A callous stomach ulcer is called in cases where its edges and bottom undergo cicatricial changes, are covered with connective tissue and the lesion of the organ wall takes on the appearance of a callous ulcer. The disease is difficult, the patient suffers from constant pain. The seasonality of the manifestations of peptic ulcer disease in such clinical cases disappears, the acidity level rises, the disease acquires a persistent course. Antiulcer therapy turns out to be ineffective, as the edges of the ulcer formation become incapable of healing.
Why is a callous ulcer dangerous?
A callous ulcer bothers the patient not only with constant pain, frequent exacerbations and the lack of effectiveness of conservative treatment. This formation is capable of being malignant and degenerating into a cancerous neoplasm . Most often, such processes occur when the lesion of the stomach is located at the border of the junction of the upper part of the organ with the esophagus. According to the observations of specialists, almost every third patient with such a diagnosis and the absence of the necessary treatment is eventually forced to turn to an oncologist.
A cancerous tumor with a callous ulcer of the stomach begins to grow in one of its edges or at the bottom. Malignancy of the ulcerative focus can occur at different periods of the ulcer history, that is, in a patient of any age category. However, more often healthy tissues are reborn into cancerous ones in middle-aged or older patients who have been suffering from stomach ulcers for many years.
With the degeneration of an ulcer into a cancerous tumor, the nature of the pain changes in patients. Patients note that the painful sensations become more persistent, appetite deteriorates sharply, weight decreases , there is an aversion to meat, unreasonable weakness and deterioration in general well-being. In such patients, hypochromic anemia is found , the acidity of gastric juice decreases and traces of blood are constantly detected in the feces.
Causes and features
The following reasons contribute to the development of gastric ulcer:
Infection with the bacterium Helicobacter pylori. This microorganism produces enzymes and ammonia that are dangerous for the mucous membrane, which corrode not only the mucous membrane, but also the walls of the stomach.
Long-term medication intake. Prolonged or improper use of non-steroidal anti-inflammatory drugs (diclofenac, indomethacin, aspirin, ibuprofen, butadione, ketoprofen) causes damage to the mucous membrane of the organ. The risk of developing an ulcer increases in cases when the patient is already 65 years old, he has already had cases of gastric bleeding, high doses of such drugs are prescribed for treatment, or glucocorticoids or anticoagulants are used against the background of their intake . Other drugs can also contribute to the development of ulcers: antihypertensive drugs , cytostatics and potassium-based drugs.
Other diseases. Diseases such as diabetes mellitus , hepatitis, pancreatitis , cirrhosis of the liver , Crohn’s disease , tuberculosis , syphilis , hyperparathyroidism , and lung cancer can contribute to the formation of ulcers .
Frequent stress. An unstable psychoemotional state is accompanied by the release of corticosteroids and catecholamines into the blood, which increase gastric secretion. Such an environment in the organ reduces the protective properties of the mucous membrane and can lead to the formation of ulcers.
Stomach trauma, large area burns, sepsis, shock and frostbite . Such conditions reduce the protective properties of the mucous membrane and cause the formation of ulcers.
The following predisposing factors can contribute to the development of an ulcer on the gastric mucosa:
- addiction to alcohol;
- frequent drinking of coffee;
- irregular and improper nutrition.
In many cases, gastric ulcers are amenable to conservative treatment, but if such a disease becomes chronic, then over time, ulcerative formation, due to persistent inflammation, lends itself to cicatricial changes and becomes callous. As a rule, it takes more than one year to form such foci of mucosal lesions. Such ulcers are covered with connective tissue and have no vessels. Because of this, metabolism is disturbed in the area of the lesion, and the tissues cannot heal. As a result, the patient is constantly in pain, the ulcer is often exacerbated and hardly amenable to drug therapy.
The features of a callous stomach ulcer include the following symptoms characteristic of this particular disease:
- persistent pain that is difficult to eliminate with drugs;
- the presence of connective tissue on the ulcer makes the healing process impossible, conservative treatment methods are ineffective;
- the occurrence of frequent and independent of external and internal causes of exacerbations.
The manifestations of callous stomach ulcers are quite characteristic, since the foci do not heal and manifest themselves with pain and digestive disorders. With this course of the disease, exacerbations of the disease lose their seasonality and occur very often.
Severe painful sensations occur often, are stabbing or cutting in nature and usually occur after eating or at night (usually after 23.00 to 3.00). Night pains can be relieved by eating food (especially dairy products) and applying a heating pad to the stomach area.
Pain with a callous ulcer can be of different localization and sometimes radiates to the spinal column or chest. Such painful sensations in the chest often become the reason that the patient mistakenly suspects the presence of heart disease.
Patients with callous gastric ulcer often complain of partial or complete loss of appetite. Against the background of prolonged fasting, they may experience new bouts of pain. In addition, restricting food intake leads to weight loss. Sometimes the disease does not affect appetite in any way, or the patient, on the contrary, starts eating more against its background.
Disruption of digestive processes with callous ulcer leads to the following symptoms:
- sour belching;
- heartburn ;
- increased saliva production;
After vomiting, the patient notes a weakening of pain and many people suffering from this disease can artificially induce a gag reflex to relieve pain. In addition, fear of pain can lead to the fact that a person deliberately significantly reduces their diet and begins to rapidly lose weight.
Callous ulcers often bleed, and blood tests show signs of anemia in patients. Due to chronic bleeding, the patient becomes pale, feels dizzy and has a sharp decrease in exercise tolerance.
Manifestations of intoxication lead to the following symptoms:
- sleep disorders;
- irritability and frequent mood swings;
- hot flashes.
The doctor can suspect the development of a callous ulcer by the patient’s history of chronic gastric ulcer, complaints of frequent and severe pain, their relief after vomiting and frequent exacerbations of this disease. When palpating an organ, a specialist can detect the presence on its wall of a small seal with even contours.
To confirm the diagnosis, the following studies are performed:
- X-ray of the stomach – a crater-like formation with rigid raised edges is visualized in the images; when palpation is attempted, the contours of the focus do not change;
- fibrogastroduodenoscopy – when examining the gastric mucosa, a crater-like ulcer of gray color with a smooth bottom and edges is found, when you try to touch it with the device, its size and shape do not change in any way, multiple erosions are visualized on the surrounding tissues, the mucous membrane is reddened and its folds converge to the crater of the ulcerative focus;
- biopsy of the ulcer tissue (performed during FGDS) – such a study is always performed to conduct a histological analysis of the sample, since in many patients with this diagnosis, the ulcer can degenerate into a cancerous tumor, with malignancy of the ulcer in the harvested tissues, cancer cells are detected;
- clinical blood test – the results show signs of anemia, other disorders are not detected;
- stool analysis – traces of blood can be detected in the samples.
Antiulcer drug therapy for callous gastric ulcer usually gives only temporary results, and ulcer healing is rare. The drugs used – antacids and antisecretory agents, vitamins B12 and U, anti-Helicobacter drugs – allow for some time to reduce pain and reduce the acidity of gastric juice, but the patient, despite the treatment, often has exacerbations.
The aggravated course of the disease becomes the reason for the appointment of a surgical operation. The essence of such interventions is excision of foci and suturing of defects or removal of part of an organ. In some cases, the operation is complemented by the removal of the vagus nerve, which makes it possible to achieve a decrease in acidity and reduce the risk of the formation of new ulcerative foci.
If signs of ulcer malignancy are detected, treatment is carried out by an oncologist. The expediency of performing the operation in such cases is determined by the stage of the cancer process. To destroy malignant cells, the patient is prescribed courses of radiation and chemotherapy.
Diet for callous ulcer
Diet therapy is of great importance in the treatment of callous ulcers, therefore, every patient with such a diagnosis should follow the diet prescribed by the doctor. The correct organization of nutrition in this disease can reduce the aggressiveness of gastric juice to a non-healing ulcer. In addition, the patient must permanently quit smoking and drinking alcoholic beverages.
The following foods and dishes should be excluded from the diet of patients with callous ulcer:
- fatty meats and fish;
- rich broths;
- fried, smoked, spicy, spicy and pickled dishes;
- carbonated drinks;
- butter and sweet pastries;
- black bread;
- strong tea.
The diet of a patient with callous ulcer may include:
- fermented milk and dairy products;
- beef, chicken or turkey broths;
- lean meats and fish;
- eggs (no more than 2 pieces per day, soft-boiled);
- semi-liquid porridge;
- crackers and yesterday’s wheat bread;
- non-acidic vegetables, berries and fruits;
- non-acidic fresh juices (vegetable or fruit).
Soups for callous stomach ulcers can be ground in a blender and croutons can be added to them. It is better to grind the meat into minced meat and cook cutlets or meatballs from it, which are steamed. Salt should be used in minimal quantities (no more than 6 g per day), and during exacerbations, it should be discarded.
Meals should be taken in small portions 5 to 8 times a day. The temperature of the dishes should not be too high or low – from 26 to 33 C.
After the operation, the doctor gives the patient a prescription to change the diet. In the postoperative period, only a specialist can give recommendations on the preparation of the menu and its expansion. Food intake at this time is carried out 8 times a day and in small portions. Dishes should enter the stomach only in liquid or puree form.
The following expert recommendations aimed at preventing damage to the mucous membrane can prevent the development of a callous stomach ulcer:
- proper organization of food;
- rejection of bad habits;
- minimizing stress;
- correct drawing up of the regime of work and rest;
- taking medications only as prescribed by a specialist;
- timely treatment and prevention of pathologies of the digestive system and other diseases.
Which doctor to contact
If you experience pain in the stomach after eating and at night, signs of indigestion (heartburn, belching, vomiting, constipation), you should consult a gastroenterologist. After the examination (X-ray, fibrogastroduodenoscopy, biopsy, histological analysis of biopsy tissue), the doctor may prescribe medication to the patient. If it is ineffective, the patient is recommended to be treated by a surgeon. If, during the histological analysis, signs of the degeneration of a callous ulcer into a cancerous tumor are found, then the patient is referred to an oncologist for further treatment.
Callous stomach ulcer is a severe form of peptic ulcer disease and significantly worsens the patient’s well-being. Frequent and severe pain, digestive disorders, the development of anemia, weight loss and a high risk of malignancy of ulcerative formation indicate the need for mandatory treatment of such a disease by a specialist. With the ineffectiveness of drug therapy and prolonged non-healing of the ulcer, the doctor recommends the patient to undergo a surgical operation, which allows to eliminate the defect in the gastric mucosa and minimizes the risk of its malignancy.