Peptic ulcer disease

Peptic ulcer is a chronic recurring disease characterized by the formation of an ulcer in the stomach or duodenum due to trophic disorders and the development of proteolysis of the mucous membrane.

The incidence rate is very high worldwide - 2-3% of the adult population, and among city dwellers, ulcer disease is 2 times higher than among rural residents, men get sick 4 times more often than women, the age of patients may be different, but ulcers of the duodenum develop mainly at the age of 30-40 years, gastric ulcers at 50-60 years. In 25-30% of cases, ulcer disease is complicated by conditions that require surgical treatment.

There is no generally accepted international classification, with the exception of the WHO statistical classification, but it does not meet clinical requirements.

According to localization, peptic ulcer disease is divided into:

• stomach (lesser curvature, greater curvature, anterior and posterior walls, pyloric, prepyloric, subcardial, fundic);
• duodenum (bulb, extrabulb);
• ulcers located in the stomach and duodenum.

Depending on the number of ulcers, they can be single or multiple.

According to the course of the disease, peptic ulcer disease is classified as acute and chronic (with frequent or rare relapses); in this case, stages of chronic course are distinguished - exacerbation, remission, incomplete remission.

According to the state of the secretory function, hyperchlorhydria, normochlorhydria, achlorhydria, and achylia are distinguished.

Disorders of the motor function of the stomach and duodenum may not be observed or may be in the form of pylorospasm, cardiospasm, hypotension or atony of the stomach, gastroptosis, bulbostasis, duodenostasis.

Depending on the presence of complications, peptic ulcer disease can be uncomplicated or complicated. Complications include:

• Bleeding from gastric ulcer and duodenal ulcer
• Penetration of gastric and duodenal ulcers
• Perforation of gastric ulcer and duodenal ulcer
• cicatricial changes ( stenosis of the pylorus and duodenum, cicatricial deformation of the stomach),
• Malignization of gastric ulcer
• or a combination of both, for example, perforation with bleeding.

According to morphological features and the state of reparative processes, ulcer disease is classified as scarring (in case of a decrease in its size), slow scarring (if the disease lasts more than 30 days). Giant (with a size of 30 mm or more), callous (with dense edges), and migrating ulcers (if they appear in different parts of the stomach and duodenum) are also distinguished.

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How does peptic ulcer disease manifest itself?

Uncomplicated gastric ulcer and duodenal ulcer have different clinical courses. Their course depends on the localization of the pathological process, its size, the state of the secretory function and motility of the stomach and duodenum, the presence of concomitant pathology of the hepatobiliary zone, and the emotional state of the patient. The clinical picture may be polymorphic or, in most cases, manifests itself as the so-called ulcerative symptom complex:

Characteristic pains, heartburn, belching, nausea and vomiting, typical periodicity of exacerbations in spring and autumn. Asymptomatic "silent" ulcer disease is rare, but they often involve bleeding and perforation.

The pain may be of varying intensity and character - aching, sucking, burning, cutting - localized in the epigastrium, less often in the right or left hypochondrium, diffuse, usually associated with food intake, the higher the pathological process is located, the faster the pain in the stomach occurs, for example, with a cardiac location, it appears after 15-20 minutes after eating, along the lesser curvature - within an hour. Peptic ulcer of the duodenum is characterized by night "hunger" pains that pass after eating or soda. With a cardiac location, the pain can radiate to the left arm and shoulder blade, forming a gastro-cardiac syndrome. Long-term constant pain is characteristic of callous defects or periprocesses (perigastritis, periduodenitis), usually with penetration. At the height of the pain syndrome, half of the patients experience nausea, and then vomiting, which brings relief and pain relief.

Heartburn is observed in almost 80% of patients who have peptic ulcer disease, occurs immediately after eating (usually after eating spicy and sour foods) or after 1-2 hours, can precede pain or develop simultaneously, and is often combined with reflux esophagitis.

The patients' appetite is not impaired, but they may lose weight due to a long-term diet or dyspeptic disorders. Vegetative-vascular dystonia and its characteristic neurotic disorders may develop.

Diagnosis of peptic ulcer disease

At present, diagnostics is not difficult, FGDS is available everywhere and should be performed at the slightest gastro-duodenal symptoms, especially since the technique allows, in addition to accurate topical diagnostics, to assess the condition of the sphincter, gastric and duodenal motility, and to take a biopsy from the ulcer walls. Recently, X-rays have been treated with restraint, the indications for its implementation are the need to clarify changes in gastric motility, the nature of cicatricial deformations, the depth of the lesion, if its bottom is not determined by endoscopy, to identify the nature of penetration.

Laboratory blood tests in uncomplicated cases of the disease do not reveal significant and specific changes, only with frequent vomiting hypochloremia may be observed. Gastric secretion is determined by several methods: using special markers by the fractional method; by the method of stimulation with irritants; by the method of direct intragastric pH-metry. A stool test for occult blood is mandatory to detect hidden bleeding.

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Treatment of peptic ulcer

Peptic ulcer disease is treated on an outpatient basis or in a hospital by gastroenterologists.