Peptic Ulcer

A peptic ulcer is a chronic relapsing disease characterized by the formation of an ulcer in the stomach or duodenum due to trophic disturbances and the development of proteolysis of the mucosa.

The incidence is very high all over the world - 2-3% of the adult population, and in urban residents the peptic ulcer is 2 times higher than in rural areas, men get sick 4 times more often than women, the age of the patients may be different, but ulcers 12-finger guts develop mainly at the age of 30-40 years, stomach ulcers in 50-60 years. In 25-30% of cases, peptic ulcer is complicated by conditions that require surgical treatment.

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

On localization the peptic ulcer is allocated:

• stomach (small curvature, large curvature, anterior and posterior walls, pyloric, prepiloric, subcardial, base);
• 12 duodenum (bulb, extra-lobular);
• ulcers located in the stomach and duodenum.

By the number of ulcers can be single and multiple.

With the flow there is a peptic ulcer of acute and chronic (with frequent or rare relapses) character; at the same time, the stages of chronic course - exacerbation, remission, incomplete remission - are distinguished.

According to the state of the secretory function, hyperchlorhydria, normochlorhydria, achlorhydria, achillium are isolated.

Violations of the motor function of the stomach and duodenum may not be noted or be in the form of pilorospasm, cardiopathy, hypotension or atony of the stomach, gastroptosis, bulbostasis, duodenostasis.

By the presence of complications, peptic ulcer disease can be uncomplicated and complicated. The complications include:

• Bleeding from gastric and duodenal ulcers
• Penetration of gastric and duodenal ulcers
• Perforation of gastric and duodenal ulcers
• cicatricial changes ( stenosis of the pylorus and duodenum, cicatricial deformity of the stomach),
• Malignant stomach ulcers
• either, their combination, for example, perforation with bleeding.

Morphological features and state of reparative processes distinguish peptic ulcer in the stage of scarring (in case of reduction of its size), slow scarring (with a duration of the disease more than 30 days). There is also a giant (at a size of 30 mm and more), callous (with dense margins), a migratory ulcer (when it appears in different parts of the stomach and duodenum).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

How does the peptic ulcer manifest?

Uncomplicated peptic ulcer of the stomach and duodenum proceeds in different ways. Its course depends on the localization of the pathological process, its size, the state of secretory function and motility of the stomach and duodenum, the presence of concomitant pathology of the hepatobiliary zone, the emotional state of the patient. The clinical picture can differ polymorphism or in most cases is manifested by the so-called ulceral symptom-complex:

Characteristic pain, heartburn, belching, nausea and vomiting, typical periodicity of exacerbations in spring and autumn. Asymptomatic "mute" peptic ulcer is rare, but often bleeding and perforation occurs.

Pain can be of varying intensity and character - aching, sucking, burning, cutting - localized in epigastrium, less often in the right or left hypochondrium, diffuse, usually associated with eating, the higher the pathological process, the faster pain in the stomach, for example, at a cardiac arrangement it appears in 15-20 minutes, after meal, on a small curvature - within an hour. Peptic ulcer of the duodenum is characterized by nocturnal "hungry" pains that go away after eating food or soda. With a cardiac location, the pain can be irradiated to the left arm and shoulder blade, forming a gastro-cardial syndrome. Prolonged permanent pain is typical for calleous defects or periprocesses (perigastritis, periduodenitis), as a rule, during penetration. At the height of the pain syndrome, half of the patients have nausea, and then vomiting, which brings relief and relief of pain.

Heartburn is observed in almost 80% of patients who have a peptic ulcer, occurs immediately after meals (usually after taking acute and sour food) or after 1-2 hours, may precede pain or develop simultaneously, often combined with reflux esophagitis.

Appetite in patients is not broken, but can be weight loss due to a prolonged diet or dyspeptic disorders. Vegeto-vascular dystonia and neurotic disorders characteristic of it can develop.

Diagnosis of peptic ulcer

Currently, diagnosis is not difficult, the FGS is available everywhere and should be performed at the slightest gastroduodenal symptomatology, all the more so that the technique allows, in addition to accurate topical diagnostics, to assess the state of pulmonary carcinomas, gastric and duodenal motility, and take a biopsy from the ulcer walls. For fluoroscopy lately have been restrained, indications for it are the need to clarify the changes in gastric motility, the nature of scar deformities, the depth of the lesion, if the bottom of it is not determined by endoscopy, to determine the nature of penetration.

Laboratory examination of blood in uncomplicated course of the disease does not reveal any significant and specific changes, only with frequent vomiting hypochloremia can be noted. Gastric secretion is determined by several methods: using special markers using the fractional method; stimulation of stimuli; by direct intragastric pH-metry. Mandatory study of feces for occult blood to detect hidden bleeding.

[14], [15], [16], [17], [18], [19], [20], [21]

Treatment of peptic ulcer

Treated ulcer disease outpatient or in a hospital gastroenterologists.