjacent area of the back. Heat will reduce stomach activity and relax the muscles of the stomach wall, which

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Introduction

ulcerative stomach physical rehabilitation

Among diseases of internal organs, diseases of the digestive system are the most common. In most cases, they are chronic and tend to periodically worsen. They worsen the functional state of all body systems, cause metabolic disorders, and reduce ability to work. A number of diseases (peptic ulcer of the stomach and duodenum, chronic hepatitis, etc.) can lead to premature disability.

The causes of diseases of the digestive system are complex and diverse, although the main place is occupied by the infectious factor. Acute intestinal infections lead to long-term disorders of the digestive system. The second place among these reasons is taken by the food factor, i.e. food poisoning, low-quality products, ingestion of harmful elements from food. The chemical factor as one of the causes of diseases of the digestive system is associated with poisoning with household chemicals, pesticides, chronic intoxication caused by the abuse of alcoholic beverages, their surrogates and uncontrolled use of medications during self-medication. Mental stress, stressful situations, i.e. neuropsychogenic factor, create a favorable background for the impact of the listed harmful factors on the gastrointestinal tract, and often serve as the direct cause of a number of diseases. And, finally, in a number of cases, a family-hereditary predisposition to diseases of the digestive system can be traced, i.e. hereditary factor.

Among the many diseases of the stomach, stomach ulcers are quite common.

Long-term, systematic treatment gives good results in chronic gastric ulcer disease. In complex treatment, along with properly organized dietary nutrition, work and daily routine, as well as therapeutic physical training, are of no small importance.

All of the above determines relevance topics of this course work.

general characteristicswork

Target. To improve the function of the digestive system of patients with gastric ulcer by developing a comprehensive physical rehabilitation program based on an analysis of scientific and methodological literature.

Tasks:

1. Based on the analysis of scientific and methodological literature, identify the main means of physical rehabilitation for gastric ulcer.

2. Develop a comprehensive rehabilitation program for patients with gastric ulcer.

Object of study. The process of rehabilitation of patients with gastric ulcer.

Statement to be defended. A comprehensive physical rehabilitation program for patients with gastric ulcers.

The structure of the course work. The course work presents the following sections: introduction, general characteristics of the work, chapter 1 “Analysis of scientific and methodological literature”, chapter 2 “Comprehensive program of physical rehabilitation for gastric ulcer”, conclusion, list of sources used.

The results of the study are presented in three tables and three figures. The course work was completed on 40 pages of computer text using 31 literary sources.

1. Analysis scientifically-methodologicalliterature

1.1 Anatomo-physiological characteristicstomach

Stomach(lat. ventriculus, gaster) is a hollow organ of the digestive tract in which accumulation and partial digestion of food occurs.

The stomach is located in the epigastric region, most of it (5/6) is located to the left of the midline.

Structure of the stomach

The following parts are distinguished in the stomach: the place where the esophagus enters the stomach - ostium cardiacum, the part of the stomach adjacent to it - pars cardiaca, the place of exit from the stomach - pylorus, its opening - ostium pyloricum, the part adjacent to it - pars pylorica, the dome-shaped part of the stomach to the left of The ostium cardiacum is called the fundus, or the fornix, fornix. The body of the stomach is located between the cardiac part and the fundus, on the one hand, and the antrum, on the other. The boundary between the antrum and the body of the stomach passes along the intermediate groove, which corresponds to the angular notch on the lesser curvature.

The stomach wall consists of three layers:

1) tunica mucosa - mucous membrane with a developed submucosal layer (tela submucosa);

2) tunica muscularis - muscular layer;

3) tunica serosa - serous membrane.

The blood supply to the stomach occurs through the branches of the abdominal trunk and the splenic artery. Along the lesser curvature there is an anastomosis between the left gastric artery and the right gastric artery, along the greater curvature - aa.gastroepiploicae sinistrae with a.lienalis and aa.gastroepiploicae Dextor with a.gastroduodenalis. Short arteries from the splenic artery reach the fundus of the stomach.

The veins of the stomach correspond to the arteries of the same name and flow into the portal vein. The innervation of the stomach is carried out by the branches of the vagus nerve (n.vagus) and the sympathetic trunk (tr.sympathicus). N.vagus enhances peristalsis and secretion of its glands, relaxes m.sphincter pylori, transmits a feeling of nausea and hunger. The sympathetic nerves of the stomach weaken peristalsis and cause contraction of m. sphincter pylori, constrict blood vessels, transmit the sensation of pain.

In the area of the body and fundus of the stomach there are located the main number of main (produce pepsinogen) and lining (produce HCl) cells, as well as additional (mucoid) cells that produce mucin, mucopolysaccharides, gastromucoprotein, and Castle factor.

Gastrin is produced in the antrum of the stomach.

The main functions of the stomach are: chemical and mechanical processing of food, its deposition and evacuation to the intestines. The stomach is also involved in intermediate metabolism, hematopoiesis, water-salt metabolism and maintaining acid-base balance (ALB).

The actual digestive function of the stomach is provided by gastric juice, which is secreted by the glands. Cells of the gastric glands secrete 8 fractions of pepsinogen, which constitute two immunologically heterogeneous groups. Pepsinogens of the first group are secreted by the fundic glands, pepsinogens of the second group by the antral glands. Gastric juice has proteolytic activity over a wide pH range with two optimal points: at pH 1.5-2.0 and 3.2-3.5. At the first pH optimum, proteolysis is carried out by pepsin, at the second - by gastricsin, which differs in amino acid composition, molecular weight and a number of other properties. The ratio of pepsin and gastricsin content under physiological conditions ranges from 1:1.5 to 1:6. Pepsin and gastrixin provide 95% of the proteolytic activity of gastric juice. Gastric juice also has minor lipo- and aminolytic activity.

The chief cells of the gastric glands are mainly stimulated by the vagus nerves through acetylcholine. Reflex stimulation of gastric enzyme secretion is also mediated by gastrin. The cholinergic effect increases the reactivity of chief cells to gastrin. Histamine enhances enzyme secretion, but is weaker than gastrin and the vagus nerves. Secretin, suppressing gastrin-stimulated release of hydrochloric acid, increases enzyme secretion. Cholecystokinin and pancreozymin have a similar effect.

Parietal cells secrete hydrochloric acid, which is involved in the activation of pepsinogen and the creation of an optimal pH for the action of gastric enzymes. Stimulation of parietal cells under physiological conditions is carried out through cholinergic nerve fibers by gastrin and histamine, and inhibition by secretin and cholecystokinin (pancreozymin). The secretory activity of the gastric glands is regulated by reflex and humoral mechanisms. According to the mechanisms of stimulation of the gastric glands, fold-reflex and neurohumoral phases are distinguished. However, it has now been established that there is no fundamental difference between them, since reflex stimulation is also carried out through the humoral link (histamine, gastrin), and nervous mechanisms change the sensitivity of the gastric glands to humoral agents. The main conductor of the central influence on the gastric glands is the vagus nerve. Gastrin is released from gastrin-producing cells of the mucous membrane of the antrum both as a result of central influence (through the vagus nerves) and due to the effect on mechano- and chemoreceptors of hydrolysis products of extractive substances: meat, ethanol, caffeine, etc. When the mucous membrane of the antrum is exposed to acidic solutions, the release of gastrin is suppressed in proportion to the increase in acidity (at pH 1.0, the release of gastrin completely stops). After the gastric chyme passes into the duodenum, hormones are formed in it, which are of great importance in regulating the activity of the hepatobiliary system, pancreas, stomach and intestines. The secretion phase, which is regulated by the duodenum and small intestine, is called the intestinal phase. The exclusion of the transit of gastric contents into the duodenum increases the secretory reaction of the gastric glands to numerous stimulants. The main inhibitors of gastric acid secretion are secretin and cholecystokinin (pancreozymin). However, a number of other gastrointestinal hormones are involved in this process.

The motor activity of the stomach ensures the deposition of food, mixing it with gastric juice and portioned evacuation of chyme into the duodenum. The reservoir function is carried out mainly by the body and fundus of the stomach, the evacuation function - by its pyloric section.

Regulation of gastric motility is ensured by nervous and humoral mechanisms. Irritation of the vagus nerves increases the motor activity of the stomach, irritation of the sympathetic nerves reduces it (adrenaline has a similar effect). The enterogastric reflex is of leading importance in the regulation of the evacuation function of the stomach: irritation of the mechano- and chemoreceptors of the duodenum and small intestines inhibits gastric motility and evacuation.

Thus, the secretory and motor functions of the stomach are closely interrelated, have a complex system of regulation and self-regulation based on feedback and provide optimal conditions for the gastric phase of digestion in close interaction with the neuro-reflex and intestinal phases.

This must be taken into account when choosing a treatment method and means of rehabilitation for peptic ulcer disease.

1.2 Etiologyand pathogenesis

Stomach ulcer is a chronic relapsing disease in which, based on secretory-trophic disorders, an ulcer forms in the mucous membrane of the gastroduodenal zone.

Quite often, the ulcer is complicated by perforation, bleeding, penetration, malignancy, cicatricial ulcerative deformation (gastric outlet stenosis, less commonly, duodenal stenosis). Perforation and bleeding pose an immediate threat to life.

Etipathogenesis Gastric ulcers are quite complex and to this day there is no consensus on this issue.

Genetic, nutritional, neuropsychic, medicinal, and infectious factors play a role in the occurrence of peptic ulcer disease.

The importance of the hereditary factor in the occurrence of peptic ulcer disease has been established with the greatest certainty (30-38%). In this case, reduced reactivity of the mucous membrane of the stomach and duodenum to the damaging effects of gastric juice and increased acidity due to the excessive development of the glandular apparatus of its mucous membrane is inherited.

Nutritional factors (consumption of coarse and spicy foods, spices, smoked foods, excessive consumption of coffee and refined carbohydrates), which can cause mechanical trauma to the mucous membrane or increased secretion and gastric motility, are somewhat less important. Severe functional disorders of the gastric glands are also caused by irregular nutrition. Secretion on an empty stomach can also cause acid-peptic damage to the stomach and duodenum. Some importance is also attached to bad habits - smoking, alcohol abuse. Nicotine, like alcohol, can cause spasm of gastric vessels, especially in combination with qualitative and quantitative nutritional disorders.

In some cases, ulcer formation is facilitated by the use of certain medications (salicylates, glucocorticoids), which can cause a decrease in the secretion of gastric mucus and regeneration of the epithelium of the gastric mucosa, and spasm of gastric vessels.

At the same time, it has been established that the development of this disease is facilitated by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, various nervous diseases). It should also be noted the importance of the hormonal factor, in particular the disruption of the production of digestive hormones (gastrin, secretin, etc.), as well as a disturbance in the metabolism of histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Violation of diet and food composition is also of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of gastric ulcers.

1. 3 Clinic

The main symptom of gastric ulcer is severe pain in the epigastric region, most often in spring and autumn. Periods of exacerbation alternate with periods of calm. During the period of exacerbation, pain is associated with food intake and occurs within 15-20 minutes. after eating or on an empty stomach (“hunger” pain). Vomiting, which often accompanies pain, brings relief. In cases where gastric ulcer is accompanied by increased secretion of the stomach, the patient is bothered by heartburn.

In typical cases, an exacerbation of a peptic ulcer is accompanied by sharp pain in the abdomen some time after eating. Sometimes an attack of severe pain ends with profuse sour vomiting. In other cases, after reaching maximum intensity, the pain gradually subsides. Possible pain at night, pain on an empty stomach, subsiding after eating.

More often the pain is localized in the epigastric region, less often in the right or left hypochondrium. It radiates to the lower back, less often to the chest, and even less often to the lower abdomen.

Abdominal pain intensifies with physical exertion, decreases in a stationary, bent position with legs drawn to the stomach, as well as when pressing on the stomach with hands.

Constant abdominal pain is characteristic of ulcers penetrating the pancreas, complicated by perivisceritis.

The pain of a stomach ulcer is often combined with heartburn and vomiting, which brings relief. Patients' appetite is usually preserved, but there is a fear of eating for fear of increased pain.

With an exacerbation of the disease, tension in the anterior abdominal wall and percussion pain in a limited area in the epigastric region are observed. Deep palpation reveals pain in the pyloroduodenal area. The diagnosis is facilitated by the presence of a characteristic ulcer history - seasonality of exacerbation of the disease, double frequency of pain.

According to the clinical course, acute, chronic and atypical ulcers are distinguished. Not every acute ulcer is a sign of peptic ulcer disease.

The typical chronic form of peptic ulcer disease is characterized by a gradual onset, an increase in symptoms and a periodic (cyclical) course.

The first stage is the prelude of an ulcer, characterized by severe disturbances in the activity of the autonomic nervous system and functional disorders of the stomach, the second by the appearance of organic changes initially in the form of a structural restructuring of the mucous membrane with the development of gastritis, the third by the formation of an ulcerative defect in the stomach, the fourth by the development of complications.

The duration of periods of remission for peptic ulcer disease ranges from several months to many years. Relapse of the disease can be caused by mental and physical stress, infection, vaccination, trauma, taking medications (salicylates, corticosteroids, etc.), and insolation.

1. 4 Rehabilitation means

Physiotherapy

Therapeutic gymnastics aims to generally strengthen the patient’s condition. Physical exercises, increasing the tone of the body, help activate its defenses. Stimulation of the functioning of all body systems by physical exercise has a beneficial effect on the general condition of the patient.

The use of therapeutic physical culture for diseases of the stomach ulcer primarily aims to improve nervous processes in the central nervous system. In cases of gastric ulcers, pathologically altered organs send perverted impulses into the central nervous system, which create foci of stagnant excitation or inhibition, disrupt the flow of neurodynamic processes and the relationship between the cerebral cortex, reticular formation and subcortex. Excitation of the motor centers of the brain that occurs during physical exercise has a normalizing effect on foci of stagnant pathological excitation and inhibition associated with disease processes. At the same time, by increasing the excitatory tone of the cerebral cortex, physical exercise improves its interaction with the subcortex. An increase in the flow of impulses from the musculoskeletal system suppresses altered impulses from the affected organs.

The most important task of therapeutic exercises is to improve the trophic processes of gastric ulcers: accelerating regeneration, slowing down and reversing the development of dystrophic and atrophic processes. Physical exercises activate metabolism in case of stomach ulcers, improve blood circulation in the abdominal cavity, reduce congestion and increase blood supply to pathologically altered tissues. Activation of hormones and enzymes during muscle work enhances tissue metabolism, while at the same time the sensitivity of tissues and organs to the action of hormones increases due to improved nervous regulation. All this accelerates the restoration and plastic processes in the altered tissues: the phenomena of inflammation subside, scarring of the ulcer is stimulated.

Therapeutic exercises help improve impaired functions. Using specially selected exercises, you can selectively influence the various functions of the resulting processes in stomach ulcers. For example, enhance the motor function of the smooth muscles of the stomach and intestines, reduce the tone of the spasmodic muscles of the pylorus and sphincters, increase gastric secretion, improve the outflow of bile from the liver and gallbladder, and the evacuation of the contents of the large intestine. Strengthening the muscles of the pelvic floor, the front and side walls of the abdomen improves the functions of the intestines and stomach, especially when the internal organs are prolapsed, and helps to normalize the position of digestion.

Therapeutic gymnastics classes combine general strengthening and special exercises.

General strengthening exercises for various muscle groups help to increase the tone of the central nervous system, improve the functions of internal organs and the musculoskeletal system. According to the mechanism of motor-visceral reflexes, they have an effect on the digestive function of stomach ulcers, and besides, against their background, the influence of special exercises is more effective.

Morning hygienic exercises

This is a necessary component of a proper daily routine. The transition from the sleep state to the waking state occurs gradually. Immediately after awakening, the predominance of inhibitory processes remains in the nervous system; a person’s mental and physical performance is reduced, almost all types of sensitivity are reduced, and the speed of reactions is significantly reduced.

The inhibited state of the central nervous system can persist for several tens of minutes or even several hours. This largely depends on the quality of sleep and the degree of general fatigue of the body.

Such a long transition from a state of sleep to a state of wakefulness is not only inconvenient in modern life, but also harmful to the health of the body, which, after waking up, is subject to significant mental and intellectual stress, when the nervous system is not yet ready to perceive them.

Therefore, activities that help facilitate the transition to a state of wakefulness after sleep are extremely important.

Systematic morning exercises stimulate muscle development, develop respiratory and circulatory organs, and improve metabolism. Taking air baths during exercises and water procedures after a gymnast hardens the body.

Therapeutic swimming

Therapeutic swimming is one of the forms of therapeutic physical culture, the peculiarity of which is the simultaneous effect on the human body of water and active (less often passive) movements. Dosed muscular work in special, unusual for humans, conditions of the aquatic environment is an important component of the effect of the procedure on the patient. The mechanical impact of the aquatic environment is due to its significantly higher density compared to air. As a result, in order to implement the motor skills acquired by a person in the air, it is necessary to master new mechanisms of movement. In addition, overcoming the resistance of a medium denser than air requires greater effort. Thus, relief (by reducing body weight) of static positions, as well as slow, smooth movements in water, is combined with significant force tension to overcome the increased resistance of the environment during fast movements. The influence of water temperature, which is the main factor in various hydrotherapy procedures, is also of great importance for creating optimal conditions for carrying out physical exercises in water. With a variety of movements, the patient can tolerate lower water temperatures (hardening effect). Conducting exercises in warmer water (close to body temperature) helps to significantly reduce reflex excitability and muscle spasticity, as well as reduce pain. The chemical effect of the aquatic environment is also important, especially when conducting classes in pools with mineral and sea water. For the correct and differentiated use of therapeutic swimming. it is necessary to take into account the complex influence of all these factors on the body as a whole, as well as on its organs and systems.

The main indications for therapeutic swimming. are: damage and diseases of the nervous system; injuries and diseases of the musculoskeletal system, conditions after surgical interventions; diseases of the cardiovascular system, diseases of the respiratory system, digestive system, endocrine diseases, metabolic disorders, etc. When there are indications for the therapeutic use of physical exercises in water, the choice of a particular technique and the permissible level of load are decided individually, taking into account the nature of the disease and the age of the patient , his general condition, level of physical fitness, in particular the ability to float on the water. However, if the patient cannot swim, this is not a contraindication for procedures in the pool.

Contraindications to physical exercise in water are the presence of open wounds, granulating surfaces, trophic ulcers; skin diseases (eczema, fungal and infectious infections); diseases of the eyes (conjunctivitis, blepharitis, keratitis) and ENT organs (purulent otitis, etc.); conditions after infectious diseases and chronic infection; trichomoniasis; radicular pain syndromes, plexitis, neuralgia, neuritis in the acute stage; acute respiratory viral infections; urinary and fecal incontinence, the presence of fistulas with purulent discharge, copious sputum production; pulmonary tuberculosis in the active stage; rheumatic heart lesions in the acute stage; decompensated diseases of the cardiovascular system, etc.

Dosed walking

Being the most natural form of physical therapy, this type of treatment is prescribed to patients at the rehabilitation stage in order to improve health and increase the functional capabilities of the body, and develop adaptive mechanisms of the cardiovascular system. During a walk, the processes of metabolism, blood circulation and breathing are stimulated, and the patient’s neuropsychic state improves.

When walking, a rhythmic alternation of tension and relaxation of the muscles of the lower extremities occurs, which has a positive effect on blood and lymph circulation, counteracting the occurrence of stagnation. Measured walking is the most common exercise; It is advisable to use it in the rehabilitation treatment of weakened patients. Physical activity is increased gradually, lengthening the distance, accelerating the pace of walking; In this case, it is necessary to take into account the terrain.

Dosed walking walks are carried out on flat terrain, starting with a route of 1000 m, then along a route of up to 2000 m and only then up to 3000 m. At the beginning of treatment with movement, it is advisable to walk at a pace characteristic of the patient, and if walks are well tolerated, every 3 -5 days you should increase the distance by 500-1000 m, while accelerating the pace of walking and accordingly reducing the number of rest breaks and their duration.

Very slow - 60-70 steps per minute, or 2.5-3 km/h;

Slow - 70-90 steps per minute, or 3-3.5 km/h;

Average - 90-120 steps per minute, or 4-5.6 km/h;

Fast -120-140 steps per minute, or 5.6-6.4 km/h;

Very fast - more than 140 steps per minute, or over 6.5 km/h.

Massage

Massage is a way to treat and prevent diseases. Massage is scientifically based, proven by many years of practice, and is the most physiological healing remedy for the human body. It is used both for preventive purposes - for general strengthening of the body, and in various fields of medicine: surgery, orthopedics, gynecology, therapy, neurology, etc.

Depending on the purpose for which massage is used, it can be divided into several types: sports, therapeutic, hygienic, cosmetic. In addition, there are various forms of massage, depending on the area of influence of massage techniques (general and local), as well as on who is performing the massage (massage performed by a massage therapist, mutual massage or self-massage). The methods of massage also differ (foot, manual, hardware and combined).

Therapeutic massage can be used as an independent method, or can be used in combination with other treatment methods. But massage can be used for medicinal purposes only as prescribed by a doctor.

Contraindications for massage:

1. Exacerbation of the disease.

2. Bleeding.

3. Acute cholecystitis.

4. Inflammatory processes in the genital organs in women.

5. Tuberculosis.

6. Pregnancy and the postpartum period, the period after an abortion (within 2 months).

7. General contraindications.

It is necessary to perform massage techniques in the following sequence:

1. Back muscle massage.

2. Massage of the neck and trapezius muscles.

3. Massage the chest muscles.

4. Massage the abdominal muscles.

Back muscle massage

1. Stroking.

2. Squeezing.

3. Kneading the long back muscles:

a) circular with the pad of the thumb;

b) circular with the pads of four fingers;

d) “pincer-shaped”;

e) circular with the pads of the thumbs.

Particular attention should be paid to the areas D7-D9, D10-L1 on the left and D9-D12-L1 on the right because they are associated with the affected organs. 4. Kneading the latissimus dorsi muscles:

a) ordinary;

b) double neck;

c) double ring;

d) circular phalanges of bent fingers.

5. Rubbing the fascia of the trapezius muscle, interscapular area, supraspinatus and infraspinatus areas:

a) straight with the pad and tubercle of the thumb;

b) circular edge of the thumb;

c) a circular tubercle of the thumb.

Massage of neck and trapezius muscles

1. Stroking.

2. Squeezing.

3. Kneading:

a) ordinary;

b) double ring;

c) phalanges of bent fingers;

d) radial side of the hand.

Abdominal muscle massage

Techniques should be performed on the rectus and oblique abdominal muscles, in areas that are directly connected to the stomach and duodenum.

1. Circular stroking.

2. Kneading on the rectus abdominis muscles:

a) ordinary;

b) double ring;

c) circular shape with phalanges of bent fingers of one and both hands alternately;

3. Kneading on the oblique abdominal muscles:

a) ordinary;

b) double ring;

c) circle-shaped by the phalanges of bent fingers;

d) circular beak-shaped.

It is necessary to conduct 12-14 massage sessions.

Physiotherapy

Physiotherapeutic treatment is contraindicated for complications of peptic ulcer disease and suspected malignancy of the ulcer.

Among the physiotherapeutic procedures used in the treatment of gastric and duodenal ulcers, the following are most often used.

Diadynamic therapy(DDT) is one of the effective physiotherapeutic methods used in the complex treatment of patients. DDT has a pronounced analgesic effect in patients with exacerbation of peptic ulcer disease and a normalizing effect on the basic functions of the stomach.

Ultrasound therapy produces micromassage of tissues, enhances metabolic processes in them, and has an anti-inflammatory effect. As a result of this therapy, the pain syndrome is quickly relieved, the secretion of gastric juice is reduced, but acid formation does not change significantly.

Magnetotherapy. As a result of exposure to a magnetic field, pain and dyspeptic disorders are relieved more quickly, and there is a tendency to reduce the acidity of gastric juice, normalize the motor function of the stomach, and heal ulcers.

Electroson- a modern method of pulsed electrotherapy. As a result of treatment, the functional state of the central and autonomic nervous system is normalized, and the healing of ulcers is accelerated.

The effectiveness of antiulcer therapy depends on its timeliness, the correct combination of diet, pharmacological agents and physical therapy.

One of the leading places, especially in sanatorium-resort conditions, is occupied by mud therapy. Mud and peat treatment is indicated in the phase of fading exacerbation. Low temperature mud reduces hypersecretion, normalizes motor function, improves blood circulation, and normalizes the reduced activity of the sympathoadrenal system.

Balneotherapy

Balneotherapy is prevention and treatment using natural or artificially prepared mineral waters.

Mineral waters can be used externally (baths, swimming pools), for drinking, inhalation, intestinal lavage and irrigation, etc. Mineral waters are characterized by a high content of mineral and organic components, have specific physicochemical properties, on which their therapeutic effect on the human body is based . Each type of mineral water has a specific effect on the body, mainly due to the presence of leading chemical elements in it.

Natural mineral water (especially thermal springs) has a more versatile effect than its artificial counterparts. In addition, the effect of natural mineral waters is enhanced by the powerful influence of other resort factors (climatic, landscape, motor, psychological).

Taking mineral water internally.

The effect of mineral water when taken orally differs significantly from its effect when used externally in the form of baths. Here, first of all, its effect on the digestive organs is manifested.

Drinking mineral waters normalize the functions of the stomach, intestines, gall bladder, and pancreas, which helps improve the digestion and absorption of food. However, their effect does not end there. The chemicals that make up mineral water are easily absorbed in the digestive tract and are distributed throughout the body through blood vessels, improving metabolic processes, strengthening the body's defenses, and restoring impaired functions.

When drinking treatment, the temperature of the mineral water taken, its composition and time of intake (on an empty stomach, with meals) are important.

Drinking treatment at a resort gives a much greater effect than in a non-resort setting. Water taken directly from the source, rest in a favorable environment, routine, and other health procedures enhance the therapeutic effect of drinking mineral waters.

Sodium chloride mineral waters are used for chronic gastritis without exacerbation, peptic ulcer of the stomach and duodenum without exacerbation, chronic inflammatory diseases of the intestines, liver, cholelithiasis.

Mineral water baths

In balneological procedures, the most widely used are various types of baths filled with mineral water with and without hydromassage, mineral-pearl, with chromotherapy, with underwater shower-massage (procedures in these baths are described in the thalassotherapy - hydrotherapy section).

The action of baths is based on the influence of water of different temperatures on numerous nerve endings located in the skin.

When taking hot baths, the blood supply to the skin and chronic inflammatory foci increases, which leads to an increase in the intensity of oxidative processes, oxidation of pathological products in inflammatory foci, and their removal from the body, accelerating recovery processes. The process of sweating and blood thickening intensifies, resulting in effective removal of toxins from the body.

When taking cold baths, a rapid narrowing of the blood vessels first occurs, which is soon replaced by their expansion, which improves blood circulation, increases the tone of the muscles and nervous system, and feels a surge of additional energy. These baths have a tonic effect.

Baths at indifferent temperatures (close to body temperature) reduce the increased excitability of the nervous system and have a relaxing effect. They are used in the treatment of hypertension, hypersthenic neuroses, with a tendency to vascular and muscle spasms, and motor function disorders.

Contraindications are all diseases in the acute stage, infectious diseases, blood diseases, malignant neoplasms.

The mechanism of action of mineral water baths consists of the influence of temperature, hydrostatic, mechanical, chemical and (or) radioactive factors. The action of the first three factors is common to mineral water baths of all types.

When using showers or bathing in pools with mineral water, its specific effects are complemented by the influence on the body of physical exercise or mechanical irritation of the skin, muscles and tendons, and therefore the effect of the procedure on blood circulation and other body systems is significantly enhanced. Differences in the properties of mineral waters determine differentiated indications and contraindications for the use of such baths.

Diet

The anti-ulcer course of treatment includes therapeutic nutrition, elimination of damaging factors, primarily smoking, taking alcoholic beverages and medications such as acetylsalicylic acid, butadione, reserpine and other drugs, especially on an empty stomach and before bedtime, creating mental and physical rest for the patient, treatment with physical factors, pharmacotherapy.

When prescribing therapeutic nutrition, the presence of concomitant diseases of the digestive system and individual tolerance to certain foods, such as milk, should be taken into account. Food is taken fractionally, in small portions, every 2-3 hours. The diet should be rich in proteins, as the therapeutic effect occurs faster, the healing of ulcers and the subsidence of the inflammatory process are accelerated. From the first days of an exacerbation, patients are recommended three times a day to eat meat and fish dishes, egg dishes, freshly prepared cottage cheese, butter, vegetable and berry sweet juices, and rosehip infusion.

Very hot and cold drinks and ice cream are prohibited. The diet should be gentle. Foods that strongly stimulate gastric secretion are excluded from the diet: strong meat, vegetable, mushroom broths, fried foods, strong tea and coffee, salted and smoked meat and fish, pepper, mustard, onions, garlic.

When a peptic ulcer is combined with cholecystitis, the hypokinetic type recommends split meals without any dietary correction; the hyperkinetic type requires food with limited fat and egg yolks.

When a peptic ulcer is combined with hepatitis, the diet includes foods containing lipotropic substances (cottage cheese, oatmeal, rice) and vitamins.

Peptic ulcer disease is often accompanied by reactive pancreatitis. In these cases, you should limit your fat intake and increase your protein intake.

1. 5 Assessment of the functional state of the digestive system

Examination of the digestive system (Fig. 1.3) includes:

Analysis of complaints;

Physical examination;

Paraclinical methods.

Digestive system:

1 - stomach; 2 - duodenum; 3 - jejunum; 4 - ileum, 5 - ileocecal valve; 6 - cecum, 7 - appendix; 8 - ascending section of the transverse colon; 9 - descending section of the transverse colon; 10 - sigmoid colon; 11 - rectum

Main complaints. Diseases of the digestive system are characterized by:

*gastrointestinal pathology -intestinal tract: dysphagia (impaired passage of food through the esophagus), regurgitation (returning part of the food taken back into the oral cavity), heartburn (a kind of painful burning sensation behind the sternum associated with the throwing of gastric contents into the lower esophagus), bad breath, belching (sudden and sometimes loud passage through the mouth of air accumulated in the stomach or esophagus), loss of appetite, perversion of taste, pain in various parts of the abdomen, a feeling of severe fullness of the stomach, nausea, vomiting, bloating, constipation or diarrhea, gastric and intestinal bleeding;

* pathology of the liver and biliary tract: pain in the right hypochondrium, sometimes in the epigastric region, belching, heartburn, nausea, vomiting, a feeling of severe fullness in the stomach after eating, jaundice, itching, increased abdominal size, increased body temperature;

*pathology of the pancreas: pain in the epigastric region, right or left hypochondrium, girdle pain, dyspepsia, jaundice, general weakness and weight loss.

Physical examination methods allow you to determine the location, size, shape and consistency of the abdominal organs, the degree of tension of the abdominal wall, its pain in one area or another, the presence of formations in the skin or subcutaneous tissue, the presence of hernias, and intestinal motility.

Basic paraclinical methods Diagnosis of diseases of the digestive system:

- contrast radiography (esophagus, stomach, duodenum, large intestine, gall bladder);

- endoscopy(esophagus, stomach, duodenum, large intestine);

- ultrasonography(liver, gall bladder, pancreas);

- laboratory methods: examination of gastric juice, duodenal contents and feces.

Basic diagnostic method stomach ulcers - gastric endoscopy. This method can identify small ulcers - 0.3-0.4 cm. You can also take a biopsy from the edge of the ulcer, from the bottom of the ulcer (ulcer detritus - destroyed muscle, elastic fibers, epithelium, blood cells - red blood cells, leukocytes). You can also determine +/- N.r. morphologically (in the Republic of Belarus the diagnosis of N.R. is exclusively morphological). Very small ulcers (less than 0.3-0.4 cm) are not visible and cannot be biopsied.

The X-ray method is used in the diagnosis of ulcers in 2 cases: 1) contraindications to FGDS (myocardial infarction, stroke, decompensation of all diseases, status asthmaticus), 2) if clinical signs suggest a violation of the evacuation of contents from the stomach and duodenum. A method for studying the secretory function of the stomach is pH-metry. Daily monitoring of intragastric pH can be performed, as well as fractional sounding. The diagnosis of gastric ulcer is confirmed by an x-ray examination, which reveals a wall defect (niche) or deformation of the stomach as a result of cicatricial changes.

Stomach ulcers can cause severe complications: bleeding, which in the case of a stomach ulcer causes bloody vomiting; perforation (perforation) of the stomach wall, leading to peritonitis - inflammation of the peritoneum; narrowing of the outlet of the stomach (pyloric stenosis) due to cicatricial processes. The possibility of ulcer degeneration and cancer formation poses a danger. Complications and long-term course of a peptic ulcer that is not amenable to conservative treatment require surgical intervention.

1. 6 Preventive measures for the disease

Many factors that cause stomach ulcers can be avoided, which means you can avoid such a serious illness as gastric ulcer. To do this, you must comply with the following requirements:

Sleep 6 - 8 hours;

Avoid fatty, smoked and fried foods;

During stomach pain, you need to be examined and eat pureed, easily digestible food 5-6 times a day: porridge, jelly, steamed cutlets, sea fish, vegetables, omelet;

Treat bad teeth so that you can chew food well;

Avoid scandals, as after nervous overstrain the pain in the stomach intensifies;

Do not eat very hot or very cold food, as this may contribute to the development of esophageal cancer;

No smoking;

Do not abuse alcohol.

We must remember that a gastric ulcer is not only local damage to the stomach. This is a painful disease of the whole body, which is easier to prevent than to adapt and treat it throughout your life.

Gastric ulcer is a chronic recurrent disease in which an ulcer forms in the mucous membrane of the gastroduodenal zone based on secretory-trophic disorders.

The complex of rehabilitation measures includes medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Thus, we came to the conclusion that the processes occurring in the cerebral cortex affect the secretion and motor functions of the gastrointestinal tract. Muscular activity also has a great influence. The use of physical exercises is especially effective for diseases that are based on functional disorders. Physical exercise is also effective in treating residual effects after inflammatory processes of duodenal ulcers. The most effective treatment for such patients is in a sanatorium-resort environment, where a complex of influences, including physical exercises, provides the necessary changes in the central nervous system and in the function of the gastrointestinal tract.

Treatment is most effective when combining therapeutic exercises with balneotherapeutic procedures and massage, especially in specialized medical institutions and resorts. To obtain the best therapeutic effect, it is necessary for the patient to independently repeat exercises for the affected digestive tracts 10-15 times during the day (as prescribed by the doctor). It is also good to use occupational therapy to train movements and replacement skills.

2. Comprehensivephysical rehabilitation program for gastric ulcer

Based on the analysis of scientific and methodological literature on the problem of physical rehabilitation of patients with gastric ulcer, a comprehensive rehabilitation program was developed.

When developing a physical rehabilitation program, we proceeded from an analysis of existing ideas about rehabilitation measures after gastric ulcer and the use of modern rehabilitation methods.

A comprehensive physical rehabilitation program lasts 1 month and includes the following basic procedures: therapeutic exercises; morning hygienic exercises; measured walking; swimming; massage; physiotherapeutic procedures (table 2.1).

Comprehensive physical rehabilitation program for patients with gastric ulcer

In the first week of rehabilitation, only LH complex No. 1, massage, and physiotherapeutic procedures are used. From the second week until the end of the rehabilitation program, the LH complex No. 2, the UGG complex, massage, dosed walking, swimming, and physiotherapeutic procedures are used.

Therapeutic gymnastics complex No. 1

	Dosage	General guidelines
I.p. ? lying on your back, closed legs extended, arms along the body. Simultaneously bend and straighten your fingers and toes		Don't hold your breath
I.p. ? Same. Free inhalation and exhalation		The tempo is slow
I.p. - Same. Slowly spread your arms to the sides - inhale, in the i.p. - exhale		The pace is slow.
I.p. ? lying on your back, arms along your body. Bend your elbows and straighten

I.p. - sitting on the bed, legs down, hands on the belt. Turn your torso to the right, arms to the sides - exhale, in the i.p. - inhale. Same to the left		The tempo is slow
I.p. ? lying on your back, feet shoulder-width apart, arms along the body. Spread your toes apart, then bring them together, making sure your legs rotate completely from the hips inwards and outwards		Breathing freely
I.p. ? lying on your back, legs connected. Raise your shoulders up - inhale, lower them - exhale		The tempo is slow
I.p. - lying on your right side, arms along your body. Move your left leg straight to the side, then return to the I.P. Turn over on your left side and do the same on your left side	4-6 times on each side	The tempo is slow
I.p. - lying on your back, hands on your stomach. Abdominal breathing
I.p. ? lying on your stomach, legs extended, arms placed along the body. Bend and straighten your legs at the knees.		The pace is average.
Relaxing while lying on your stomach		Breathing freely
I.p. - lying on your stomach. Get on all fours. Straighten up and kneel, return to IP.		Breathing freely
I.p. ? lying on your back, legs bent at the knees, feet near the buttocks. Spread your knees - inhale, connect - exhale		The tempo is slow
I.p. ? lying on your back, bend your arms resting on your elbows. Raise the pelvis, lower it		The tempo is slow
I.p. ? lying on your back, arms along your body. Relax - calmly inhale and exhale		The tempo is slow
I.p. ? Same. Lower your right foot down and raise your left hand up, the same with your left foot and right hand. Perform without stopping, changing position	repeat 4-6 times in each direction	Medium tempo, free breathing
I.p. - Same. Turns to the right and left side. Place your left foot towards your buttock; Slowly pushing off the bed with your left foot, turn onto your right side. Return to i.p. Also turn on your left side		Don't hold your breath
I.p. - lying on your back. Full breath

Therapeutic gymnastics complex No. 2

	Dosage	General guidelines
Walking in place: normal, raising your hip high		Average tempo
I.p. - basic stance, hands on the belt. Head tilts to the right, left, forward, backward		The tempo is slow
I. p. - main stand. Take your left leg back, arms up - inhale; return to i. p. - exhale. Same thing on the other leg	5-6 times with each leg	Gaze fixed on hands
I.p. - stand with legs apart, arms forward, palms inward; jerking your arms up and back		Average tempo
I.p. - stand with legs apart, hands to shoulders, elbows down. Perform 4 circular movements of the arms in the shoulder joints. The same in the other direction.	5-6 times in each direction	The pace is average, breathing is arbitrary
I.p. - stand with your legs apart, hands on your belt. Rotate your torso to the sides	6-8 each way	The tempo is slow
I.p. - stand with legs apart, arms along the body. Lean to the right. The left hand slides up to the armpit, and the right hand down the thigh. Return to i.p. The same thing - with a tilt to the left	6-8 times each way	The pace is slow, breathing is free.
I.p. - stand with legs apart. Lean forward, trying to touch the floor with your hands - exhale, return to the position. - inhale		Average tempo
Calm diaphragmatic breathing
I.p. - stand with legs apart, arms to the sides. Swing your feet forward	5-6 times with each leg	Do not bend your knees, keep your body straight
I.p. - stand with legs apart; lunge forward with your left leg, at the same time bring your arms forward with your palms facing outward; same with the other foot	5-6 times with each leg	Do not bend your torso forward
I.p. - emphasis sitting in the back. Raise your pelvis from the floor, then return to the i.p.		Breathing is arbitrary
I.p. - Same. Extension and abduction of straight legs		Do not lift your feet off the floor
I.p. - emphasis while standing on your knees. Raise your right bent leg up and back, return to standing position. Same with the left leg ...

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An integrated approach with mandatory consideration of individual characteristics of the process is an unshakable principle of treatment and rehabilitation of peptic ulcer disease. The most effective method of treating any disease is the one that most effectively eliminates the cause that causes it. In other words, we are talking about a targeted impact on those changes in the body that are responsible for the development of ulcerative defects in the mucous membrane of the stomach and duodenum.

The peptic ulcer treatment program includes a complex of diverse measures, the ultimate goal of which is to normalize gastric digestion and correct the activity of regulatory mechanisms responsible for the disorganization of the secretory and motor functions of the stomach. This approach to treating the disease ensures a radical elimination of the changes that have occurred in the body. Treatment of patients with peptic ulcer should be comprehensive and strictly individualized. During an exacerbation, treatment is carried out in a hospital setting.

Comprehensive treatment and rehabilitation Patients with gastric and duodenal ulcers are provided with: drug treatment, diet therapy, physical and hydrotherapy, drinking mineral water, exercise therapy, therapeutic massage and other therapeutic agents. The anti-ulcer course also includes the elimination of factors contributing to the relapse of the disease, provides for the optimization of working and living conditions, a categorical prohibition of smoking and drinking alcohol, and a prohibition of taking medications that have an ulcerogenic effect.

Drug therapy has as its goal:

1. Suppression of excess production of hydrochloric acid and pepsin or their neutralization and adsorption.

2. Restoration of the motor-evacuation function of the stomach and duodenum.

3. Protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis.

4. Stimulation of regeneration processes of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

The basis of drug treatment of exacerbations of peptic ulcer disease is the use of anticholinergics, ganglion blockers and antacids, with the help of which an effect on the main pathogenetic factors is achieved (reduction of pathological nervous impulses, inhibitory effect on the pituitary-adrenal system, reduction of gastric secretion, inhibition of motor function of the stomach and duodenum, etc. .).

Alkalizing agents (antacids) are widely included in the treatment complex and are divided into two large groups: soluble and insoluble. Soluble antacids include sodium bicarbonate, as well as magnesium oxide and calcium carbonate (which react with hydrochloric acid in gastric juice and form soluble salts). Alkaline mineral waters (Borjomi, Jermuk, etc.) are also widely used for the same purpose. Antacids should be taken regularly and multiple times throughout the day. The frequency and timing of administration are determined by the nature of the violation of the secretory function of the stomach, the presence and time of onset of heartburn and pain. Most often, antacids are prescribed an hour before meals and 45-60 minutes after meals. The disadvantages of these antacids include the possibility of changing the acid-base state with prolonged use in large doses.

An important therapeutic measure is diet therapy. Therapeutic nutrition in patients with gastric ulcers must be strictly differentiated depending on the stage of the process, its clinical manifestation and associated complications. The basis of dietary nutrition for patients with gastric and duodenal ulcers is the principle of sparing the stomach, that is, creating maximum rest for the ulcerated mucous membrane. It is advisable to consume foods that are weak stimulants of juice secretion, quickly leave the stomach and little irritate its mucous membrane.

Currently, special anti-ulcer therapeutic diets have been developed. The diet must be followed for a long time and after discharge from the hospital. During an exacerbation, products that neutralize hydrochloric acid are prescribed. Therefore, at the beginning of treatment, a protein-fat diet and carbohydrate restriction are needed.

Meals should be small and frequent (5-6 times a day); diet - complete, balanced, chemically and mechanically gentle. Dietary nutrition consists of three consecutive cycles lasting 10-12 days (diets No. 1a, 16, 1). In case of severe neurovegetative disorders, hypo- and hyperglycemic syndromes, the amount of carbohydrates in the diet is limited (up to 250-300 g), in case of trophic disorders and accompanying pancreatitis, the amount of protein increases to 150-160 g; in case of severe acidism, preference is given to products with antacid properties : milk, cream, soft-boiled eggs, etc.

Diet No. 1a is the most gentle, rich in milk. Diet No. 1a includes: whole milk, cream, steamed curd soufflé, egg dishes, butter. And also fruits, berries, sweets, jelly and jellies from sweet berries and fruits, sugar, honey, sweet berry and fruit juices mixed with water and sugar. Sauces, spices and appetizers are excluded. Drinks - rosehip decoction.

While on diet No. 1a, the patient must remain in bed. It is maintained for 10 - 12 days, then they switch to a more intense diet No. 1b. On this diet, all dishes are prepared pureed, boiled in water or steamed. The food is liquid or mushy. It contains various fats, chemical and mechanical irritants to the gastric mucosa are significantly limited. Diet No. 1b is prescribed for 10-12 days, and the patient is transferred to diet No. 1, which contains proteins, fats and carbohydrates. Avoid foods that stimulate gastric secretion and chemically irritate the gastric mucosa. All dishes are prepared boiled, pureed and steamed. A patient with a stomach ulcer should receive diet No. 1 for a long time. You can switch to a varied diet only with your doctor's permission.

Application of mineral waters occupies a leading place in the complex treatment of diseases of the digestive system, including peptic ulcers.

Drinking treatment is practically indicated for all patients with peptic ulcer disease in the stage of remission or unstable remission, without severe pain, in the absence of a tendency to bleeding and in the absence of persistent narrowing of the pylorus.

Prescribe mineral waters of low and medium salinity (but not higher than 10-12 g/l), containing no more than 2.5 g/l carbon dioxide, sodium bicarbonate, sodium bicarbonate-sulfate waters, as well as waters with a predominance of these ingredients, but more complex cationic composition, pH from 6 to 7.5.

Drinking treatment should begin from the first days of the patient’s admission to the hospital, but the amount of mineral water per appointment during the first 2-3 days should not exceed 100 ml. In the future, if well tolerated, the dose can be increased to 200 ml 3 times a day. With increased or normal secretory and normal evacuation function of the stomach, water is taken warm 1.5 hours before meals, with reduced secretion - 40 minutes -1 hour before meals, with slower evacuation from the stomach 1 hour 45 minutes - 2 hours before food.

In the presence of severe dyspeptic symptoms, mineral water, especially bicarbonate water, can be used more often, for example 6-8 times a day: 3 times a day 1 hour 30 minutes before meals, then after meals (about 45 minutes) at the height of dyspeptic symptoms and, finally, before bed.

In some cases, when taking mineral water before meals, patients experience increased heartburn and pain. Such patients sometimes tolerate drinking mineral water 45 minutes after eating well.

Often this method of drinking treatment has to be resorted to only in the first days of a patient’s admission; later, many patients switch to drinking mineral water before meals.

Persons with peptic ulcer disease in remission or unstable remission of the disease, in the presence of dyskinesia and concomitant inflammatory phenomena of the colon, are shown: microenemas and cleansing enemas from mineral water, intestinal showers, siphon intestinal lavages.

Gastric lavage is prescribed only when indicated, for example, in the presence of severe symptoms of concomitant gastritis. Various types of mineral and gas baths have become widespread in the treatment of patients with peptic ulcers. The method of choice is oxygen, iodine-bromine and mineral baths. Carbon dioxide baths are contraindicated for patients with peptic ulcers with severe symptoms of autonomic dyskinesia. One of the methods of treating patients with peptic ulcer disease in remission is peloidotherapy.

The most effective types of mud therapy include mud applications on the anterior abdominal wall and lumbar region (temperature 40°C, exposure 20 minutes), alternated with baths every other day. The course of treatment is 10-12 mud applications. If mud applications are contraindicated, diathermo mud or galvanic mud is recommended for the epigastric area.

Various methods are widely used psychotherapy - hypnotherapy, autogenic training, suggestion and self-hypnosis. Using these methods, it is possible to influence psychopathological disorders - asthenia, depression, as well as neurovegetative and neurosomatic functional-dynamic disorders of the stomach.

During the hospital rehabilitation period, exercise therapy, therapeutic massage, and physiotherapy are used.

Therapeutic physical culture prescribed after acute manifestations of the disease have subsided.

Objectives of exercise therapy:

Normalization of central nervous system tone and cortico-visceral relationships,

Improvement of psycho-emotional state;

Activation of blood and lymph circulation, metabolic and trophic processes in the stomach, duodenum and other digestive organs;

Stimulation of regenerative processes and acceleration of ulcer healing;

Reducing stomach muscle spasms; normalization of the secretory and motor functions of the stomach and intestines;

Prevention of congestion and adhesions in the abdominal cavity.

Massotherapy prescribed to reduce central nervous system excitation, improve the function of the autonomic nervous system, normalize the motor and secretory activity of the stomach and other parts of the gastrointestinal tract; strengthening the abdominal muscles, strengthening the body. Segmental reflex and classical massage are used. They act on the paravertebral zones D9-D5, C7-C3. In this case, in patients with gastric ulcer, these areas are massaged only on the left, and in patients with duodenal ulcer - on both sides. They also massage the area of the collar zone D2-C4, the abdomen.

Physiotherapy prescribed from the first days of the patient’s stay in the hospital, her tasks:

Reducing the excitability of the central nervous system, improving the regulatory function of the autonomic nervous system;

Elimination or reduction of pain, motor and secretory disorders;

Activation of blood and lymph circulation, trophic and regenerative processes in the stomach, stimulation of ulcer scarring.

First, drug electrophoresis, electrosleep, sollux, UHF therapy, ultrasound are used, and when the exacerbation process subsides, diadynamic therapy, microwave therapy, magnetic therapy, ultraviolet irradiation, paraffin-ozokerite applications, pine baths, radon baths, circular showers, aeroion therapy.

The post-hospital rehabilitation period is carried out in a clinic or sanatorium. Exercise therapy, therapeutic massage, physiotherapy, and occupational therapy are used.

Sanatorium-resort treatment is recommended (Crimea, etc.), during which: walks, swimming, games; in winter - skiing, ice skating, etc.; diet therapy, drinking mineral water, taking vitamins, ultraviolet radiation, contrast shower.

COMPLEX PHYSICAL REHABILITATION OF PATIENTS WITH Peptic Ulcer of the Stomach and Duodenum at the Inpatient Stage

Introduction

Chapter 1. General characteristics of gastric and duodenal ulcers

1.1 Anatomical and physiological features of the stomach and duodenum

1.2 Etiology and pathogenesis of gastric and duodenal ulcers

1.3 Classification and clinical characteristics of gastric and duodenal ulcers

Chapter 2. Comprehensive physical rehabilitation of patients with gastric and duodenal ulcers

2.1 General characteristics of physical rehabilitation means for gastric and duodenal ulcers

2.2 Exercise therapy in physical rehabilitation of patients with gastric and duodenal ulcers

2.2.1 Mechanisms of the therapeutic effect of physical exercises for gastric and duodenal ulcers

2.2.2 Purpose, objectives, means, forms, methods and techniques of exercise therapy for gastric and duodenal ulcers at the inpatient stage

2.3 Therapeutic massage for gastric and duodenal ulcers

2.4 Physiotherapy for this pathology

Chapter 3. Evaluation of the effectiveness of physical rehabilitation for gastric and duodenal ulcers

List of used literature

INTRODUCTION

Relevance of the problem. In the general structure of diseases of the digestive system, the leading place is occupied by the pathology of the stomach and duodenum. In approximately 60-70% of adults, the formation of peptic ulcers, chronic gastritis, duodenitis begins in childhood and adolescence, but they are especially often observed at a young age (20-30 years) and mainly in men.

Peptic ulcer is a chronic, recurrent disease, prone to progression, involving in the pathological process, along with the stomach and duodenum (in which ulcerative defects of the mucous membrane are formed during periods of exacerbation), other organs of the digestive system, the development of complications that threaten the patient’s life.

Peptic ulcer of the stomach and duodenum is a common disease of the gastrointestinal tract. Available statistics indicate a high percentage of patients in all countries. Over the course of a lifetime, up to 20% of the adult population suffers from this disease. In industrialized countries, 6-10% of the adult population suffers from peptic ulcers, with duodenal ulcers predominating compared to gastric ulcers. In Ukraine, about 5 million people are registered with peptic ulcers of the stomach and duodenum. Peptic ulcer of the stomach and duodenum affects people at the most working age - from 20 to 50 years. The disease is more common in men than women (male to female ratio is 4:1). At a young age, duodenal ulcers are more common, and at older ages - gastric ulcers. Among city residents, peptic ulcer disease is more common than among the rural population.

Currently, given the relevance of the problem, its not only medical, but also social significance, the pathology of the stomach and duodenum, pathogenesis, new methods of diagnosis, treatment and prevention of gastric diseases attract the attention not only of clinicians and therapists, but due to significant “rejuvenation” » diseases by pediatricians, geneticists, pathophysiologists, immunologists, and physical rehabilitation specialists.

Considerable experience has been accumulated in the study of gastric and duodenal ulcers. Meanwhile, many aspects of this problem have not yet been resolved. In particular, the issues of using physical rehabilitation means in the complex treatment of this disease are very relevant. In this regard, there is a need to constantly improve the means, forms, methods and techniques of therapeutic physical culture and therapeutic massage, which led to the choice of this research topic.

Goal of the work - to develop an integrated approach to the physical rehabilitation of patients with gastric and duodenal ulcers at the inpatient stage of rehabilitation treatment.

To achieve this goal, the following were decided tasks:

1. Study and analyze literary sources on the problem of physical rehabilitation of patients with gastric and duodenal ulcers.

2. Characterize the anatomical and physiological features of the stomach and duodenum.

3. Reveal the etiology, pathogenesis, classification and clinical picture of gastric and duodenal ulcers.

4.Draw up a program for comprehensive physical rehabilitation of persons with peptic ulcer of the stomach and duodenum, taking into account the period of the disease and the stage of rehabilitation.

5. Characterize methods for assessing the effectiveness of exercise therapy for gastric and duodenal ulcers.

Novelty of the work is that we have drawn up a program of comprehensive physical rehabilitation of persons with gastric and duodenal ulcers, taking into account the period of the disease and the stage of rehabilitation.

Practical and theoretical significance. The program of comprehensive physical rehabilitation of patients with gastric and duodenal ulcers presented in the work can be used in medical institutions, as well as in the educational process for training specialists in physical rehabilitation in the discipline “Physical rehabilitation for diseases of internal organs.”

Scope and structure of work. The work is written on 77 pages of computer layout and consists of an introduction, 3 chapters, conclusions, practical recommendations, and a list of references (59 sources). The work contains 1 table, 2 drawings and 3 complexes of therapeutic exercises.

CHAPTER 1. GENERAL CHARACTERISTICS OF Peptic Ulcer of the Stomach and Duodenum

1.1 Anatomical and physiological features of the stomach and duodenum

The stomach is the most important organ of the digestive system. It represents the widest part of the digestive tract. Located in the upper abdomen, mainly in the left hypochondrium. Its initial section is connected to the esophagus, and its final section is connected to the duodenum.

Fig.1.1. Stomach

The shape, volume and position of the human stomach are highly variable. They can change at different times of the day and night depending on the filling of the stomach, the degree of contraction of its walls, the phases of digestion, body position, individual structural features of the body, the condition and influence of neighboring organs - the liver, spleen, pancreas and intestines. The stomach, with increased contraction of the walls, often has the shape of a bull's horn, or a siphon; with reduced contractility of the walls and its descent, it has the shape of a bowl.

As food moves through the esophagus, the volume of the stomach decreases and its walls contract. Therefore, to fill the stomach during an X-ray examination, it is enough to introduce 400-500 ml of a contrast suspension to get an idea of all its parts. The length of the stomach with an average degree of filling is 14-30, width is from 10 to 16 cm.

There are several sections in the stomach: the initial (cardiac) - the place of transition of the esophagus into the stomach, the body of the stomach - its middle part and the outlet (pyloric, or pylorus), adjacent to the duodenum. There are also front and back walls. The border along the upper edge of the stomach is short and concave. It is called lesser curvature. Along the lower edge - convex, more elongated. This is a greater curvature of the stomach.

In the wall of the stomach, at the border with the duodenum, there is a thickening of muscle fibers, arranged circularly in the form of a ring and forming an obturator apparatus (pylorus), which closes the exit from the stomach. The same, but less pronounced obturator apparatus (sphincter) is present at the junction of the esophagus and the stomach. Thus, with the help of obturator mechanisms, the stomach is limited from the esophagus and duodenum.

The activity of the obturator apparatus is regulated by the nervous system. When a person swallows food, reflexively, under the influence of irritation of the walls of the esophagus by food masses passing through the pharynx, the sphincter located in the initial part of the stomach opens, and food passes from the esophagus to the stomach in a certain rhythm. At this time, the pylorus, located in the outlet section of the stomach, is closed, and food does not enter the duodenum. After the food masses remain in the stomach and are processed by gastric juices, the pylorus of the outlet section opens, and the food passes into the duodenum in separate portions. At this time, the sphincter of the initial section of the stomach is closed. Such harmonious activity of the pylorus and cardiac sphincter ensures normal digestion, and eating food causes pleasant sensations and pleasure.

If the gastric obturator apparatus is narrowed under the influence of scarring, ulcerative or tumor processes, a severe painful condition develops. When the sphincter of the initial part of the stomach narrows, the act of swallowing is disrupted. Food is retained in the esophagus. The esophagus is stretched. Food undergoes rotting and fermentation. When the pylorus narrows, food does not enter the duodenum, but stagnates in the stomach. It stretches, gases and other products of rotting and fermentation accumulate.

If the innervation of the stomach is disrupted or its muscular layer is damaged, the sphincter ceases to fulfill its obturator role. They gape constantly. Acidic stomach contents can back up into the esophagus and cause discomfort.

The walls of the stomach consist of 3 membranes: the outer serous, the middle muscular and the internal mucosa. The mucous membrane of the stomach is its most important part, playing a leading role in digestion. At rest the mucous membrane is whitish, in an active state it is reddish. The thickness of the mucous membrane is not the same. It is maximum in the outlet section, gradually becomes thinner and in the initial part of the stomach it is 0.5 mm.

The stomach is richly supplied with blood and innervated. The nerve plexuses are located deep within its walls and outside the organ.

As noted, the stomach performs important functions for the body. Due to the presence of developed muscular and mucous membranes, the closing apparatus and special glands, it plays the role of a depot, where food entering the esophagus from the oral cavity accumulates, its initial digestion and partial absorption occur. In addition to the storage role, the stomach performs other important functions. The main one is the physical and chemical processing of food and its gradual rhythmic transportation in small portions to the intestines. This is accomplished by coordinated motor and secretory activity of the stomach.

The stomach performs another important function. It absorbs water and some soluble substances (sugar, salt, protein products, iodine, bromine, vegetable extracts) in small quantities. Fats, starch, etc. are not absorbed in the stomach.

The excretory function of the stomach has been known for a long time. With severe kidney disease, a large amount of waste accumulates in the blood. The gastric mucosa partially secretes them: urea, uric acid and other nitrogenous substances, as well as dyes foreign to the body. It turned out that the higher the acidity of gastric juice, the faster the ingested dyes are released.

Consequently, the stomach is involved in inter-day metabolism. It partially removes from the body products formed as a result of the breakdown of proteins, which are not used by the body and can cause poisoning. The stomach influences water-salt metabolism and maintains a constant acid-base balance, which is very important for the body.

The influence of the stomach on the functional state of other organs has been established. The reflex effect of the stomach on the gallbladder and bile ducts, intestines, kidneys, cardiovascular system and central nervous system has been proven. These organs also affect the function of the stomach. This relationship leads to dysfunction of the stomach in case of diseases of other organs, and vice versa, diseases of the stomach can cause diseases of other organs.

Thus, the stomach is an organ important for normal digestion and vital functions, having a complex structure and performing numerous functions.

Such diverse functions provide the stomach with one of the leading places in the digestive system. On the other hand, violations of its function are fraught with serious illnesses.

1.2 Etiology and pathogenesis of gastric and duodenal ulcers

Currently, a group of factors has been identified that predispose to the development of gastric and duodenal ulcers.

Group I associated with functional and morphological changes in the stomach and duodenum, leading to disruption of gastric digestion and a decrease in mucosal resistance with subsequent formation of peptic ulcers.

Group II includes disorders of regulatory mechanisms: nervous and hormonal.

III group - characterized by constitutional and hereditary characteristics.

IV group - associated with the influence of environmental factors.

Group V - associated with concomitant diseases and medications.

Currently, a number of exogenous and endogenous factors are known that contribute to the occurrence and development of gastroduodenal ulcers.

TO exogenous factors relate:

Eating disorder;

Bad habits (smoking, alcohol);

Neuropsychic stress;

Professional factors and lifestyle;

Drug effects (the following drugs have the greatest damaging effect on the gastric mucosa: non-steroidal anti-inflammatory drugs - aspirin, indomethacin, corticosteroids, antibacterial agents, iron, potassium preparations, etc.).

TO endogenous factors relate:

Genetic predisposition;

Chronic Helicobacter gastritis;

Metaplasia of the gastric epithelium of the duodenum, etc.

Among them, the most significant is hereditary predisposition. It is detected in 30-40% of patients with duodenal ulcers and much less frequently in cases of gastric ulcers. It has been established that the prevalence of peptic ulcer disease in relatives of probands is 5-10 times higher than in relatives of healthy people (F.I. Komarov, A.V. Kalinin, 1995). Hereditary ulcers are more likely to worsen and bleed more often. Predisposition to duodenal ulcers is transmitted through the male line.

The following are distinguished: genetic markers of peptic ulcer disease:

An increased number of parietal cells in the gastric glands and, as a result, a persistently high level of hydrochloric acid in the gastric juice; high blood serum content of pepsinogens I, II and the so-called “ulcerogenic” fraction of pepsinogen in the gastric contents;

Increased release of gastrin in response to food intake; increased sensitivity of parietal cells to gastrin and disruption of the feedback mechanism between the production of hydrochloric acid and the release of gastrin;

The presence of O (I) blood group, which increases the risk of developing gastric ulcers of the duodenum by 35% compared to persons with other blood groups;

Genetically determined deficiency in gastric mucus of fucoglycoproteins - the main gastroprotectors;

Impaired production of secretory immunoglobulin A;

Absence of the intestinal component and decreased alkaline phosphatase B index.

The main etiological factors of gastric and duodenal ulcers are the following:

Infection helicobacteria. Currently, this factor is recognized by most gastroenterologists as leading in the development of peptic ulcer disease. Helicobacter infection is one of the most common infections. This microorganism is the cause of chronic Helicobacter pylori gastritis, as well as a leading factor in the pathogenesis of gastric and duodenal ulcers, low-grade gastric lymphoma and gastric cancer. Helicobacter are considered class I carcinogens. The occurrence of duodenal ulcers in almost 100% of cases is associated with infection and colonization of Helicobacter, and gastric ulcers are caused by this microorganism in 80-90% of cases

Acute and chronic psycho-emotional stressful situations. Domestic pathophysiologists have long paid great attention to this etiological factor in the development of peptic ulcer disease. With the clarification of the role of Helicobacter, neuropsychic stressful situations began to be given much less importance, and some scientists began to believe that peptic ulcer disease is not associated with this factor at all. However, clinical practice knows many examples of the leading role of nervous shocks and psycho-emotional stress in the development of peptic ulcer disease and its exacerbations. Theoretical and experimental substantiation of the enormous importance of the neuropsychic factor in the development of peptic ulcer disease was made in the fundamental works of G. Selye on the general adaptation syndrome and the influence of “stress” on the human body.

Nutritional factor. Currently, it is believed that the role of the nutritional factor in the development of gastric and duodenal ulcers is not only not decisive, but has not been strictly proven at all. However, it is assumed that irritating, very hot, spicy, coarse, too hot or cold foods cause excessive gastric secretion, including excessive formation of hydrochloric acid. This may contribute to the implementation of the ulcerogenic effects of other etiological factors.

Abuse of alcohol and coffee, smoking. The role of alcohol and smoking in the development of peptic ulcer disease has not been definitively proven. The leading role of these factors in ulcerogenesis is problematic, if only because peptic ulcer disease is very common among people who do not drink alcohol or smoke and, on the contrary, does not always develop in those who suffer from these bad habits.

However, it has been definitely established that peptic ulcers of the stomach and duodenum occur 2 times more often in smokers compared to non-smokers. Nicotine causes constriction of gastric vessels and ischemia of the gastric mucosa, enhances its secretory ability, causes hypersecretion of hydrochloric acid, increases the concentration of pepsinogen-I, accelerates the evacuation of food from the stomach, reduces pressure in the pyloric region and creates conditions for the formation of gastroduodenal reflux. Along with this, nicotine inhibits the formation of the main protective factors of the gastric mucosa - gastric mucus and prostaglandins, and also reduces the secretion of pancreatic bicarbonates.

Alcohol also stimulates the secretion of hydrochloric acid and disrupts the formation of protective gastric mucus, significantly reduces the resistance of the gastric mucosa and causes the development of chronic gastritis.

Excessive coffee consumption has an adverse effect on the stomach, which is due to the fact that caffeine stimulates the secretion of hydrochloric acid and contributes to the development of ischemia of the gastric mucosa.

Alcohol abuse, coffee and smoking may not be the root causes of gastric and duodenal ulcers, but they undoubtedly predispose to its development and cause exacerbation of the disease (especially alcoholic excesses).

The influence of drugs. There is a whole group of drugs known that can cause the development of acute gastric or (less commonly) duodenal ulcers. These are acetylsalicylic acid and other nonsteroidal anti-inflammatory drugs (primarily indomethacin), reserpine, and glucocorticoids.

Currently, a point of view has emerged that the above-mentioned drugs cause the development of acute gastric or duodenal ulcers or contribute to the exacerbation of chronic ulcers.

As a rule, after stopping taking the ulcerogenic drug, the ulcers heal quickly.

Diseases contributing to the development of peptic ulcer. The following diseases contribute to the development of peptic ulcers:

Chronic obstructive bronchitis, bronchial asthma, emphysema (with these diseases respiratory failure, hypoxemia, ischemia of the gastric mucosa and a decrease in the activity of its protective factors develop);

Diseases of the cardiovascular system, accompanied by the development of hypoxemia and ischemia of organs and tissues, including the stomach;

Cirrhosis of the liver;

Diseases of the pancreas.

Pathogenesis. Currently, it is generally accepted that peptic ulcer of the stomach and duodenum develops as a result of an imbalance between the factors of aggression of the gastric juice and the factors of protection of the mucous membrane of the stomach and duodenum towards the predominance of aggression factors (Table 1.1.). Normally, the balance between the factors of aggression and defense is maintained by the coordinated interaction of the nervous and endocrine systems.

Pathogenesis of peptic ulcer according to Ya. D. Vitebsky. According to Ya. D. Vitebsky (1975), the development of peptic ulcer disease is based on chronic disturbance of duodenal patency and duodenal hypertension. The following forms of chronic disturbance of duodenal patency are distinguished:

Arteriomesenteric compression (compression of the duodenum by the mesenteric artery or mesenteric lymph nodes);

Distal periduodenitis (as a result of inflammatory and cicatricial lesions of the Treitz ligament);

Proximal perijunitis;

Proximal periduodenitis;

Total cicatricial periduodenitis.

With subcompensated chronic disturbance of duodenal patency (depletion of duodenal motility and increased pressure in it), functional insufficiency of the pylorus, antiperistaltic movements of the duodenum, and episodic discharge of duodenal alkaline contents with bile into the stomach develop. Due to the need to neutralize it, the production of hydrochloric acid increases, this is facilitated by the activation of gastrin-producing cells by bile and an increase in gastrin secretion. Acidic gastric contents enter the duodenum, causing the development of first duodenitis, then duodenal ulcers.

Table 1.1 The role of aggressive and protective factors in the development of peptic ulcer disease (according to E.S. Ryss, Yu.I. Fishzon-Ryss, 1995)


Protective factors:	Aggressive factors:
Resistance of the gastroduodenal system: Protective mucous barrier; Active regeneration of the surface epithelium; Optimal blood supply. 2. Antroduodenal acid brake. 3. Anti-ulcerogenic nutritional factors. 4. Local synthesis of protective prostaglandins, endorphins and enkephalins.	1. Hyperproduction of hydrochloric acid and pepsin not only during the day, but also at night: Parietal cell hyperplasia; Chief cell hyperplasia; Vagotonia; Increasing the sensitivity of the gastric glands to nervous and humoral regulation. 2. Helicobacter pylori infection. 3. Proulcerogenic nutritional factors. 4. Duodenogastric reflux, gastroduodenal dysmotility. 5. Reverse diffusion of H +. 6. Autoimmune aggression.
Neuroendocrine regulation, genetic factors

In case of decompensated chronic disturbance of duodenal patency (depletion of duodenal motility, duodenal stasis), constant gaping of the pylorus and reflux of duodenal contents into the stomach are observed. It does not have time to be neutralized, alkaline contents dominate in the stomach, intestinal metaplasia of the mucous membrane develops, the detergent effect of bile on the protective layer of mucus is manifested, and a stomach ulcer is formed. According to Ya. D. Vitebsky, chronic disturbance of duodenal patency is present in 100% of patients with gastric ulcer, and in 97% of patients with duodenal ulcer.

1.3 Classification and clinical characteristics of gastric and duodenal ulcers

Classification of gastric and duodenal ulcers (P. Ya. Grigoriev, 1986)

I. Localization of the ulcerative defect.

1. Stomach ulcer.

Cardial and subcardial sections of the stomach.

Mediogastric.

Antrum.

Pyloric canal and prepyloric section or lesser and greater curvature.

2. Duodenal ulcer.

2.1.Bulbar localization.

2.2.Postbulbar localization.

2.2.1. Proximal part of the duodenum.

2.2.2. Distal part of the duodenum.

II. Phase of the disease.

1. Exacerbation.

2. Relapse.

3. Faded exacerbation.

4. Remission.

III. The nature of the current.

1. First identified.

2. Latent flow.

3. Mild flow.

Moderate severity.

Severe or continuously relapsing course. IV. Size of ulcers.

1. Small ulcer - up to 0.5 cm in diameter.

2. Large ulcer - more than 1 cm in the stomach and 0.7 cm in the duodenal bulb.

3. Giant - more than 3 cm in the stomach and more than 1.5-2 cm in the duodenum.

4. Superficial - up to 0.5 cm in depth from the level of the gastric mucosa.

5. Deep - more than 0.5 cm in depth from the level of the gastric mucosa.

V. Stage of ulcer development (endoscopic).

1. Stage of enlargement of the ulcer and increase in inflammatory phenomena.

The stage of greatest magnitude and most pronounced signs of inflammation.

The stage of subsidence of endoscopic signs of inflammation.

Ulcer reduction stage.

The stage of ulcer closure and scar formation.

Scar stage.

VI. The condition of the mucous membrane of the gastroduodenal zone, indicating the location and degree of activity.

VII. Violation of the secretory function of the stomach.

VIII. Violation of the motor-evacuation function of the stomach and duodenum.

1.Hypertensive and hyperkinetic dysfunction.

2.Hypotonic and hypokinetic function.

3. Duodenogastric reflux.

IX. Complications of peptic ulcer.

1.Bleeding.

2.Perforation.

3.Penetration indicating the organ.

4.Perivisceritis.

5. Pyloric stenosis.

6. Reactive pancreatitis, hepatitis, cholecystitis.

7. Malignancy.

X. Terms of scarring of the ulcer.

1.Usual terms of scarring (duodenal ulcer - 3-4 weeks, stomach ulcer - 6-8 weeks).

2. Long-term non-scarring (duodenal ulcer - more than 4 weeks, stomach ulcer - more than 8 weeks).

The severity of peptic ulcer disease.

1. Mild form (mild severity) - characterized by the following features:

*exacerbation occurs once every 1-3 years;

*pain syndrome is moderate, pain stops in 4-7 days;

*ulcer is shallow;

*in the remission phase, ability to work is preserved.

2. The form of moderate severity has the following criteria:

*relapses (exacerbations) are observed 2 times a year;

*pain syndrome is severe, pain is relieved in hospital after

*characteristic of dyspeptic disorders;

*the ulcer is deep, often bleeds, and is accompanied by the development

perigastritis, periduodenitis.

3. Severe form is characterized by the following symptoms:

*relapses (exacerbations) occur 2-3 times a year or more often;

*pain is pronounced, relieved in hospital within 10-14 days

(sometimes longer);

*severe dyspepsia and weight loss;

*ulcer is often complicated by bleeding, development of pyloric stenosis, perigastritis, periduodenitis.

Clinical characteristics of gastric and duodenal ulcers.

Pre-ulcerative period. In most patients, the development of a typical clinical picture of the disease with a formed ulcer of the stomach and duodenum is preceded by a pre-ulcer period (V. M. Uspensky, 1982). The pre-ulcer period is characterized by the appearance of ulcer-like symptoms, however, during endoscopic examination it is not possible to determine the main pathomorphological substrate of the disease - an ulcer. Patients in the pre-ulcer period complain of pain in the epigastric region on an empty stomach (“hungry” pain), at night (“night” pain) 1.5-2 hours after eating, heartburn, and sour belching.

On palpation of the abdomen, local pain in the epigastrium is noted, mainly on the right. High secretory activity of the stomach (hyperaciditis), increased content of pepsin in gastric juice on an empty stomach and between meals, a significant decrease in antroduodenal pH, accelerated evacuation of gastric contents into the duodenum (according to FEGDS and fluoroscopy of the stomach) are determined.

As a rule, such patients have chronic Helicobacter pylori gastritis or gastroduodenitis.

Not all researchers agree with the identification of the pre-ulcer period (condition). A. S. Loginov (1985) proposes to call patients with the above-described symptom complex a group at increased risk for peptic ulcer disease.

Typical clinical picture.

Subjective manifestations. The clinical picture of peptic ulcer disease has its own characteristics associated with the location of the ulcer, the age of the patient, the presence of concomitant diseases and complications. Nevertheless, in any situation, the leading subjective manifestations of the disease are pain and dyspeptic syndromes.

Pain syndrome. Pain is the main symptom of peptic ulcer and is characterized by the following features.

Localization of pain. As a rule, pain is localized in the epigastric region, and with a gastric ulcer - mainly in the center of the epigastrium or to the left of the midline, with an ulcer of the duodenum and prepyloric zone - in the epigastrium to the right of the midline.

With ulcers of the cardiac part of the stomach, atypical localization of pain behind the sternum or to the left of it (in the precordial region or the region of the apex of the heart) is quite often observed. In this case, a thorough differential diagnosis of angina pectoris and myocardial infarction should be carried out, with mandatory electrocardiographic examination. When the ulcer is localized in the postbulbar region, pain is felt in the back or right epigastric region.

Time of onset of pain. In relation to the time of eating, pain is distinguished between early, late, night and “hungry”. Early are pains that occur 0.5-1 hour after eating, their intensity gradually increases; the pain bothers the patient for 1.5-2 hours and then gradually disappears as the gastric contents are evacuated. Early pain is typical for ulcers localized in the upper parts of the stomach.

Late pain appears 1.5-2 hours after eating, night pain - at night, hungry pain - 6-7 hours after eating and stops after the patient eats again and drinks milk. Late, night, hungry pains are most typical for the localization of ulcers in the antrum and duodenum. Hunger pain is not observed in any other disease.

It should be remembered that late pain can also occur with chronic pancreatitis, chronic enteritis, and night pain with pancreatic cancer.

Nature of pain. Half of the patients have pain of low intensity, dull, in approximately 30% of cases it is intense. The pain can be aching, boring, cutting, cramping. The pronounced intensity of the pain syndrome during exacerbation of a peptic ulcer requires differential diagnosis with an acute abdomen.

Frequency of pain. Peptic ulcer disease is characterized by periodic occurrence of pain. An exacerbation of peptic ulcer disease lasts from several days to 6-8 weeks, then a remission phase begins, during which patients feel well and are not bothered by pain.

Pain relief. Characteristic is a decrease in pain after taking antacids, milk, after eating (“hunger” pain), often after vomiting.

Seasonality of pain. Exacerbations of peptic ulcer disease are more often observed in spring and autumn. This “seasonality” of pain is especially characteristic of duodenal ulcers.

The appearance of pain during peptic ulcer disease is due to:

· irritation by hydrochloric acid of sympathetic nerve endings in the area of the bottom of the ulcer;

· motor disorders of the stomach and duodenum (pylorospasm and duodenospasm are accompanied by increased pressure in the stomach and increased contraction of its muscles);

· spasm of blood vessels around the ulcer and the development of ischemia of the mucous membrane;

· decreased pain threshold during inflammation of the mucous membrane.

Dyspeptic syndrome. Heartburn is one of the most common and characteristic symptoms of peptic ulcer disease. It is caused by gastroesophageal reflux and irritation of the esophageal mucosa by gastric contents rich in hydrochloric acid and pepsin.

Heartburn can occur at the same time after eating as pain. But in many patients it is not possible to note the connection between heartburn and food intake. Sometimes heartburn may be the only subjective manifestation of a peptic ulcer.

Therefore, in case of persistent heartburn, it is advisable to perform FEGDS to exclude peptic ulcer disease. However, we must remember that heartburn can occur not only with a peptic ulcer, but also with calculous cholecystitis, chronic pancreatitis, gastroduodenitis, isolated cardiac sphincter insufficiency, and diaphragmatic hernia. Persistent heartburn can also occur with pyloric stenosis due to increased intragastric pressure and the manifestation of gastroesophageal reflux.

Belching is a fairly common symptom of peptic ulcer disease. The most typical belching is sour; it occurs more often with a mediogastric ulcer than with a duodenal ulcer. The appearance of belching is caused simultaneously by insufficiency of the cardia and antiperistaltic contractions of the stomach. It should be remembered that belching is also extremely common with diaphragmatic hernia.

Vomiting and nausea. As a rule, these symptoms appear during the period of exacerbation of peptic ulcer disease. Vomiting is associated with increased tone of the vagus nerve, increased gastric motility and gastric hypersecretion. Vomiting occurs at the “height” of pain (during the period of maximum pain), vomit contains acidic gastric contents. After vomiting, the patient feels better, the pain significantly weakens and even disappears. Repeated vomiting is characteristic of pyloric stenosis or severe pylorospasm. Patients often induce vomiting to relieve their condition.

Nausea is characteristic of mediogastric ulcers (but is usually associated with concomitant gastritis), and is also often observed with postbulbar ulcers. At the same time, nausea, as E. S. Ryss and Yu. I. Fishzon-Ryss point out (1995), is completely “uncharacteristic of an ulcer of the duodenal bulb and rather even contradicts this possibility.”

Appetite with peptic ulcer is usually good and may even be increased. With severe pain syndrome, patients try to eat rarely and even refuse to eat for fear of pain after eating. A decrease in appetite is observed much less frequently.

Impaired motor function of the large intestine.

Half of patients with peptic ulcer experience constipation, especially during exacerbation of the disease. Constipation is caused by the following reasons:

*spastic contractions of the colon;

*diet poor in plant fiber and, as a result, lack of intestinal stimulation;

*decreased physical activity;

*taking antacids calcium carbonate, aluminum hydroxide.

Data from an objective clinical study. On examination, an asthenic (usually) or normosthenic body type attracts attention. The hypersthenic type and excess body weight are not very typical for patients with peptic ulcer disease.

Signs of autonomic dysfunction with a clear predominance of the tone of the vagus nerve are extremely characteristic: cold, wet palms, marbling of the skin, distal limbs; tendency to bradycardia; tendency to arterial hypotension. The tongue of patients with peptic ulcer is usually clean. With concomitant gastritis and severe constipation, the tongue may be coated.

Palpation and percussion of the abdomen with uncomplicated peptic ulcer reveals the following symptoms:

· moderate, and in the period of exacerbation, severe pain in the epigastrium, usually localized. With a gastric ulcer, the pain is localized in the epigastrium along the midline or on the left, with a duodenal ulcer - more on the right;

· percussion pain - Mendelian symptom. This symptom is detected by abrupt percussion with a finger bent at a right angle along symmetrical areas of the epigastric region. According to the localization of the ulcer, local, limited pain appears during such percussion. Sometimes the pain is more pronounced when you inhale. Mendel's symptom usually indicates that the ulcerative defect is not limited to the mucous membrane, but is localized within the wall of the stomach or duodenum with the development of peri-process;

· local protective tension of the anterior abdominal wall, more typical for duodenal ulcers during exacerbation of the disease. The origin of this symptom is explained by irritation of the visceral peritoneum, which is transmitted to the abdominal wall through the mechanism of the viscero-motor reflex. As the exacerbation subsides, the protective tension of the abdominal wall progressively decreases.

Diagnostics. To make a correct diagnosis, the following signs must be taken into account.

Basic:

1) characteristic complaints and a typical ulcer history;

2) detection of an ulcerative defect during gastroduodenoscopy;

3) identification of the “niche” symptom during X-ray examination.

Additional:

1) local symptoms (pain points, local muscle tension in the epigastric region);

2) changes in basal and stimulated secretion;

3) “indirect” symptoms during X-ray examination;

4) hidden bleeding from the digestive tract.

Treatment of peptic ulcer. The complex of rehabilitation measures includes medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Conservative treatment of peptic ulcer is always complex, differentiated taking into account factors contributing to the disease, pathogenesis, localization of the peptic ulcer, the nature of clinical manifestations, the degree of dysfunction of the gastroduodenal system, complications and concomitant diseases

During the period of exacerbation, patients should be hospitalized as early as possible, since it has been established that with the same treatment method, the duration of remission is longer in patients treated in a hospital. Treatment in a hospital should be carried out until the ulcer is completely scarred. However, by this time gastritis and duodenitis still persist, and therefore treatment should be continued for another 3 months on an outpatient basis.

The antiulcer course includes: 1) elimination of factors contributing to the relapse of the disease; 2) therapeutic nutrition; 3) drug therapy; 4) physical methods of treatment (physiotherapy, hyperbaric oxygen therapy, acupuncture, laser therapy, magnetic therapy).

Elimination of factors contributing to the relapse of the disease involves organizing regular meals, optimizing working and living conditions, strictly prohibiting smoking and drinking alcohol, and prohibiting the use of medications that have an ulcerogenic effect.

Therapeutic nutrition is provided by prescribing a diet that must contain the physiological norm of protein, fat, carbohydrates and vitamins. Compliance with the principles of mechanical, thermal and chemical sparing is provided (table No. 1A, diet No. 1 according to Pevzner).

Drug therapy aims to: a) suppress the excess production of hydrochloric acid and foam or their neutralization and adsorption; b) restoration of motor-evacuation function of the stomach and duodenum; c) protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis; d) stimulation of regeneration processes of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

Physical methods of treatment - thermal procedures during the period of subsiding of the exacerbation (application of paraffin, ozokerite) with an uncomplicated course of the disease and no signs of hidden bleeding.

For long-term non-scarring ulcers, especially in elderly and senile patients, irradiation of the ulcerative defect with a laser (through a fiber gastroscope) is used; 7-10 irradiation sessions significantly shorten the time of scarring.

In some cases, there is a need for surgical treatment. Surgical treatment is indicated for patients with peptic ulcer disease with frequent relapses with continuous therapy with maintenance doses of antiulcer drugs.

During the period of remission of a peptic ulcer, it is necessary: 1) exclusion of ulcerogenic factors (cessation of smoking, consumption of alcohol, strong tea and coffee, drugs from the group of salicylates and pyrazolone derivatives); 2) compliance with the work and rest regime, diet; 3) spa treatment; 4) clinical observation with secondary prevention

Patients with newly diagnosed or rarely recurrent peptic ulcers should undergo seasonal (spring autumn) preventive courses of treatment lasting 1-2 months.

Prevention. There are primary and secondary prevention of peptic ulcers. Primary prevention is aimed at active early detection and treatment of pre-ulcerative conditions (functional indigestion of the hypersthenic type, antral gastritis, duodenitis, gastroduodenitis), identification and elimination of increased risk factors for the disease. This prevention includes sanitary-hygienic and sanitary-educational measures for the organization and promotion of rational nutrition, especially among people working on night shifts, transport drivers, teenagers and students, to combat smoking and alcohol consumption, to create favorable psychological relationships in the work team and at home, explaining the benefits of physical education, hardening and organized recreation.

The task of secondary prevention is to prevent exacerbation and relapse of the disease. The main form of preventing exacerbation is medical examination. It includes: registration of people with peptic ulcer disease in the clinic, constant medical supervision of them, prolonged treatment after discharge from the hospital, as well as spring-autumn courses of anti-relapse therapy and, if necessary, year-round treatment and rehabilitation.

CHAPTER 2. COMPLEX PHYSICAL REHABILITATION OF PATIENTS WITH ULCER DISEASE OF THE STOMACH AND DUODENAL AT THE INPATIENT STAGE

2.1 General characteristics of physical rehabilitation means for patients with gastric and duodenal ulcers

The peptic ulcer treatment program includes a complex of diverse measures, the ultimate goal of which is to normalize gastric digestion and correct the activity of regulatory mechanisms responsible for the disorganization of the secretory and motor functions of the stomach. This approach to treating the disease ensures a radical elimination of the changes that have occurred in the body. Treatment of patients with peptic ulcer disease should be comprehensive and strictly individualized. During an exacerbation, treatment is carried out in a hospital setting.

Comprehensive treatment and rehabilitation Patients with peptic ulcer of the stomach and duodenum are provided with: drug treatment, diet therapy, physical and hydrotherapy, drinking mineral water, exercise therapy, therapeutic massage and other therapeutic agents. The anti-ulcer course also includes the elimination of factors contributing to the relapse of the disease, provides for the optimization of working and living conditions, a categorical prohibition of smoking and drinking alcohol, and a prohibition of taking medications that have an ulcerogenic effect.

Drug therapy has as its goal:

1. Suppression of excess production of hydrochloric acid and pepsin or their neutralization and adsorption.

2. Restoration of the motor-evacuation function of the stomach and duodenum.

3. Protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis.

4. Stimulation of regeneration processes of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

Application of mineral waters occupies a leading place in the complex treatment of diseases of the digestive system, including peptic ulcers.

In some cases, when taking mineral water before meals, patients experience increased heartburn and pain. Such patients sometimes tolerate drinking mineral water 45 minutes after eating well.

Often this method of drinking treatment has to be resorted to only in the first days of a patient’s admission; later, many patients switch to drinking mineral water before meals.

Treatment of chronic gastritis, gastric and duodenal ulcers

For effective treatment, prevention of complications and relapses of peptic ulcer and chronic gastritis, rehabilitation measures, their continuity and complexity are of great importance. At all stages of rehabilitation treatment, with varying degrees of importance, the following are used: compliance with the protective regime, taking medications, diet therapy, physical and spa methods, psychotherapy, exercise therapy, massage.

In the treatment of patients with chronic gastritis and peptic ulcers, there are 2 main tasks: treatment of the active phase of the disease and prevention of relapses.

The solution to these problems is carried out continuously, sequentially, at 3 stages of medical rehabilitation: inpatient, outpatient and sanatorium.

The objectives of restorative treatment are: eradication of H. pylori, improvement of blood and lymph circulation in the gastroduodenal area, relief of pain, acceleration of healing of the mucous membrane of the stomach and duodenum, normalization of secretory and motor functions, reduction of dyspeptic disorders.
At the inpatient stage, rehabilitation treatment involves a number of measures.

Treatment regimen. The patient is prescribed bed rest or semi-bed rest for about 7 days, subsequently replacing it with free rest.

Diet therapy. In case of severe exacerbation, the patient is prescribed diet No. 1, in case of secretory insufficiency - diet No. 2. The meals are fractional (5-6 times). The amount of protein is increased to 120-140 g/day. Be sure to use high doses of vitamins.

Pharmacotherapy. Since H. pylori is currently recognized as one of the most important causes leading to the development of chronic gastritis and peptic ulcers, drug therapy aimed at its suppression seems to be an essential component of the treatment of hospitalized patients. Another group of pharmacological drugs used in therapy includes antisecretory agents (proton pump inhibitors).

Exercise therapy

In the complex therapy of peptic ulcers and chronic gastritis, exercise therapy plays an important role. As is known, in the development of these diseases an important role is played by disturbances in the activity of the central nervous system, therefore the therapeutic effect of physical exercise is due to its normalizing effect on the nervous system - the cerebral cortex and its autonomic parts.

The use of exercise therapy for peptic ulcer disease is indicated after acute pain and significant dyspeptic disorders have subsided, usually from the beginning of the 2nd week, i.e. patients in the phase of fading exacerbation, as well as incomplete and complete remission, with an uncomplicated course of the disease.

Objectives of exercise therapy: improving blood and lymph circulation in the abdominal cavity; normalization of gastric and duodenal motility, secretory and neurohumoral regulation of digestive processes; creating favorable conditions for reparative processes in the mucous membrane of the stomach and duodenum;
prevention of complications (adhesions, congestion, etc.); strengthening and normalizing the tone of the abdominal, back, and pelvic muscles (most closely related to the functioning of the internal organs); improving the function of the cardiorespiratory system (including developing the skill of full breathing); normalization of psycho-emotional state; increasing the overall physical and mental performance of the body.

Contraindications for use: generally accepted contraindications for exercise therapy; period of exacerbation of peptic ulcer or chronic gastritis; complicated course of peptic ulcer; severe pain and significant dyspeptic disorders.

The patient’s condition determines the motor mode and, accordingly, the characteristics of exercise therapy. In the hospital, during an exacerbation of gastric and duodenal ulcers, the patient successively moves from bed rest to free rest, and in the clinic and sanatorium - from gentle to training.

Forms of exercise therapy: UGT; LH; measured walking; self-study of the patient.

Exercise therapy means: general developmental exercises for large muscle groups of the upper and lower extremities.

The effectiveness of these exercises increases if they activate muscles innervated from the same segments of the spinal cord as the stomach and duodenum (C3-Th8), namely: muscles of the neck, trapezius, rhomboids, infraspinatus and supraspinatus, erector torso, rectus abdominal muscle. Special exercises are also used - breathing (static and dynamic), for the abdominal muscles, to relax the muscles, displacing the abdominal organs.

Starting positions: in the 1st half of the course - lying on your back and side, as the most gentle, causing the least functional changes and at the same time providing the best conditions for performing breathing exercises, as well as for strengthening the abdominal and pelvic floor muscles. In the 2nd half of the course - lying on your back, on your side, on all fours, on your knees, sitting and standing. The starting position, kneeling and on all fours, is used to limit the impact on the abdominal muscles if it is necessary to cause movement of the stomach and intestines. The starting positions of standing and sitting have the greatest impact on the abdominal organs.

Methods: individual classes in the 1st half of the course of treatment in a hospital, small group classes in the 2nd half and group classes at the sanatorium-polyclinic stage.

Dosage control. No complaints and good subjective and objective tolerability of PH sessions.
PH is the main form of physical therapy in a hospital; it is used after the end of the acute period of the disease. A course of exercise therapy in a hospital includes 12-15 sessions, of which the first 5-6 are aimed at muscle relaxation, thereby providing a sedative effect on the central nervous system and improving intestinal motility. During an exacerbation of peptic ulcer disease, increased excitability of skeletal muscles is noted.

Therefore, the fast pace of exercises, especially those that are difficult to coordinate, and its frequent changes, supplemented by muscle tension, worsen the patient’s condition. Taking this into account, LH exercises during this period should be elementary movements performed somewhat monotonously and at a slow pace, which ensures the appearance of relaxation and a feeling of calm in patients.

During the first lessons (bed rest, respectively, the starting position is lying down), it is necessary to teach the patient abdominal breathing, achieving a small amplitude of vibrations of the abdominal wall. Exercises, causing minor changes in intra-abdominal pressure, help improve blood circulation in the abdominal cavity and gentle massage of internal organs, reduce spastic phenomena and thereby normalize peristalsis. During the day, rhythmic breathing exercises are performed by the patient 5-6 times. Movements in the joints of the limbs are also performed with a small amplitude and at a slow pace. They are more aimed at relaxing muscles.

Attention! Exercises for the abdominal muscles are excluded in the subacute period of the disease!

You can carefully include exercises with static tension in the muscles of the shoulder girdle, upper and lower extremities; tension intensity - 25-50% of the maximum; duration - 4-5 s. The duration of LG classes is 8-12 minutes.

The LH procedure can be combined with massage, elements of hydrotherapy and autogenic training.

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, good tolerance of physical activity, a free regimen is prescribed. LH classes are performed with a load of medium intensity. They use general strengthening exercises for all muscle groups from various starting positions and special exercises for the anterior abdominal wall, lumbar region and shoulder girdle. Sudden movements are excluded. Exercises are maintained while relaxing skeletal muscles.

In addition to diaphragmatic breathing (maximum depth), dynamic breathing exercises are also used. Gradually include exercises with dumbbells (0.5-2 kg), medicine balls, and on a gymnastic wall. The duration of the LH session is 20-25 minutes.

At this stage of treatment, in order to increase RF, it is possible to include health-improving training in the rehabilitation treatment program in the form of dosed walking of up to 2-3 km per day, usually after functional tests with physical activity - this helps to individualize this type of training.

After discharge, patients perform the LH complex mastered in the hospital at home independently. If patients subsequently continue to engage in exercise therapy for 1-2 months, their duration of remission increases significantly. During this period, the level of load increases even more, exercises with weights are used more often, musical accompaniment is used to reduce the monotony of classes, and walking is used more actively as a workout.

In sanatorium-resort conditions (sanatoriums, sanatoriums, etc.), patients are treated during the period of remission. All means of exercise therapy are used: physical exercise, massage, autogenic training, natural and preformed physical factors that ensure further normalization of impaired gastrointestinal functions, adaptation to increasing physical activity, restoration of physical and mental performance.

Massage

Massage has a normalizing effect on the neuro-regulatory apparatus of the stomach and intestines, as a result of which their secretory and motor activity improves, blood circulation is activated both in the abdominal cavity and in the stomach and duodenum itself. Thus, by accelerating the healing process, massage is an effective additional therapeutic method.

Objectives of massage: pain reduction; normalization of gastric and duodenal motility; improving blood and lymph circulation, eliminating congestion in the abdominal cavity; activation of metabolism and trophic processes in affected tissues, normalization of the tone of the autonomic nervous system; improving the functional state of the central nervous system, as well as the psycho-emotional and general condition of the patient.

Indications for use: peptic ulcer of the stomach and duodenum, chronic gastritis with increased or decreased secretory function, postoperative ruby adhesions, reflex intestinal dyskinesia.

Contraindications for use: general, excluding the use of massage; diseases of the gastrointestinal tract with a tendency to bleeding, as well as in the acute stage and during exacerbation.

Massage area: collar area, back, abdomen.

Position of the patient: most often in a supine position, options are also possible - lying on the side, sitting.

Massage technique. Massage can be performed using the following techniques: classical massage, segmental, vibration, cryo-massage.

Segmental massage is the most effective. The first stage of this massage option is to search for segmental zones. In diseases of the stomach and duodenum, the tissues associated with the C3-Th8 segments are mainly affected, mostly on the left.

Segmental massage can be prescribed immediately after the acute condition subsides. The therapeutic effect usually occurs after 4-7 procedures. The total number of procedures until a lasting effect is achieved rarely exceeds 10.

In case of gastritis with hypersecretion and peptic ulcer disease, they begin by eliminating changes in the tissues on the back surface of the body, first of all, in the most painful points on the back near the spine in the area of the Th7-Th8 segments and at the lower angle of the scapula in the area of the Th4-Th5 segments, then proceed on the front surface of the body.

Classic therapeutic massage can also be prescribed, but later than segmental - usually in the middle or end of the subacute period, when pain and dyspeptic symptoms have significantly softened. Its effect is usually insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Impact techniques are excluded. For a general relaxing effect on the body, it is advisable to additionally massage the collar area.

The procedure begins with a back massage. The duration of the procedure is from 10 to 25 minutes. The course of treatment is 12-15 procedures, every other day.

Physiotherapy

The complex of therapeutic effects performed in a hospital may also include physiotherapeutic methods, the purpose of which is to: reduce pain, have an anti-inflammatory effect in the gastroduodenal area, which improves blood and lymph circulation in it; in the presence of an ulcerative defect - activation of trophic processes.

Contraindications for physiotherapy are: penetration, preperforative condition, suspected malignancy. As a rule, the effectiveness of physiotherapy for pyloric stenosis and chronic callous ulcers is low. After gastric or intestinal bleeding of ulcerative etiology, heat treatment on the stomach area for the next 3-6 months is contraindicated.

One of the most effective methods that reduce even significant pain is the use of SMT therapy. When the electrode is placed in the epigastric region, microcirculation in the gastroduodenal region is activated and perineural edema is reduced, providing noticeable anti-inflammatory and analgesic effects.

In case of severe pain syndrome, the method of medicinal electrophoresis continues to retain its position. The most commonly used is electrophoresis of novocaine, as well as papaverine, atropine, platyphylline, dalargip on the epigastric region. In addition to the analgesic effect, they have an antispasmodic and absorbable effect, which is important for this pathology.

Another physiotherapeutic method that has an anti-inflammatory, mild analgesic effect, improves microcirculation and thereby stimulates the regeneration processes of the mucous membrane around the ulcer is magnetic therapy; An alternating magnetic field is more often used. Its use is especially relevant in the presence of contraindications for electrotherapy, as well as in elderly patients. Magnetic therapy is used at any stage of treatment of peptic ulcer, including in the acute phase.

One of the frequently used methods for treating peptic ulcers and chronic gastritis is extremely high-frequency therapy (EHF). It allows you to improve the activity of the autonomic and neuroendocrine systems, accelerates relativistic processes in the mucous membrane, causing the disappearance of pain and dyspeptic syndromes, and increases the nonspecific resistance of the body. The impact is carried out on the epitastric region, BAP or on the area of maximum pain in the abdominal wall.

Another common method is laser therapy. For peptic ulcers of the stomach and duodenum, it is indicated in the acute stage, occurring with persistent pain, with frequent relapses of the disease, intolerance to pharmacological agents. Laser therapy is also used in the remission stage to consolidate the results of treatment and prevent relapses of the disease.

Taking into account the important role of the psycho-emotional factor in the etiology and pathogenesis of peptic ulcer, especially of the duodenum, the use of the electrosleep method and its more modern version - central electroanalgesia - is effective. They provide a good and long-term anti-stress, tranquilizing effect, stabilization of vegetative-vascular manifestations. The use of electrosleep and central electroanalgesia procedures is possible at any stage of the treatment of peptic ulcer and chronic gastritis.

At the outpatient stage, to the listed methods of physiotherapy, methods of gentle application of heat treatment (therapeutic mud, ozokerite, paraffin) are added to the epigastric region, especially in case of pain.

These procedures go well with sedative hydrotherapy (general warm fresh, pearl, sea or pine baths, as well as iodine-bromine and radon baths).

Complex therapy for peptic ulcer disease includes drinking treatment with mineral waters. Drinking mineral waters are used mainly for the treatment of chronic gastritis and peptic ulcers with preserved or increased secretory function. In addition, they can be successfully used in almost any phase of the course of peptic ulcer disease. The basis for the early use of mineral waters is their good detoxifying effect on gastric contents. This is accompanied by an increase in the release of alkaline secretions (bile and pancreatic juice) into the cavity of the duodenum, which additionally helps to improve their exfoliating function.

For peptic ulcers, mineral waters are prescribed in degassed form, since carbon dioxide, mechanically irritating the neuroreceptor apparatus of the stomach, stimulates the secretion of gastric juice.

Peptic ulcer disease is traditionally classified as a psychosomatic disease, so the inclusion of psychotherapy is an important component in both treatment and relapse prevention. Elements of rational psychotherapy ensure the patient’s correct understanding of the characteristics of this disease, and autogenic training skills ensure stabilization of the mental state and autonomic functions. But usually the 5th exercise (warmth in the solar plexus) is excluded from the program. The use of psychopharmacological agents (usually tranquilizers) is also indicated for this group of patients.

Prevention of relapses and treatment of residual effects of chronic gastritis and peptic ulcer disease is most appropriate to carry out at the sanatorium-resort stage. A wide range of rehabilitation measures are used here, aimed at normalizing the functions of not only the gastroduodenal region, but also the body as a whole. In this case, the physical factors of therapy are combined with diet therapy and the intake of mineral waters.

Contraindications for spa treatment are: a history of bleeding (up to 6 months) and a tendency to bleed; period of pronounced exacerbation of diseases; pyloric stenosis; suspicion of malignancy; the first 2 months after gastric resection surgery.

Similar principles are used to treat some other diseases of the stomach and duodenum: chronic gastritis with increased secretory function and chronic erosive gastritis, since in a significant percentage of cases they end in peptic ulcer disease. Spa treatment is also used in conditions after organ-preserving operations for complications of peptic ulcer disease (for example, after suturing a perforated ulcer).