ЯЗВА ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ – DUODENAL ULCER

Самым распространенным симптомом язвы кишечника является боль вверху живота, которая часто возникает, когда больной голоден и проходит после еды. Она может быть очень сильной, но иногда ноющей, а также может отдавать в области сердца или в спину.

Также больные иногда чувствуют голод, спустя некоторое время. Язве кишечника сопутствует вздутие живота, метеоризм, тошнота, отрыжка. Больные часто просыпаются от боли в животе. В общем, болевые ощущения во время сна являются распространенным симптомом этого заболевания. Это случается из-за повышенной секреции кислоты после ужина. Примерно 80 % больных жалуются на ночную боль в животе. Наибольшее количество кислоты вырабатывается в желудке около трех часов ночи, что дает возможность рассматривать ночные боли как ответную реакцию кишечника на повышенную кислотность.

Если лечение отсутствует достаточно долго, то дополнительным симптомом язвы становится частая рвота с кровью. Также кровь обнаруживается в кале больного, что говорит о внутреннем кровотечении, которое может закончиться летальным исходом.

Встречаются случаи, когда заболевание протекает бессимптомно. Обычно такой формой течения болезни страдают пожилые люди.

Общая картина показывает, что заболевание язвой двенадцатиперстной кишки не имеет строгих клинических проявлений. Именно поэтому нужно обязательно соотносить симптоматику с результатом диагностики.

Язвенная болезнь — одно из самых распространен­ных заболеваний желудочно-кишечного тракта. Язвенная болезнь чаще всего возникает в период между 25 и 40 годами, т. е. поражает молодой и самый трудоспо­собный возраст. Но она может обнаружиться и в стар­ческом возрасте, и в более молодом. Язвенная болезнь двенадцатиперстной кишки чаще обнаруживается у молодых лиц, а у более старших – - язвенная болезнь желудка. Давно замечено, что язвенная болезнь гораз­до чаще поражает мужчин, чем женщин, и такое соот­ношение сохраняется до сих пор.

Основным звеном этого болезненного процесса яв­ляется возникновение язвенного дефекта на слизистой оболочке желудка или двенадцатиперстной кишки. Раз­личные механизмы этого сложного процесса, участие в нем самых разнообразных факторов порождают и различную выраженность болезненных признаков. Это в свою очередь требует индивидуального подхода к ле­чению каждого больного, страдающего язвенной бо­лезнью, идет ли речь о лекарственном или же о дие­тическом лечении.

Долгое время существовало мнение, что язва — это процесс местный, ограничивающийся желудком или же двенадцатиперстной кишкой. Поэтому все существовав­шие способы лечения язвенной болезни и были, как правило, нацелены на лечение местного язвенного про­цесса, т. е. на саму язву.

Много лет ведутся споры вокруг нервно-трофиче­ской и нервно-вегетативной теории язвенной болезни. Она подтверждается фактами, что поражение некото­рых отделов центральной и вегетативной нервной си­стемы может вызвать язвенную болезнь. Так, язвенная болезнь иногда развивается после контузии, о чем сви­детельствует опыт советской медицины в Великой Оте­чественной войне. Выдающийся советский ученый А. Д. Сперанский считал, что «каждый участок нервной системы может стать исходным пунктом нервно-дист­рофического процесса». Сегодня уже не вызывает сомнений значение вегетативной нервной системы в про­исхождении язвенной болезни. Не удивительно поэтому, что в наше время большинство методов лечения язвен­ной болезни, включая и лечебное питание, направлено в основном на воздействие на вегетативную нервную систему.

Доказано также, что желудок и двенадцатиперстная кишка могут подвергаться рефлекторным влияниям со стороны больных желчного пузыря, кишечника, подже­лудочной железы и других органов, и в то же время указанные органы могут изменяться и заболевать под влиянием постоянных раздражений, поступающих из пораженных язвенным процессом желудка или двенад­цатиперстной кишки. Отсюда ясно, почему важно свое­временное лечение сопутствующих язвенной болезни заболеваний и почему при подборе лечебного пи­тания для больного язвенной болезнью необходимо учитывать состояние всех органов пищеварительного тракта.

Заслуживает внимания аллергическая теория, кото­рая так объясняет возникновение язвы: различные факторы повышают чувствительность слизистой обо­лочки желудка или двенадцатиперстной кишки, кото­рая затем может бурно реагировать на обыкновенные раздражители, в том числе и на отдельные пищевые продукты и, особенно, на лекарственные средства. Зло­употребление лекарствами, самолечение могут приве­сти к неприятным последствиям. Особенно осторожно следует относиться к ацетилсалициловой кислоте (ас­пирин), кофеину, преднизолону. Без разрешения врача их принимать не следует. Врач при назначении лече­ния больному с язвенной болезнью обязательно учиты­вает его индивидуальную переносимость не только лекарств, но и отдельных продуктов питания. При ма­лейших же подозрениях на повышенную к ним чувствительность больному такие средства и продукты не рекомендуются.

Выдающиеся советские физиологи К, М. Быков и И. Т. Курцин считали, что длительное язвенное пора­жение желудка и двенадцатиперстной кишки у роди­телей может отрицательно сказаться на строении сли­зистой оболочки желудочно-кишечного тракта у их потомства. Такая слизистая оболочка будет иметь бо­лее низкую сопротивляемость к различным воздейст­виям. Также могут передаваться по наследству приоб­ретенные в течение жизни особенности нервной систе­мы (склонность к невротическим реакциям, высокая возбудимость, неуравновешенность), создавая более легкую почву для возникновения язвенной болезни у потомства. Однако частое распространение язвенной болезни у членов одной семьи нередко является резуль­татом одинаковых условий быта, одинакового питания, одних и тех же отрицательных эмоциональных воздей­ствий. Требуют дальнейшего изучения и отмеченные не­которыми исследователями особенности химического состава крови больных язвенной болезнью, групповая принадлежность их крови, биохимический состав желу­дочного сока и др.

Некоторые ученые придерживаются инфекционной теории язвенной болезни, согласно которой желудок или двенадцатиперстная кишка страдают от постоянно­го воздействия болезнетворных микроорганизмов или от продуктов их жизнедеятельности. Это может наблю­даться при хроническом тонзиллите, больных зубах. Вот почему при лечении язвенной болезни надо стре­миться к ликвидации этих хронических очагов инфек­ции.

Учащение заболеваемости язвенной болезнью про­исходит преимущественно в ранние весенние, поздние осенние, а иногда — в зимние месяцы. Летом большин­ство язвенных больных чувствуют себя лучше или даже совсем не предъявляют жалоб. Такая сезонность име­ется у большинства больных язвенной болезнью.

Сказывается особенность питания в разные времена года, например употребление в пищу большого количества клетчатки осенью, когда много овощей и фруктов. Воз­можно, имеются сезонные колебания общей реактив­ности организма с изменением возбудимости нервной системы. Отмечено усиление язвенных болей и при рез­ких метеорологических колебаниях, и при неустойчи­вом атмосферном давлении. Весной же в развитии обострения язвенной болезни может играть роль обед­нение пищи витаминами, особенно аскорбиновой кис­лотой. При организации диетического лечения больному язвенной болезнью в целях профилактики обострения заболевания учитывают и сезонный фактор.

Научно доказано, что у курильщиков под влиянием никотина усиливается выделение желудочного сока, а мышцы желудка спастически сокращаются, что может провоцировать боли в животе. Спустя некоторое время движения желудка замедляются, и он на 15—20 минут как бы замирает. В это время в желудке резко нару­шаются процессы переваривания пищи. Особенно с большим трудом переваривается белок. Курение отби­вает аппетит, а это тоже резко ухудшает процессы пи­щеварения, тем более что у курильщиков курение не­редко заменяет прием пищи, что вообще недопустимо. Никотин может непосредственно воздействовать на слизистую оболочку желудочно-кишечного тракта и приводить к развитию в ней явлений воспаления. Под влиянием курения происходит сужение кровеносных со­судов желудка и кишечника, что может неблагоприятно сказаться на состоянии их стенки, особенно у лиц по­жилого возраста. Даже этих данных, по-видимому, вполне достаточно, чтобы получить представление о том, как пагубно воздействует никотин на желудочно-кишечный тракт и способствует развитию язвенной болезни и ее частым обострениям. Терапевтам прак­тически неизвестны случаи благополучных исходов язвенной болезни у курящих. Скорее наоборот: у них язвенная болезнь часто осложняется кровотечением и другими серьезными осложнениями. Поэтому польза от диетического лечения язвенной болезни тем реальнее, чем раньше бросить курить.

Злоупотребление алкоголем также приводит к из­вращению желудочной секреции, которая даже после однократного его приема долго еще остается нарушен­ной. У лиц, злоупотребляющих спиртными напитками, обнаруживаются глубокие изменения железистого ап­парата желудка. Современная наука рассматривает алкоголь как один из факторов, способствующих разви­тию язвенной болезни.

Прием алкоголя, как известно, снижает критическое отношение человека к своим поступкам, и больной язвенной болезнью под влиянием алкоголя употребляет такую пищу, которая ему противопоказана.

Из всего сказанного ясно, что лечение язвенной бо­лезни специальной диетой несовместимо с употребле­нием спиртных напитков и курения.

Mr H. came requesting vasectomy. He was a small businessman whose wife helped in the playgroup. Their children were older and starting secondary school. The doctor pictured his wife as an intensely earthbound mother putting continued efforts into child rearing and understanding the needs of parents and their desire to procreate. Mr H. spent most of his time at the shop.

The doctor asked him how he would feel about never being able to father a child again. He paused, quietened and said how he loathed the shop. He had hoped that his wife would put more hours in serving to let him do other things. No, he really did not want a vasectomy either, he was wondering about becoming a mature student and doing primary teaching. Neither member of this couple really wanted sterilization despite peer pressure.

One cannot assume that the marriage will benefit from vasectomy (Howard, 1979).

*153/197/1*

To those who decide the time is right for the wanted baby, a pregnancy is achieved by the majority of couples within the first two years of trying to conceive. Modern contraception has encouraged people to feel in control of their lives so that when its use is discontinued, expectations of an ensuing pregnancy occurring immediately are very high. When one does not occur, the emotional anxieties begin to feature very largely in the daily agenda of the woman, and sometimes of the couple.

The most common single problem, accounting for a quarter of all infertility problems, is that of sperm defect or dysfunction. Nearly a half are caused by a mixture of female problems, another quarter by unexplained reasons, and finally 6% due to coital problems. These are useful figures to remember when trying to put infertility problems into perspective and form a balanced view of the cause, if any. However, they do not give any indication of the amount of emotional disturbance felt by the individuals involved. The feelings of failure, utter disbelief and sometimes denial that they are in this situation can be seen in such statements as, ‘We’re not ready for children yet’ or ‘We’re quite busy enough with our dogs at the moment’.

*116/197/1*

Miss A. came to the family planning clinic accompanied by her fiance. She requested a pregnancy test which was positive. The couple came into the office beaming with pleasure. Miss A. had missed a few Pills but they really ‘couldn’t understand’ how she had fallen pregnant. However, they felt sure of parental support and would just hasten their wedding plans. This apparently unplanned pregnancy was obviously not unwanted. The doctor wondered how unplanned this pregnancy was but further discussion at this point seemed irrelevant. The couple wanted the doctor to share in their good news and point them in the direction of antenatal care.

Some very definitely planned pregnancies may turn out to be unwanted. This may be due to a change in circumstances such as deterioration in the relationship, bereavement or redundancy, making the woman feel unable to care for a child or change her objectives. Sometimes a woman may like the idea of becoming pregnant, but once faced with the prospect of having a baby in a few months, she makes a more realistic appraisal of her circumstances.

*80/197/1*

Certainly, once inserted, the woman has nothing more to do. Few women even check for the threads of the coil, although all are taught to do so. Most women, after the first few months of anxiety – how can such a tiny thing be effective? Has it got lost? Will the bleeding ever stop? – seem to forget that the coil is there, between periods, anyway. Menstruation is frequendy heavy, sometimes painful, sometimes preceded and followed by spotting or a brown discharge. Surprisingly, most women are content to put up with this, it seems to be natural, acceptable. It is a price they are prepared to pay. Indeed, sometimes the heavy bleed is seen as a letting out of bad blood, and therefore a good thing. There are women who are grateful that the long menstruation provides an excellent excuse for avoiding intercourse. Other women may return for a check because of a particularly heavy bleed, but if all is well clinically, they go away cheerfully. It is as though the regular, heavy, monthly bleed is actually reassuring – proof that the coil is there, proof that it, and the women themselves, are working.

*43/197/1*

Mrs A. did not believe in contraception, and although she said it was not because of her religion she said, ‘It’s just that you should have what God sends along and not interfere.’ She was in her late 20s and had nine children from 12 pregnancies. After each pregnancy the use of contraception was suggested by the midwife, health visitor or doctor. Each time the answer was the same, and given in such a way that the professionals felt almost like child killers for even mentioning contraception. Eventually Mrs A. reached breaking point with her tenth child and a difficult delivery. Tired and worn out, she attended the doctor’s surgery frequently for various ailments, both her own and those of her children. Finally, she managed to bring herself to ask for a sterilization. Fortunately, the doctor refrained form saying ‘I told you so’ and managed to expedite the operation in an understanding and friendly way.

This patient illustrates a well-known situation where the actual experience of childbirth and child rearing can change attitudes towards contraception. For Mrs A. there were further factors in her urge to have all the children she could have. She was the unwanted illegitimate child of a holiday romance and in her childhood she had been pushed around from pillar to post with no one to call her own. Her children were her bastion against the world, her own tribe as it were. Her sense that it was morally right to have what God sent fitted her unconscious inner need for a large family.

*6/197/1*

Some women attach enormous significance to their lover’s ability to get an erection. They think that a firm erection is a sign of genuine love. A woman who believes the penis is some type of emotional-sexual lie detector will feel threatened and rejected by a man with an erection problem. She may doubt herself intensely and she may jump to all types of conclusions about the cause of his problem.

If the above scenario strikes a chord in you, you should probably explore your feelings further, perhaps with the help of a counselor. It’s important to recognize just what messages you give yourself about the situation, and what you express to your lover. A woman who feels that erections are proof of a man’s love may feel too hurt to participate in treatment, She may resist facing the problem, fearing that ultimately, her husband is going to leave her. But our research indicates that couples who deal directly with potency problems often fare extremely well, both in resolving the sexual difficulty and in maintaining, and even strengthening, their relationship.

Whatever course of treatment you and your lover choose, get started as soon as you can. It is much better to get to the problem early. Even in the best of situations, the void left by not knowing what is causing a potency problem is often filled with anxiety, depression and debilitating self-doubt—for both the man and the woman. That’ s why we recommend that you take care of yourself—and help your partner—by getting qualified professional help early. You wouldn’t want a painful stomachache to go untreated, and the emotional pain that potency problems can cause is just as, or more, debilitating and serious.

*197\184\8*

Scientists also know that libido is linked to the male sex hormone testosterone. Technically an androgen, a type of steroid that acts as a male sex hormone, testosterone provides the masculinizing elements that orchestrate development of muscle tissue, the lowering of the voice during puberty, and overall growth, including that of the penis. It has other consequential applications as well, affecting libido, memory, and lean body mass. Interestingly, at birth, boys have the same testosterone levels as young adult males. They drop quickly, however, and remain low until puberty. At that time they rise, setting in motion the development of masculine characteristics.

Testosterone production continues to climb as men get older, eventually tapering off at around the age of forty. At that point they drop off about 10 percent each decade. By the time a man reaches sixty, his level may be one third what it was between the ages of twenty and forty. In that period of time, his reading ranges from 300 to 1,000 nanograms per deciliter of blood. It’s estimated that about one third of men over the age of fifty have lowered testosterone levels, and by the age of sixty-five, more than 60 percent have low testosterone. Despite a lowering of testosterone, the «free» testosterone levels usually remain in the normal and adequate range. It’s only a distinct minority of men who require some testosterone supplementation. The hallmark of the testosterone-depleted man is decreased libido.

Nature may have intended testosterone to decline with age. The body may be guarding itself against the enlarging of the prostate gland —which grows in the presence of testosterone—by dropping down normal production of the hormone. Still, the significance of that decline remains unclear. Circulating in a man’s bloodstream and acting on his brain to enhance his sexual desire, the hormone may also intensify penile sensation. Testosterone levels rise and fall throughout the day; some researchers think there is an hourly difference. There is even a monthly variation. Typically, testosterone levels are lowest in February and highest in the autumn.

But despite the fact that testosterone has a very pronounced effect on libido, it has little to do with whether or not a man achieves an erection. Even so, some doctors mistakenly link diminished testosterone levels with erectile dysfunction and prescribe testosterone patches or monthly injections for their patients. Raising minimally depressed testosterone levels rarely, if ever, improves erections.

Testosterone replacement is highly controversial, except in cases of men with a condition known as hypogonadism. Men with this ailment have extremely low levels of testosterone—under 300 nanograms per deciliter—due to decreased function of the testes. Their symptoms include lessened libido, mood swings, insomnia, irritability, decreased bone mass, weakness, lethargy, and loss of lean body mass. These men also have decreased erection capability, an overall drop in sex drive, and are at risk for osteoporosis.

*143\183\8*

Another antioxidant, Pycnogenol (pronounced pick-nah-geh-nol) is a patented formulation of nutrient-packed bioflavonoids extracted from the bark of French pine trees. It offers protection to the endothelial cells which line the heart and blood vessels from free radical damage. Flavonoids—vitamin-like compounds naturally found in fruits (especially citrus), vegetables, seeds, nuts, grains, soybeans, cocoa, tea, and wine—help thwart a host of health ravagers, including viruses, cancer, toxic substances, and heart disease.

Water-soluble, Pycnogenol is readily absorbed in the body and performs a particularly remarkable function by prolonging the quantity of vitamin C in the body. Recent research at the University of California saturated. But at the higher dose, less vitamin C was absorbed from the intestines and more was eliminated in the urine. Also, the urine contained oxalate and urate, two breakdown products of vitamin C that contribute to the formation of kidney stones. at Berkeley has shown that Pycnogenol can have a positive effect on nitric oxide regulation as well. It’s nitric oxide that is so critical for the dilation of penile blood vessels at the time of erection.

In addition to aiding the body in neutralizing free radicals, Pycnogenol also decreases blood pressure by inhibiting the formation of angiotensin, a substance in the blood that constricts vessels. Animal studies with Pycnogenol in Hungary have reported a pronounced decrease in both systolic and diastolic blood pressures. And new research is beginning to show that it may assist in lowering blood pressure without ED-producing side effects common to many antihypertensive drugs.

To receive maximum benefits, I strongly recommend Pycnogenol as part of your preventive antioxidant program. For my patients, I prescribe a two-phase schedule: the first part is the saturation phase, the second is the maintenance phase. To begin, the saturation dose schedule is followed for ten days. During that time, Pycnogenol is taken twice daily with meals. The most effective dosage is 1.5 milligrams per pound of body weight daily. For example, a person weighing 140 pounds would take 210 milligrams every day. Then, during the maintenance stage, the dosage is halved. This is the amount necessary to ensure continued maximum effectiveness. The new amount is also taken twice a day with meals.

*115\183\8*

For women in long-term relationships, ED brings numerous problems, as well as opportunities. As Dr. Broad points out, «If physical attractiveness and sexuality have been the main glue of the relationship, then the narcissistically vulnerable woman may instantly doubt her worth as a human being. Fear of abandonment, staved off while the relationship was predictable and viable, may suddenly surface when the partner develops ED.»

This perspective was voiced by Amanda, a forty-eight-year-old woman who worried that her husband, Jeff, would blame his ED on her and leave. «He’ll find a younger woman, I know he will,» she told me. «We were such a great-looking couple—everybody said so. But now, after three children and twenty years of marriage I look different. He won’t respond to me anymore. I know he’s halfway out the door.»

Another outlook was stated by Joan, a very wealthy woman whose marriage to Victor was one of convenience. «I know he had a girlfriend before his ED kicked in. Frankly, it never bothered me. Sex isn’t a big part of our marriage. I expect him to accompany me when I need him —but then he’s on his own. Now he wants to spend all his time with me, which isn’t a part of our deal. We have what I think of as a business arrangement—not an emotional one.»

Both these women are intent on focusing solely on their own perspectives. Because they won’t—or can’t—consider the causes of their husbands’ ED, much less the emotional underpinnings of their marriages, they’re unable to figure out what to do. As Dr. Broad states, «For these women, ED is not a sign that their partners—or their relationship—is in crisis. Rather, they experience the ED as an injury to their self-esteem. The major failure of their partners is that they can’t function in a way that enhances their own self-esteem.»

What happens, then, when a solution to ED is readily at hand?

*86\183\8*

Taking all these factors into account, let’s look at how another man more successfully handles a situation similar to William’s.

Jeff, 44, works for the state government in a middle-management position. He has a certain number of hassles to deal with every day on the job. He runs his department with efficiency, but budget cutbacks have left him short-staffed, and everyone is feeling crunched by the amount of work they must do.

Recently promoted, Jeff has to listen to his staffs complaints about the poor working conditions, and he finds this one of the most difficult parts of his job. His work day starts early but he usually tries to leave by five o’clock. Once a week he plays soccer with a neighborhood team, and at least twice a week he and a co-worker shed their business suits and jog out of the office during lunchtime.

Jeff has been married to Sara for 15 years. They have two children, Susie, 4, and Jeff, Jr., 10. Recent months have been filled with stressful events: the death of Sara’s father; the serious illness of another grandparent; Jeffs recent promotion, which hasn’t worked out as well as they had hoped; and tight finances, partly because Sara’s employer reduced her hours at work.

Jeff has never had any erection problems until recently. One Friday night, he found himself unable to become erect, despite the fact he was very aroused. But he didn’t panic. «I knew it was the beer I’d been drinking,» he says, smiling as he recalls the incident.

Because he knew the cause of his difficulty, Jeff did not experience performance anxiety. And he didn’t feel threatened as a man, but just took it in stride. His self-awareness was crucial in his response to the situation.

Jeff told his wife he thought the culprit was the six-pack and she agreed. Sara didn’t attribute any deep meaning to the problem, probably because she felt secure in her relationship with her husband.

And Jeff didn’t withdraw from his wife. Instead, he cuddled with her for a while, before they each drifted off to sleep.

Left’s suppose that a week later, the same problem recurs, but this time, alcohol isn’t in the picture. Jeffs response to the problem is crucial. He doesn’t immediately assume the worst. In his mind, he goes over recent changes in his life. He did just start taking a prescription drug. Feeling that ifs something of a long shot, he calls his physician. After consulting a reference book, the doctor somewhat apologetically confirms that impotence can be a side effect of the medication. Reducing the dosage solves the problem.

Even without such a simple explanation, Jeffs attitude remains a crucial element in how successful he is in solving his problem. In general, Jeff has a positive attitude towards sex, despite «zero» formal sex education. «I never took a class in high school or college where the physiology of erection was explained or even discussed.» Now, having read a lot on his own, he feels more knowledgeable.

Jeffs attitude towards lovemaking and his marriage is positive. «I have a certain philosophy about making love,» says this soft-spoken man. «When you don’t make love, you’ve lost the time, and it can’t ever be regained. So it’s nice to enjoy it often.» Unlike William, who takes his stresses and pressures to bed with him, Jeff is careful to leave the rest of the world behind when he wants to make love. «I shut off the office when I close the bedroom door,» he says. That’s such good advice, we might all do well to use it as a motto.

Jeffs and William’s stories are good examples of sexual success and failure. The moral of both is that the way to sexual success is to understand the factors behind erection problems and to deal with them in a logical, constructive way.

*57\184\8*