Symptoms of peptic ulcer disease

The clinical symptoms of peptic ulcer and duodenal ulcer are varied, and a typical picture does not always form, which significantly complicates diagnosis.

The classic picture of peptic ulcer disease is characterized primarily by a typical pain syndrome, which was first described at the beginning of the 20th century by Moynigan:

• hunger pains (on an empty stomach or 1.5-2 hours after eating), often at night;
• persistent, paroxysmal, cutting, stabbing;
• radiate to the back, right shoulder, shoulder blade;
• localized in the epigastrium and to the right of the midline;
• disappear after eating, taking antacids or antispasmodics;
• seasonal exacerbations (autumn-spring).

Dyspeptic symptoms are characteristic:

• vomiting at the height of pain without preceding nausea, heartburn, belching;
• appetite is usually preserved, even increased;
• constipation.

Signs of vagotonic autonomic dystonia are often detected - fatigue, increased sweating, emotional lability, arterial hypotension, bradycardia.

The main complaint in duodenal ulcer is pain of varying severity, depending on the age, individual characteristics of the patient, the state of his nervous and endocrine systems, anatomical features of the ulcer defect, and the severity of functional disorders of the gastrointestinal tract. Usually, the pain is localized in the epigastric or paraumbilical region, sometimes spread throughout the entire abdomen. In a typical case, the pain is intense, occurs regularly, takes on a nocturnal and "hunger" character, and decreases with food intake. The so-called Moynigan rhythm of pain occurs (hunger - pain - food intake - light interval - hunger - pain, etc.).

Dyspeptic disorders in the form of vomiting, belching, nausea, heartburn are less common in children than in adults. As the duration of the disease increases, the frequency of dyspeptic symptoms increases. Some patients experience decreased appetite, delayed physical development, a tendency to constipation or unstable stool.

As the duodenal ulcer progresses, emotional lability worsens, sleep is disturbed due to pain, increased fatigue is characteristic, and an asthenic condition may develop.

It has been established that there is no relationship between clinical symptoms and the stage of duodenal ulcer even with a typical clinical picture of the disease in 50% of patients, and in a quarter of patients the course is asymptomatic. In this case, the equivalent of an exacerbation of ulcer disease is a variety of neurovegetative symptoms.

Most often, the first episodes of abdominal pain in 43% of patients occur at the age of 7 to 9 years, in almost all cases without an obvious cause. In most children, pain is unsystematic and unclear. Complaints of dyspeptic disorders at first admission are noted in 24% of children. When palpating the abdomen, pain is detected in 70% of patients, most often in the epigastric region.

Relapse of duodenal ulcer has a similar clinical picture, however complaints of abdominal pain occur less frequently (in fewer patients), and palpation of the abdomen is painful in approximately 2/3 of children.

In some children, with late diagnosis of the disease or recurrent course of the disease, relatively rapid development of complications occurs: deformation of the duodenal bulb, bleeding, perforation and penetration. In children with complications of duodenal ulcer, clinical symptoms may be erased.

Gastrointestinal bleeding may be preceded by epigastric pain or other symptoms, but "asymptomatic" bleeding may be the only symptom (in 25% of children with primary duodenal ulcers). Hidden bleeding, which does not affect treatment tactics and is not recorded, occurs with almost every relapse of the disease.

Perforation is a severe complication of peptic ulcer disease that requires emergency surgical treatment. Most often (about 80%), perforation occurs in the anterior wall of the duodenal bulb. Clinical symptoms of perforation are acute ("dagger-like") pain in the epigastric region, sharp tension in the muscles of the anterior abdominal wall ("board-like belly"), signs of pneumoperitoneum and peritonitis with rapid deterioration of the patient's condition. In 75-90% of cases, X-ray examination reveals free gas in the abdominal cavity.

Penetration is the spread of the ulcer beyond the wall of the stomach and duodenum into the surrounding tissues and organs. Due to the absence of direct endoscopic signs indicating ulcer penetration, this complication is often not recognized in both children and adults. Possible penetration is indicated by a change in the clinical picture, the occurrence of girdle pain or irradiation to the back (penetration into the pancreas), into the right hypochondrium (penetration into the lesser omentum), upward and to the left with imitation of pain in the heart (penetration of the ulcer of the subcardial and cardiac sections of the stomach). In X-ray examination, penetration is indicated by an additional shadow of barium sulfate suspension near the silhouette of the organ, a three-layer ulcer "niche", the presence of an isthmus and a long-term barium retention.

Deformation of the duodenal bulb can lead to stenosis, most often observed in the pylorus and postbulbar region of the duodenum. The occurrence of stenosis during an exacerbation of the ulcerative process against the background of tissue edema and spastic contractions of smooth muscles is considered functional stenosis, and the presence of persistent narrowing of the lumen of the organ due to cicatricial deformations is characterized as organic stenosis. The establishment of a "splash noise" in the patient during palpation in the epigastrium on an empty stomach indicates pronounced pylorobulbar stenosis.

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