THE CASE OF FORMATION OF «KISSING» ULCERS OF DUODENAL BULB OF THE PATIENT WITH CHRONIC NONATROPHIC GASTRITIS ON THE BACKGROUND OF THE EATING OF A VEGETABLE SALAD AND PHYSICAL EXERTION

Abstract

Introduction: In certain situations the constituents of food can serve as a catalysator for the formation of such a pathology as peptic ulcer. Not the last role in the formation of ulcerous defects under certain conditions play physical excertion, which is accompanied by sharp rhythmic contraction of the muscles of the anterior abdominal wall. The aim: To analyze the case of formation of "kissing" ulcers of the duodenal bulb of the 25-year-old patient. Materials and methods: The patient took comprehensive examination: step-by-step рН-metry, esophagogastroduodenoscopy, helicobacter infection test (НР) (helicobacter urease test and microscopic examination of stained smears), histological investigations of the gastric stump mucous, HELIC - test. Case report: It was found that on the eve of the ulcer in the patient's diet during breakfast there was a salad of fresh white cabbage, fresh cucumbers, tomato and radishes and at lunch the patient was subjected to prolonged physical exercise. The level of gastric juice corresponded to the basal normacidity total; endoscopic diagnosis: «Kissing» ulcers duodenal bulb in an active stage. Chronic gastritis type B ». Testing for HP infection revealed a high concentration of the active form of bacteria, the HELIC -test showed a high concentration of ammonia in the stomach cavity. Conclusions: An abrupt stimulation of secretion by cabbage juice and the presence of urea in vegetables, of which the salad was cooked, led to the formation of a large level of "residual ammonia" in the cavity of the stomach. Physical strain finally formed the mechanism of ulcer formation.