Peptic ulcer disease is a chronic polyethiological pathology with the formation of ulcerous lesions in the stomach, a tendency to progression and formation of complications. The main clinical signs of peptic ulcer disease include pain in the stomach and dyspeptic phenomena. The standard of diagnosis is endoscopic examination with biopsy of the pathological areas, gastric radiography, and detection of H. pylori. Complex treatment: diet- and physiotherapy, eradication of Helicobacter infection, operative correction of complications of disease.
Gastric ulcer (GI) is a cyclically recurrent chronic disease characterized by ulceration of the gastric wall. GI is the most common pathology of the gastrointestinal tract: according to various data, in the world this disease affects from 5 to 15% of the population, and among urban residents the pathology occurs five times more often. Many specialists in gastroenterology combine the concepts of stomach ulcer and duodenal ulcer, which is not quite correct: ulcers in the duodenum are diagnosed 10-15 times more often than stomach ulcers. Nevertheless, ulcer requires careful study and development of modern methods of diagnosis and treatment, as this disease can lead to the development of lethal complications. To help with treatment, take Aprazol.
About 80% of cases of primary detection of peptic ulcer are in the working age (up to 40 years). In children and adolescents peptic ulcer is diagnosed very rarely. Among the adult population there is a predominance of men (women suffer from peptic ulcer 3-10 times less often), but in old age the gender differences in the incidence of the disease are smoothed out. In women the disease is lighter, in most cases it is asymptomatic, rarely complicated by bleeding and perforation.
Peptic ulcer takes the second place among the causes of disablement (after cardiovascular disease). Despite the long period of study of this nosology (more than a century), therapeutic methods of treatment that can stop the progression of the disease and completely cure the patient have not yet been found. The incidence of FMD is steadily increasing worldwide, requiring the attention of general practitioners, gastroenterologists and surgeons.
The disease is polyetiological. There are several groups of causes according to the degree of significance.
The main etiological factor in the formation of peptic ulcer disease is infection with H. pylori – more than 80% of patients test positive for Helicobacter infection. In 40% of patients with peptic ulcer disease infected with Helicobacter bacterium, anamnestic data indicate a family predisposition to this disease.
The second most important cause of the formation of peptic ulcer disease is considered to be the intake of nonsteroidal anti-inflammatory drugs.
Rarer etiological factors of this pathology include Zollinger-Ellison syndrome, HIV-infection, connective tissue diseases, cirrhosis of the liver, heart and lung diseases, kidney damage, exposure to stress factors that lead to the formation of symptomatic ulcers.
The main significance for the formation of peptic ulcer disease is a violation of the balance between the protective mechanisms of the mucous membrane and the influence of aggressive endogenous factors (concentrated hydrochloric acid, pepsin, bile acids) against the background of GI evacuation function disorder (gastric hypokinesia, duodeno-gastric reflux, etc.). Inhibition of protection and delay of mucous membrane regeneration is possible against a background of atrophic gastritis, at a chronic course of Helicobacter infection, ischemia of gastric tissues against a background of collagenosis, long-term intake of NSAIDs (synthesis of prostaglandins slows down, which leads to decrease of mucus production).
Morphological picture in peptic ulcer disease undergoes a number of changes. The primary substrate of ulcer appearance is erosion – superficial damage of gastric epithelium, formed on the background of mucosal necrosis. Eroses are usually found in the small curvature and pyloric region of the stomach, these defects are rarely isolated. The size of erosions can vary from 2 millimeters to several centimeters. Visually, an erosion is a mucosal defect, which does not differ in appearance from the surrounding tissues, the bottom of which is covered with fibrin. Full epithelialization of an erosion with favorable course of erosive gastritis occurs within 3 days without formation of scar tissue. In the unfavorable outcome erosions are transformed into an acute gastric ulcer.
An acute ulcer is formed when the pathological process spreads deep into the mucosa (beyond its muscular plate). Ulcers are usually single, round in shape and look like a pyramid on cut. The edges of the ulcer also do not differ from the surrounding tissues in appearance, the bottom is covered with fibrin deposits. Black coloring of the bottom of the ulcer is possible if the vessel is damaged and hematin (a chemical substance formed by oxidation of hemoglobin from destroyed red blood cells) is formed. The favorable outcome of an acute ulcer is scarring within two weeks, the unfavorable one is marked by the transition of the process into a chronic form.
Progression and intensification of inflammatory processes in the area of ulcerous defect leads to increased formation of scar tissue. Because of this, the bottom and edges of a chronic ulcer become dense, different in color from the surrounding healthy tissue. A chronic ulcer tends to enlarge and deepen during an exacerbation, during remission it decreases in size.
To date, scientists and clinicians all over the world have not been able to agree on the classification of gastric ulcer defects. Domestic specialists systematize this pathology according to the following features:
causative factor – H. pylori-associated or unassociated ulcers, symptomatic ulcers;
localization – ulceration of cardia, antral or body of the stomach, pylorus; large or small curvature, anterior, posterior wall of the stomach;
number of defects – single ulcer or multiple ulcers;
size of the defect – small ulcer (up to 5 mm), medium (up to 20 mm), large (up to 30 mm), giant (over 30 mm);
disease stage – acute, remission, scarring (red or white scar), cicatricial deformity of the stomach;
disease course – acute (diagnosis of peptic ulcer disease for the first time), chronic (there are periodic exacerbations and remissions);
complications – gastric bleeding, perforated peptic ulcer, penetration, cicatricial-ulcerous stenosis of the stomach.
Symptoms of peptic ulcer disease
The clinical course of peptic ulcer disease is characterized by periods of remission and exacerbation. Exacerbation of peptic ulcer is characterized by the appearance and increase of pain in the epigastric region and under the xiphoid process of the sternum. If there is gastric body ulcer, the pain is localized to the left of the central line of the body; if there is pyloric ulceration, the pain is on the right side. Pain may also irradiate to the left side of the chest, scapula, lower back, and spine.
Peptic ulcer disease is characterized by the onset of pain syndrome immediately after a meal with increasing intensity within 30-60 minutes after eating; pylorus ulcer can lead to development of night, hunger and late pains (3-4 hours after a meal). The pain syndrome is managed by applying a heating pad to the stomach area, taking antacids, antispasmodics, proton pump inhibitors, and H2-histamine receptor blockers.
In addition to pain syndrome, DU is characterized by a coated tongue, bad breath, dyspeptic symptoms – nausea, vomiting, heartburn, increased flatulence, unsteady stool. Vomiting predominantly occurs at the height of gastric pain, brings relief. Some patients tend to induce vomiting to improve their condition, which leads to the progression of the disease and the appearance of complications.
Atypical forms of peptic ulcer disease may manifest as pain in the right iliac area (appendicular type), in the heart area (cardiac type), lower back (radiculitis pain). In exceptional cases, the pain syndrome in DU may be absent at all, then the first sign of the disease becomes bleeding, perforation or scar stenosis of the stomach, which cause the patient to seek medical help.
When a gastric ulcer is suspected, a standard set of diagnostic measures (instrumental, laboratory) is performed. It is aimed at visualization of ulcerous defect, determination of the cause of the disease and exclusion of complications.
Esophagogastroduodenoscopy. It is the gold standard of peptic ulcer diagnosis. EGDS allows to visualize peptic ulcer defect in 95% of patients, determine the stage of disease (acute or chronic ulcer). Endoscopic examination allows to diagnose timely complications of peptic ulcer disease (bleeding, cicatricial stenosis), to perform endoscopic biopsy, surgical hemostasis.
Gastrography. Gastric radiography is of primary importance in the diagnosis of cicatricial complications and penetration of ulcer into the adjacent organs and tissues. If endoscopic imaging is not possible, radiography can verify gastric ulcer in 70% of cases. For more accurate result it is recommended to use double contrast – at that defect is visible in the form of niche or persistent contrast stain on the stomach wall, to which folds of mucosa converge.
Diagnosis of helicobacter infection. Taking into account the huge role of Helicobacter infection in the development of DU, all patients with this pathology undergo obligatory tests for detection of H. pylori (ELISA, PCR diagnostic, breath test, examination of biopsy specimens, etc.).
Ancillary to peptic ulcer disease are:
Ultrasound of the OPP (reveals concomitant pathology of the liver, pancreas),
Electrogastrography and antroduodenal manometry (enables to estimate motility of the stomach and its evacuatory ability),
intragastric pH-metry (detects aggressive damaging factors),
Fecal occult blood test (conducted for suspected gastric bleeding).
If the patient is admitted to the hospital with a clinical picture of “acute abdomen”, diagnostic laparoscopy may be required to rule out gastric perforation. Gastric ulcer disease must be differentiated from symptomatic ulcers (especially drug-induced), Zollinger-Ellison syndrome, hyperparathyroidism, and gastric cancer.
Prognosis and prevention
Prognosis in peptic ulcer disease largely depends on the timeliness of seeking medical care and effectiveness of anti-Helicobacter therapy. Peptic ulcer is complicated by gastric bleeding in every fifth patient, from 5 to 15% of patients suffer from perforation or penetration of ulcer, 2% develop cicatricial stenosis of the stomach. In children the frequency of peptic ulcer complications is lower – no more than 4%. The probability of developing gastric cancer in patients with peptic ulcer is 3-6 times higher than in people who do not suffer from this pathology. If you are unable to go to work due to illness, you can look for a remote job here https://jobstellar.com.
Primary prevention of peptic ulcer disease includes prevention of Helicobacter infection, exclusion of risk factors for the development of this pathology (smoking, cramped living conditions, low standard of living). Secondary prevention is aimed at preventing recurrences and includes the observance of diet, exclusion of stress, prescription of anti-Helicobacter drug regimen at the appearance of the first symptoms of DU. Patients with peptic ulcer disease require lifelong monitoring, endoscopic examination with mandatory testing for H. pylori once every six months.