Clinic for peptic ulcer disease. Peptic ulcer disease. Clinic. Diagnostics. Complications. Diagnosis of duodenal ulcer

Peptic ulcer of the stomach and duodenum characterized by classic symptoms. However, there are often cases of atypical course of the disease. The clinical picture and symptoms depend on the characteristics of the ulcerative process (localization, complications), the duration of its existence, the changes that have occurred in other organs and the state of protective reactions of local tissues and the whole body.

Peptic ulcer of the stomach and duodenum occurs cyclically, sometimes for many years, sometimes giving severe exacerbations in the spring and autumn periods, sometimes almost completely relieving the patient of its painful manifestations. In recent years, there has been a disappearance of such a cyclical nature of the disease - it flows like any chronic disease, gradually progressing, sometimes giving exacerbations, which in surgical patients cannot be associated with the change of seasons. The leading and very expressive symptom of peptic ulcer disease is pain associated with eating.

They appear immediately after eating for ulcers of the cardial part of the stomach, after 40-60 minutes for ulcers of the lesser curvature, after 2 hours for ulcers of the pyloric part of the stomach, and hunger pains for ulcers of the duodenum. The nature and intensity of pain is variable. Very often the pain appears in the form of an attack and is very painful. During a painful attack, patients rush around, look for a position that reduces pain: they get on all fours, lower the upper half of the body from the bed and place their elbows on the floor, lean their chest and stomach against the wall and constantly groan in an annoying manner.

These severe pains force the patient to press down on the abdominal wall with his hands and hold a hot heating pad on his stomach for a long time, causing burns and the formation of age spots. Very often, patients suddenly feel a decrease in pain in some position, freeze in it for a while and stop moaning. But soon another intensification of pain returns to motor restlessness, notes of extreme exhaustion and despair appear in the groans. Such severe pain symptoms occur with large ulcers involving the serous membrane and penetrations.

The pain is localized in the epigastric region near the xiphoid process, but more often below, and when the ulcer is localized in the duodenum, closer to the right hypochondrium. Uncomplicated ulcers in the absence of peri-process do not cause irradiation of pain.

In some patients, an attack of pain begins with drooling, and this sign is well remembered by the suffering person. It happens that after eating, in complete well-being and in a good mood, the patient suddenly becomes wary, and fear appears in his facial expression. A few moments later, he jumps out from behind the table and, with his mouth half-open and filled with saliva, runs to the sink, leans his hands on the wall, bows his head down, and immediately viscous saliva flows through his lower lip in an almost continuous stream. Due to the onset of nausea and in anticipation of approaching pain, the patient moans barely audibly monotonously.

Then the groans intensify, the patient leaves the sink, squeezes his stomach with his hands and, in a half-bent position, grabbing a heating pad on the move or irritably demanding it from frightened relatives, hurries to bed - a pain attack sets in. People caring for the patient quickly place a basin by the bed not only to collect saliva that continues to be released - at the height of a painful attack, vomiting occurs, sometimes repeated and severe. Immediately after vomiting, the pain subsides, the patient’s condition improves, and subsequently he looks forward to vomiting (excruciating in the first period), and sometimes causes it himself by inserting a finger into the pharynx. The pain can be dull, aching, pressing and accompanied by a feeling of fullness in the epigastric region or in the right hypochondrium.

Vomit - This is the second classic symptom of peptic ulcer of the stomach and duodenum. It gives constant relief and this differs from vomiting associated with other pathological processes. Vomit may contain streaks of blood. Vomiting is often preceded by drooling and nausea, which are mild in some patients and completely absent in others.

Peptic ulcer disease is characterized by heartburn. It occurs in 70-75% of patients and indicates hypersecretion and high acidity of gastric juice. Heartburn occurs after eating, before eating, and can appear without any connection with food intake. Heartburn can occur with normal or even low acidity of gastric juice. For many years I observed a patient who had suffered from gastric ulcer for more than 40 years. All the time she complained of periodic attacks of pain, drooling and painful heartburn, which persisted (albeit mildly and inconsistently) for 5 years after Subtotal gastrectomy performed according to about a large cancerous ulcer of the lesser curvature. Therefore, the symptom of heartburn must be assessed carefully.

Repeated attacks of pain, salivation, and vomiting lead to significant neuropsychic changes. Many patients have a distinct clinical picture of neurasthenia and even psychasthenia. They are irritated, hot-tempered, do not react adequately to their surroundings, and are poorly behaved. The characteristic features of patients with gastric and duodenal ulcers are hypersociality, anxiety and irritability (V.P. Belov, 1971).

P. A. Kanishchev (1973) among 186 patients with gastroduodenal ulcers found neurasthenia in 80, hysteria in 24, psychasthenia in 15, neurosis-like syndromes in 27, psychopathy and psychopathic personality in 19; 129 patients had a history of mental trauma (usually chronic). Old authors, noting neuropsychic disorders in patients, attached importance to the neuropsychic status in the origin of peptic ulcer disease. Mikulicz (1902) wrote that a stomach ulcer predisposes to hypochondria, neurasthenia and hysteria, but “we must remember that an ulcer can also join neurosis.”

With sometimes preserved increased appetite, patients refuse to eat, fearing attacks of pain, which worsens the condition, increasing emaciation and asthenia.

The clinical picture is complemented by intestinal dysfunction: most patients suffer from constipation, many produce “sheep” feces; but there may also be diarrhea, especially if the pancreas is involved in the process and with a sharp decrease in the acidity of gastric juice.

The clinical picture of peptic ulcer disease in elderly people is characterized by weariness and sometimes latent course. Atypical forms are common (up to 46.4% according to Ciorapciu et al.). People over 60 years of age experience severe complications much more often (up to 40-67% - M. F. Kamaev et al., 1963; A. N. Shabanov et al., 1970), among which bleeding ranks first.

Diagnosis consists of a detailed study of complaints, medical history, life history, objective examination and additional research methods, of which laboratory and x-ray are of leading importance. Recently, gastroscopy and duodenoscopy have become widely used in practice.

Complaints from patients are characteristic and provide very valuable information about the nature of the patient’s suffering. Studying the anamnesis involves finding out the time of onset of the first complaints, the increase and change of symptoms. It is necessary to pay special attention to the possible causes of the disease and, if identified, begin treatment of the patient by eliminating them (treatment of carious teeth, dental restoration, diet, etc.).

The condition of patients with uncomplicated peptic ulcer disease is satisfactory, and in some patients outside of an attack it is good. Nutrition, as a rule, is reduced, patients are irritable, and do not always react adequately to their surroundings. The complexion is pale, there are often dark circles under the eyes from sleepless nights and impaired bowel function. The tongue is coated with a whitish coating, and an unpleasant odor from the oral cavity is often noted. There are pigment spots in the epigastrium from prolonged use of heating pads. The abdomen is regularly shaped or somewhat flattened in the epigastrium, and here the abdominal wall lags behind in breathing, especially during an exacerbation.

Active movements cause pain at the site of the pathological process (if the peritoneum is involved in the process - perigastritis, periduodenitis). In these same places, percussion pain is determined. Palpation reveals muscle tension and pain according to the location of the ulcer. During the lull in the process, there may be no pain or muscle tension. Deep palpation must be carried out carefully. At the same time, pain points are identified, making it possible to more accurately determine the localization of the process, as well as the condition of the white line of the abdomen (epigastric hernias can simulate a peptic ulcer). Check for splashing noise.

This symptom will be positive not only with pyloric stenosis, but also with large gastric secretion. Superficial and deep palpation should be carried out taking into account the projection of organs onto the abdominal wall. Shoffard's triangle is of particular importance for a clearer localization of pain and its differentiation from pain associated with the head of the pancreas (Fig. 111). Some clinicians study Zakharyin-Ged hypersthesia zones, as well as Openhovesky, Boas and Herbst pain points. More information from an objective examination is provided by patients with ulcers that have caused a reaction in the visceral and parietal peritoneum.

A thorough analysis of complaints, anamnesis and the results of an objective examination will undoubtedly provide clear guidance for determining the nature of the disease. All manifestations of the disease should be taken into account. For example, lethargy, loss of appetite and fatigue in a patient with a history of ulcers will make you think about the appearance of a cancer process, and irradiation to the right shoulder girdle, which is added to severe pain, will make you think about the penetration of the ulcer into the liver or gall bladder.

Laboratory testing includes a general analysis of blood, urine, feces, gastric juice, determination of the daily amount of urine, electrolytes, liver functions, coagulation and anticoagulation systems. If necessary, laboratory research is deepened. The study plan must include a consultation with a therapist, an electrocardiogram, and a determination of pulmonary function. The diagnosis of peptic ulcer is completed by X-ray examination methods and gastroscopy. I will dwell only on the methods that are directly related to the diagnosis of the disease.

A thoughtful study of the general blood test is necessary. A decrease in hemoglobin will suggest bleeding, a shift in the white blood count to the left will indicate significant inflammation, and an accelerated ROE will make you pay more attention to the differential diagnosis of cancer and ulcers.

The study of gastric juice involves determining acidity, which, as indicated above, is sharply increased when the ulcer is localized in the duodenum, and when the ulcer is localized in the stomach - normal, decreased or slightly increased. Currently, the fractional method of studying gastric juice according to Kutch, not to mention one-step methods for taking gastric juice with a thick probe, is considered outdated and does not meet modern clinical requirements. To characterize gastric secretion, basal secretion is determined (reflects the state of the glands in the interdigestive period), an insulin test is performed (reflects the sensitivity of the vagal secretory apparatus) and a histamine test (shows the number of functioning parietal cells).

Determination of basal gastric secretion (basal acid output - BAO) is of great diagnostic importance. High basal secretion occurs with duodenal ulcers, normal or reduced - with ulcers and stomach cancer. Very high VAO numbers (above 20 mEq when the norm is 2 mEq) indicate Zollinger-Ellison syndrome. Sparberg and Kirsner (1964) claim that zero acidity of even one sample when determining basal secretion excludes duodenal ulcer. To study basal secretion on an empty stomach, a thin probe is inserted into the stomach and gastric juice is pumped out for 60 minutes.

Immediately after determining the basal secretion, they begin to perform a histamine test (Kau test, 1953) - the maximum release of hydrochloric acid in an hour (maximal acid output - MAO) after subcutaneous administration of histamine at the rate of 0.04 mg per 1 kg of patient weight. Histamine is a stimulant of the second phase of gastric secretion. 30 minutes before the administration of histamine, the patient is given an antihistamine (suprastin 2 ml of a 2% solution intramuscularly).

Then, within an hour, gastric juice secreted under the influence of histamine is collected, and the content of hydrochloric acid in it is determined (in mEq/h). Rune (1966) revealed a correction between the amount of secreted hydrochloric acid and the proteolytic activity of gastric juice, which allows us to consider the Kay test as a method characterizing not only the state of the parietal cells, but also the main cells of the gastric glands (S. M. Ryss, E. S. Ryss) .

Normally, MAO is 17-22.5 meq/h (Vagon, 1963), and according to Segal (1965) - from 1 to 20 meq/h. With a gastric ulcer, MAO is within normal limits or its levels are reduced, with duodenal ulcers - 25-60 mEq/h, and with Zolliger-Ellison disease - 60 mEq/h. The ratio of HLW and MAO is of interest. Normally, VAO accounts for 10-20% of maximum gastric secretion. The same indicators occur in patients with ulcers and stomach cancer. In case of duodenal ulcer, VAO is equal to 20-40% of MAO. Higher numbers of basal secretion in relation to the histamine test indicate a duodenal ulcer or Zollinger-Ellison syndrome.

G. L. Levin (1970) warns against the unconditional use of a histamine test, which can give severe paradoxical reactions and is unsafe for the patient. Kay's test is contraindicated in febrile patients, with high blood pressure, severe atherosclerosis, allergic diseases, bleeding, severe cardiovascular disorders and in the general serious condition of the patient.

To determine the first phase of gastric secretion (sensitivity of the vagal secretory apparatus), the Hollander insulin test is used. This test is based on an increase in gastric secretion under the influence of hypoglycemia, which causes irritation of the vagus nerves. 10-20 units are administered intravenously. insulin (0.2 units per 1 kg of weight) and examine gastric juice every 15-60 minutes (depending on the method), the acidity of which increases sharply and then gradually returns to normal as hypoglycemia is eliminated.

An insulin test is used to determine the completeness of vagotomy. In some clinics, a single-stage (Maratka, 1964) or sequential (Patel, 1965; V. S. Mayat et al., 1969, etc.) histamine-insulin test is performed.

Recently, most foreign authors and many domestic surgeons, based on the results of the above methods for studying gastric secretion, determine the nature and scope of surgical intervention, which in England, the USA, Canada, France and in many other countries (in 53 countries, according to the III Congress , gastroenterologists in Tokyo) is almost fatally accompanied by truncal or selective vagotomy.

In this regard, the importance of histamine and insulin tests is overestimated. The data of many authors who scrupulously study HLW and MAO, despite firm conclusions about the importance of these samples, do not convince of their high accuracy. Thus, Grossman et al. (1963) performed Kay’s test in 1032 patients with duodenal ulcers and in 1249 healthy people and found that “in almost half of the patients with duodenal ulcers, gastric secretion was higher than in healthy people” (cited from F. F. Kostyuk, 1970).

This means that in more than half of the patients the histamine test had no significance. Levin et al. (1948) studied basal secretion in 560 healthy individuals, in 222 patients with duodenal ulcers, in 50 with gastric ulcers and found the presence of hydrochloric acid on an empty stomach in 55% of healthy men and 40% of healthy women. Goyal et al. (1966) found that the volume of basal secretion in healthy people per hour is 22-115 ml, and in patients with duodenal ulcers - 35-131 ml. The lack of convincingness of the results of the study of basal and stimulated gastric secretion is also evidenced by the table published by Goyal et al. (Table 6).

Gastric secretion can also be judged by uropepsinogen. Gastric ulcers do not cause an increase in the level of uropepsinogen; its content can be normal, decreased and rarely increased. Duodenal ulcers are accompanied by a significant increase in uropepsinogen. Radioisotope studies and determination of the motor function of the stomach (electrogastrography) are included in practice. Great importance is attached to intragastric pH-metry (Hart, Lick, 1963; G. L. Levin, 1970; Yu. M. Pantsyrev et al., 1972; A. A. Shalimov et al., 1973). All patients undergo the Gregersen test (detection of occult blood in the stool), which has not lost its significance to this day.

The most important method in recognizing stomach diseases is x-ray, which, however, cannot be considered absolutely accurate. S.A. Reinberg said that there is no radiological diagnosis, but there is a clinical and radiological diagnosis.

X-ray signs of an ulcer include a niche (Fig. 112) - a persistent barium stain and radial convergence of mucosal folds. A niche is a defect in the stomach wall formed at the site of an ulcer, which is filled during examination with a contrast agent. It can be small (0.5-0.6 cm in diameter) and barely perceptible during fluoroscopy, but it can also be large, reaching a diameter of 4-5 or more centimeters. When localizing a deep niche along the lesser curvature, the liquid level can be detected (Fig. 113). A barium stain occurs in cases where the ulcer is localized on the anterior or posterior wall of the stomach or duodenum. This spot remains on the wall of the organ after the passage of the bulk of the contrast agent, which is only partially retained in the area of ​​the mucosal defect (in the ulcer).

Indirect signs include a painful point on palpation, pyloric spasm, prolonged barium retention (up to 6 hours), circular spasm of the stomach (symptom of the “pointing finger”, or incisura spastica), increased peristalsis, large amounts of gastric juice, deformation of the bulb, “irritated bulb " and some others. Unfortunately, x-rays do not always detect an ulcer.

In cases that are difficult to diagnose, they resort to parietography, X-ray kymography, etc. Errors occur within 5-12% even among very experienced radiologists. It is difficult to overestimate the role of modern devices (fibrogastroscopes, fibroduodenoscopes) in recognizing stomach diseases, which allow you to examine the entire mucous membrane of the stomach and duodenum, if necessary, take a piece of tissue for examination, catheterize the common bile duct or pancreatic duct.

Thoughtful use of the above research methods, of which clinical remains the leading one, recognition of gastric and duodenal ulcers is practically ensured for all patients. This is due, to a certain extent, to the fact that patients with long-term ulcers are admitted to the surgical clinic. However, sometimes extreme difficulties arise when the question of the nature of the disease can only be resolved on the operating table.

Differential diagnosis of gastroduodenal ulcers should be carried out with other diseases of the stomach, with epigastric and diaphragmatic hernias, with hernias of the esophageal opening and white line of the abdomen, with pancreatitis, cholecystitis, hepatitis, chronic appendicitis (with high localization of the cecum), diseases of Meckel's diverticulum.

Peptic ulcer disease (PU) is a fairly common pathology of the digestive tract. According to statistics, up to 10-20% of the adult population encounter it; in large cities the incidence rate is much higher than in rural areas.

This disease is associated with the formation of ulcers on the mucous membrane of the stomach and duodenum; in the absence of proper treatment, ulcers lead to serious complications and even death. The disease can be asymptomatic for a long time, but it is very dangerous during exacerbations. A correctly selected treatment regimen for stomach and duodenal ulcers ensures healing and prevents complications.

Causes of peptic ulcer

The main reason why the disease occurs is the activity of the bacterium Helicobacter Pylori: it provokes inflammation, which over time leads to the formation of ulcers on the mucous membrane. However, bacterial damage is aggravated by some additional factors:

• Improper, irregular diet. Snacks on the go, lack of a full breakfast, lunch and dinner, an abundance of spices and over-salted dishes in the diet - all this negatively affects the stomach and creates a favorable environment for the growth of bacteria.
• Bad habits. Peptic ulcers are especially common in those who smoke on an empty stomach; drinking alcohol also contributes to serious damage to the mucous membranes.
• Stress and negative emotions. The development of an ulcer and its exacerbation is provoked by constant nervous excitement, as well as constant mental overload.
• Hereditary factor. It has already been established that if there are cases of ulcers in the family, then the chance of a similar digestive disorder increases significantly.

The ulcer develops over a long period of time: at first, a person notices discomfort in the stomach and minor disturbances in the digestive process, over time they become more and more pronounced.

If measures are not taken in time, an exacerbation with serious complications is possible.

Main symptoms of ulcer

An exacerbation of ulcer occurs suddenly, the duration can reach several weeks.

Various factors can provoke an exacerbation: overeating with a serious violation of the diet, stress, overwork, etc. Symptoms vary depending on the location of the ulcer:

1. If pain occurs immediately after eating and gradually decreases over the next two hours, this usually indicates that the ulcer is localized in the upper part of the stomach. The pain decreases as food gradually passes into the duodenum during digestion.
2. If pain, on the contrary, occurs within 2 hours after eating, this indicates an ulcer located in the antrum of the stomach: from it food enters the duodenum, and it is in this area that a large accumulation of Helicobacter pylori is most often observed.
3. Night pain, which also occurs during long breaks between meals, most often occurs with ulcerative lesions of the duodenum.
4. In addition to pain of various types in the abdomen, a characteristic symptom of an ulcer is heartburn, which is associated with increased acidity of gastric juice. Heartburn occurs simultaneously with pain or appears before it. With sphincter weakness and reverse peristalsis, patients experience sour belching and nausea; these symptoms often accompany peptic ulcer disease.
5. Another common symptom is vomiting after eating, and it brings significant relief to the patient. Appetite often decreases, some patients have a fear of eating due to fear of pain - because of this, significant exhaustion is possible.

Methods for diagnosing ulcers

To diagnose stomach and duodenal ulcers, you must consult a gastroenterologist; the sooner the patient comes for help, the higher the chance of recovery or long-term remission without exacerbations.

In case of a sharp exacerbation with bleeding, urgent surgical intervention is necessary, in this case it is necessary to urgently call an ambulance.

The main method of examining the stomach is fibrogastroduodenoscopy: it allows the doctor to see the condition of the mucous membrane in order to detect an ulcer and assess the advanced state of the disease. Not only the location of the ulcer is assessed, but also its condition: presence of scars, size.

At the same time, a tissue sample of the mucous membrane is taken to identify Helicobacter pylori and a more accurate diagnosis. A clinical blood test is also carried out, it allows you to evaluate deviations from the norm in the condition of the body.

Although FGDS is a rather unpleasant research method, it is the most informative, so it cannot be abandoned. In some cases, it is supplemented by x-ray examination.

Methods and regimens for treating peptic ulcers

The treatment regimen for peptic ulcer disease is based on taking antibiotics to get rid of Helicobacter pylori and avoid serious complications.

Three- and four-component treatment regimens are prescribed by a gastroenterologist; only a specialist can select specific drugs in accordance with the individual characteristics of the patient. Several groups of drugs are used to treat ulcers:

• Antibiotics. Two drugs are prescribed at the same time, the doctor selects the drugs taking into account possible allergic reactions. Self-prescription of antibiotics is unacceptable; they should only be selected by a doctor. The course of treatment takes at least 7-10 days; even if you feel significantly better, you should not stop taking the pills.
• Drugs that should neutralize the effect of gastric juice. These include Omeprazole, Pantoprazole and other common medications familiar to most patients with digestive disorders.
• Substances that form a film on the surface of the mucous membrane. It protects it from the aggressive effects of gastric juice, which contributes to faster healing of the ulcer.
• Antacids, the main purpose of which is to reduce the acidity of gastric juice. They significantly reduce heartburn and improve the well-being of patients; such drugs have an adsorbing effect.
• Prokinetics (Cerucal, Motilium and others) are drugs designed to normalize the motility of the duodenum and ensure normal movement of food through the intestines. They are prescribed for a feeling of heaviness in the stomach or early satiety.

Complex therapy rarely takes more than two weeks. After this, it is only necessary to help the stomach recover faster; for this, special nutritional plans and additional treatment methods are used.

Diet for gastric ulcer

When diagnosing ulcer, patients are prescribed therapeutic nutrition, designed to provide a gentle regime for the stomach and duodenum with a reduction in load.

For this purpose, diet group No. 1 is used; they are prescribed during the acute phase of the disease. The diet prescribes the following restrictions for patients:

1. Foods that irritate the stomach are completely excluded from the diet. These are spicy, sour, fatty dishes, pickles, marinades, etc.
2. You should not eat vegetables containing large amounts of fiber - they can also have a negative effect on digestion during an exacerbation. You can only eat boiled vegetables; in the first days they can only be consumed pureed.
3. You should not consume sour dairy products and salty cheeses; sour fruits and natural juices are also excluded from the diet.
4. Alcohol and carbonated drinks are completely excluded; drinking coffee is undesirable.

All these restrictions prevent further negative effects on the digestive tract and prevent the development of complications.

Deviations from the diet can lead to serious complications, including bleeding and perforation of ulcers.

Additional treatments

In addition to drug treatment, methods of physiotherapy and physical therapy are added during the recovery stage.

They help strengthen the body and minimize the consequences of digestive disorders.

At home, as prescribed by a doctor, you can make warming alcohol compresses - the heat helps reduce pain and improve blood circulation.

Patients with peptic ulcer disease are prescribed sanatorium-resort treatment: in addition to health procedures and the climate at the resort, drinking mineral water “Borjomi”, “Smirnovskaya”, “Essentuki” has a beneficial effect.

Physical therapy exercises are aimed at improving blood circulation and preventing congestion, they improve secretory and motor function, and stimulate appetite. A set of therapeutic and health procedures in compliance with medical recommendations gives excellent results and helps eliminate the negative consequences of peptic ulcer disease.

The sooner the patient turns to specialists, the greater the chance of successful healing of the ulcer with normalization of well-being. It is important to take care of yourself in time and go to an appointment with a gastroenterologist at the first negative manifestations.

Complications of peptic ulcer

Peptic ulcer disease is dangerous due to serious complications during exacerbation, often requiring urgent surgery to prevent death. The following complications are common:

• Gastric and intestinal bleeding. A characteristic symptom is vomit, which is the color of coffee grounds, and black stools.
• Perforation of the ulcer. A rupture leads to the entry of the contents of the digestive tract into the abdominal cavity, resulting in a condition that threatens the patient’s life. Emergency surgery is required.
• Penetration is a condition of the so-called hidden breakthrough, in which the contents of the intestine can enter other organs of the abdominal cavity. Only urgent surgery can save the patient.
• When healing scars on the mucous membranes, the pylorus may narrow, which leads to disruption of the digestive tract. Treatment is only surgical.
• Signs of complications from a peptic ulcer and internal bleeding are sudden weakness, fainting, a sharp drop in blood pressure, and severe abdominal pain. In case of vomiting blood and other signs of complications, it is necessary to take the patient to the hospital as soon as possible in order to prevent irreparable consequences.

Peptic ulcer disease is a disease that is largely associated with the irregular rhythm of life in a big city. It is necessary to find time to eat well; taking care of digestion will relieve discomfort and long-term complex treatment. If digestive problems have already arisen, there is no need to postpone a visit to the doctor until later. Timely diagnosis is an important factor in successful treatment.

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Most often, exacerbation of duodenal ulcers occurs due to gross neglect of diet, abuse of alcohol and junk food that irritates the intestinal mucosa, as well as exposure to stress and fatigue.

Signs of exacerbation are mainly diagnosed in the off-season - spring and autumn. This is due to the deterioration of general immunity during this period. The course of the disease is characterized by cyclicity, when periods of stable remission alternate with exacerbations of the pathology.

Forms of the disease

Exacerbation of duodenal ulcer, its symptoms and treatment depend on the form of the disease.

The disease is classified according to the following criteria:

• Is it possible to have pea soup during an exacerbation of an ulcer?
• treatment of duodenal ulcers with propolis
• symptoms treatment of colon ulcers

By relapse rate:

• a form that has exacerbations from one to three times a year;
• a disease that recurs more than three times in a year.

According to the location and depth of the lesion:

• superficial or deep ulceration;
• an ulcer located in the area of ​​the bulb or in the post-bulb area.

By the number of mucosal lesions:

• single outbreak;
• multiple foci.

Acute duodenal ulcer gives a very pronounced clinical picture with vivid symptoms, making it difficult to confuse it with any other disease. The chronic form of duodenal ulcer without exacerbation may not produce symptoms at all and proceed hidden.

Causes of duodenal ulcers

The causes of the disease may be due to family history, dietary habits and bad habits. In some cases, the disease is caused by the bacterium Helicobacter pylori, which affects the lining of the stomach and intestines.

Without adequate and timely treatment, the ulcer may undergo malignant degeneration.

The most likely factors for the occurrence of the disease are the following:

• abuse of alcohol and tobacco products, which leads to impaired blood circulation in organs, as well as irritation of the mucous membranes of the gastrointestinal tract;
• irregular meals with long intervals between meals, as well as a predominance in the diet of foods that are fried in fat, too sour, fatty and pickled. Food including canned, smoked foods and sauces;
• prolonged and uncontrolled use of NSAIDs, which led to inflammation of the intestinal lining;
• prolonged stress and fatigue can cause duodenal ulcers in people with an unbalanced psyche and mild excitability of the nervous system.

In the first stages, the disease does not always produce noticeable symptoms, so the patient often sees a doctor with an advanced form of the disease. The trigger mechanism for the disease can also be existing pathologies of the endocrine system, liver and kidneys, and infectious diseases.

Tuberculosis, diabetes, hepatitis, pancreatitis lead to intestinal irritation and can provoke duodenal ulcer. The causes of the disease can also be mechanical damage due to surgery.

Symptoms of relapse of the disease

Clinical symptoms of duodenal pathology do not appear immediately; often, at the very beginning, the disease proceeds latently. An advanced form of peptic ulcer disease can suddenly manifest itself with life-threatening symptoms. In a third of people with this pathology, the presence of the disease is determined after a post-mortem autopsy.

The main diagnostic signs of duodenal ulcers:

• epigastric pain;
• symptoms of gastrointestinal dysfunction;
• neurological symptoms.

The main symptom of the disease is pain in the pit of the stomach or in the upper part of the navel. Relapse often provokes pain in the back and heart area. This is due to the fact that it can radiate from its localization site to other parts of the body, distorting ideas about the real source of pain. Therefore, gastroenterologists primarily focus on discomfort in the navel area.

All painful sensations occur on an empty stomach, and immediately after eating the abdominal pain subsides. But if the patient overeats or consumes foods prohibited by the nutritionist, the pain may intensify.

Often, the symptoms of exacerbation of a duodenal ulcer exhaust the patient, not allowing him to fully rest at night. This occurs due to excessive production of acid, which irritates the diseased area of ​​the intestinal mucosa.

Even during stable remission, a stressful situation, a violation of the diet and the use of pharmacological drugs (hormones or NSAIDs) can lead to a worsening of the condition, pain and nausea.

The second most important sign of duodenal ulcer is gastrointestinal dysfunction, characterized by the ability to bring relief to the patient:

• constant long-term constipation;
• bloating, belching and flatulence;
• dark stool indicating the presence of blood.

The third most important are neurological symptoms. Signs of exacerbation of duodenal ulcer may include: irritability, sleep disturbance, depressed mood, and weight loss.

Diet for exacerbation of duodenal ulcers

Nutrition for gastrointestinal pathologies is of paramount importance. In the first days of the disease, nutrition is limited to a small amount of pureed food. Vegetable and bakery products are excluded.

After 5 days, you are allowed to eat vegetarian soups in which white crackers can be soaked. In addition, puree or soufflé from boiled poultry and fish fillets is allowed; for dessert you can eat fruit jelly.

In the second week, meat dishes are added to the treatment menu, which must be steamed; these can be poultry or fish meatballs. In addition, you should eat eggs in the form of an omelet or boiled, milk porridge with a small amount of butter, as well as mashed carrots or potatoes.

Contraindicated in case of exacerbation of duodenal ulcer:

• mushroom, meat broth;
• confectionery and baked goods;
• dishes that were fried in fat;
• too fatty foods;
• fresh fruits and vegetables;
• fatty sea fish;
• alcohol-containing products;
• any lean meat;
• spices, sauces and marinades.

To neutralize the aggressive effects of hydrochloric acid, you should eat little and often. It is better to treat duodenal ulcers in a hospital setting, and dietary table No. 1-a or 1-b is indicated; such nutrition should last 4 months. After discharge, you can follow diet No. 5.

Pathology therapy

Duodenal ulcers, depending on the severity of clinical manifestations, can be treated conservatively and surgically.

The impact method includes the following set of measures:

• therapeutic nutrition;
• pharmacological agents (antibiotics, antacids and antisecretory drugs);
• herbal decoctions;
• Surgical treatment is indicated only if conventional methods are ineffective. Most often, the patient needs surgical help after constant exacerbations of the disease, with impaired ulcer healing and severe scarring.

When Helicobacter pylori is detected, treatment should include a complex of several antibiotics with antiprotozoal and bactericidal effects:

• Amoxicillin;
• Tetracycline;
• Clarithromycin;
• Metronidazole.

In order to neutralize the acidity of gastric juice, antacids are used:

• Maalox;
• Rennie;
• Phosphalugel;
• Almagel;
• Gastal.

To improve the healing of the duodenal membrane, antiulcer drugs are prescribed:

• De-nol;
• Venter;
• Misoprostol.

In addition, antisecretory agents are prescribed:

• Rabeprozole;
• Omeprazole;
• Esomeprazole;
• Lanzoprazole.

When, after taking medications for a long time under the supervision of a doctor, the patient does not feel any improvement, then it is advisable to agree to surgical intervention, which will consist of removing the affected area or suturing the duodenum.

Complications of duodenal ulcers

If duodenal ulcers are treated incorrectly, the pathology can periodically worsen and ultimately cause serious complications.

• If blood vessels are involved in the process, the disease can be complicated by hemorrhage. Hidden bleeding can be identified by such a characteristic sign as anemia. If the hemorrhage is abundant, then it can be determined by the type of stool (they turn black).
• Perforation of an ulcer is the appearance of a hole in the wall of the duodenum. This complication can be determined by the occurrence of acute pain during palpation or a change in body position.
• Narrowing of the duodenal lumen occurs as a result of edema or scar. Identified by bloating, uncontrollable vomiting, and lack of stool.
• Ulcer penetration – penetration into neighboring organs through a defect in the duodenum. The main symptom is pain radiating to the back.

A duodenal ulcer can worsen during the off-season (autumn, spring) and is most often triggered by poor diet or stress. The main symptom is pain in the navel area. To avoid this, you need to remember about preventive measures, compliance with all the conditions prescribed by a specialist, including strengthening the immune system and following a diet.

Symptoms and manifestations of stomach ulcers

A disease in which lesions of various sizes and shapes form in the human stomach is called chronic gastric ulcer. This disease continues for a long time and has periodic exacerbations, followed by a remission state. What types and signs of the disease exist in adults? How does a stomach ulcer manifest itself and is it treatable?

Characteristic

Peptic ulcer of the stomach and duodenum is a disease that is accompanied by the appearance of ulcers and erosions on the mucous surface layer of the ventricle, which has a unique size and shape (acute flat, giant, chronic, etc.). Frequent exacerbations of the disease occur in the spring or winter, when the functioning of all organs in the body undergoes a restructuring. Particularly common causes of peptic ulcers are repeated nervous tension, poor nutrition and bad habits. Due to these reasons, the functioning of the gastrointestinal tract is disrupted; gastric juice does not stimulate the functioning of the ventricle, but causes the exact opposite (destructive) effect on the surface layer of the stomach.

Causes of the disease

The acid-fast bacterium Helicobacter pylori.

The main role in the occurrence of the disease belongs to the acid-fast bacterium Helicobacter, which is the causative agent (Helicobacter pylori infection). It can destroy the mucous membrane of both the ventricle and duodenum. With the help of a diagnostic study, a microbial pathogen is identified, which can be found in the majority of the population of the entire planet, but not everyone suffers from peptic ulcer disease. The situation is that an ulcer of the body of the stomach is formed not only due to the existence of bacteria in the body, but also under the influence of other secondary reasons. So, the causes of stomach ulcers:

• nervous tension;
• very bad genetics;
• there is no diet and mistakes have been made in nutrition: excessive consumption of “junk” food (fast food, fatty, fried, spicy foods);
• bad habits - excessive alcohol consumption, smoking;
• prescribing independent treatment, which can easily lead to a steroid ulcer - uncontrolled use of medications (treatment with antibiotics, laxatives).

Infection of a person with the Helicobacter bacteria (Helicobacter pylori infection) occurs when people come into close contact with each other (when shaking hands, through household items), when personal hygiene rules are ignored when using shared toilets. When the stomach is damaged, the bacterium, which continues to evolve reproductively and actively in it, secretes organic substances that contribute to damage to the protective surface layer of the ventricle and small intestine, and also disorganizes the functioning of cells, which can lead to the formation of ulcers and erosions. Only palpation and diagnostic tests will help to detect a microbe in the body and understand whether a person is infected with it.

Classification of stomach ulcers

Peptic ulcer of the stomach and duodenum has the following classification:

• perforated;
• stressful;
• peptic;
• chronic;
• mirror;
• callous;
• lesser and greater curvature of the stomach;
• medication (steroid);
• disease of the antrum and cardiac (subcardial) parts of the stomach.

Clinical symptoms

The symptoms are:

1. the appearance of heaviness and discomfort in the abdomen;
2. belching air or food, heartburn;
3. gagging;
4. lack of appetite and complete apathy towards food;
5. bowel disorder, manifested by diarrhea or constipation;
6. causeless weight loss;
7. formation of excess gases (intestinal flatulence);
8. excessive sweating;
9. white or yellowish coating on the tongue;
10. anemia;
11. pain syndromes in the intestines and other organs.

Symptoms and stages of the disease

Without complications (stage 1 disease)

The main signs of an ulcer are pain and cramps in the stomach.

The main signs of a stomach and duodenal ulcer are pain and spasms, which prompt a person to go to a medical facility. Pain can vary in characteristics and locations. The pain appears unexpectedly, after every snack and full lunch. They are located approximately in the central part of the abdomen, just above the navel.

Pain syndromes characteristic of gastric and duodenal ulcers differ in time and are divided into:

• early, 40−60 minutes after eating;
• 3-4 hours after eating, that is, late;
• less common at night (night pain);
• on an empty stomach (hunger pains are provoked by long breaks between meals).

The manifestation of pain in all types of ulcers depends on the properties of the food consumed (for example, too spicy or sour food provokes their occurrence); on the state of the nervous system (people suffering from nervous disorders are the most susceptible to pain). Sometimes signs of an ulcer do not appear at all, so people live and do not even suspect the existence of the disease. You can only find out about the presence of the disease and see what a human stomach affected by an ulcer looks like through palpation and diagnostic testing.

Pain in uncomplicated peptic ulcers, as usual, has a slow development and course, periodically increasing and subsiding. Pain that begins to appear is reduced by food, water and various soda solutions. If the pain becomes stronger, the person holds his stomach in a half-bent position, which indicates the “ulcer pose.”

In addition to the pronounced signs, there are also symptoms of a stomach ulcer in adults that occurs without complications, these include: heartburn, belching after eating (accompanied by a sour, putrid odor), vomiting, a feeling of heaviness in the stomach, stool upset (mainly constipation, with in which the release of feces is accompanied by painful sensations in the abdomen), an increase in appetite or, conversely, a complete refusal to eat.

Manifestation of a complicated form (2 stages)

Special forms of ulcers (3 stages)

Special forms of the disease include: pyloric ulcer, giant and postbulbar. The clinical picture of the presented types of ulcers lasts a long time and is expressed as follows: regular painful sensations, heartburn, and unreasonable vomiting. The signs of a stomach ulcer are somewhat mixed - abdominal pain can be bothersome in periods, the appearance of which occurs in the spring or autumn. Spasms and cramps occur early (40 minutes after eating); late (3-4 hours after eating); pain occurs in the left or right corner of the stomach; the pain manifests itself so intensely that it radiates to the back. They are a direct indication for immediate treatment.

Possible complications

If a man or woman is suspected of having gastric ulcers, they should not be ignored under any circumstances - treatment must be carried out, otherwise they will cause a lot of unpleasant complications. Firstly, a stomach ulcer threatens a person with regular painful sensations; secondly, it can provoke bleeding at the most unexpected moment; This is a disease that causes perforation of the stomach walls. It is possible to develop such ailment as gastric outlet stenosis. The biggest and most dangerous problem is degeneration into a malignant tumor and possible death. Therefore, it is necessary to carry out treatment in a timely manner, adhere to medical recommendations (diet and proper nutrition), so that the consequences of a stomach ulcer do not cause any trouble and life is healthy and carefree.

Since classical description of a stomach ulcer Cruvelier has passed 150 years, but still, despite numerous studies in this area, disputes regarding both the ethnology of peptic ulcer disease and its treatment do not subside. Peptic ulcer disease is a fairly common disease. According to various statistics, it affects from 4 to 12% of the adult population. The majority of diseases occur in the 3rd-4th decade of life, with duodenal ulcers more common in young people, and gastric ulcers more common in older people. It has been noted that men suffer from peptic ulcers 4 times more often than women.

Exists many origin theories this pathology, but none of them fully reveals the complexity of the disease. Currently, peptic ulcer disease is considered to be a polyetiological disease, which is based on the interaction of three groups of factors - nervous, hormonal and local. The importance of nervous factors in the etiology of peptic ulcer disease is shown in the works of K. M. Bykov, I. T. Kurtsin and other students of I. P. Pavlov. A significant role in the etiology of this disease has been established for the adrenal cortex and dysfunction of other endocrine organs. In recent years, the importance of changes directly in the gastroduodenal zone has been confirmed: weakening of the resistance of the mucous membrane to the peptic action of gastric juice, impaired motility, etc. Thus, peptic ulcer disease acts as a complex, multifaceted disease of the whole organism, the manifestation of which was the ulcerative niche. Taking into account this idea of ​​peptic ulcer disease, the complexity of its conservative and surgical treatment becomes clear.

Ulcer niche can be of various sizes and depths: from a few millimeters to giant ulcers that occupy almost the entire stomach, from superficial ulcers within the mucous membrane to perforated ones. Chronic, long-standing ulcers have dense, “calloused” edges. These ulcers are called callous ulcers; they are difficult to treat conservatively and often lead to complications such as bleeding, penetration and malignancy. Ulcers that penetrate into neighboring organs are called penetrating ulcers. Most often, ulcers, especially of the posterior wall of the duodenum and stomach, penetrate into the pancreas. Ulcers of the anterior wall often perforate into the free abdominal cavity. Favorite localization of ulcers: in the stomach - the lesser curvature, in the duodenum - the bulb. When large ulcers heal, deformation of the stomach, stenosis of the lumen of the pylorus or duodenum with impaired evacuation from the stomach may develop.

If with peptic ulcer duodenum, the clinical picture is, as a rule, so clear that the diagnosis becomes completely clear after the first conversation with the patient, but with a stomach ulcer the situation is more complicated. A distinct ulcerative symptom complex is not always observed: the higher the ulcer is located in the stomach, the more confusing the picture of the disease, as a rule, is.

The most characteristic symptom of peptic ulcer are pain. Duodenal ulcers are characterized by hunger pain (on an empty stomach or 1.5-2 hours after eating), which decreases or disappears completely after eating. Pain is provoked by errors in diet (alcohol, spicy food), smoking, and great emotional stress. The pain can radiate to the back, liver area, or heart. It has been noted that ulcers of the posterior wall of the duodenum, penetrating the pancreas, often manifest as intense back pain (especially at night). Duodenal ulcers are characterized by seasonal (spring and autumn) exacerbations.

If the stomach ulcer is located in the pyloric region, then the pain can be the same as with duodenal ulcers. With ulcers of the body of the stomach, pain is most often felt in the left hypochondrium and appears 10-30 minutes after eating. With cardial and subcardial ulcers, pain is usually noted in the area of ​​the xiphoid process. With a stomach ulcer, pain is not always clearly associated with food intake. In women, even with duodenal ulcers, the clinical picture is often blurry.

Vomiting most often occurs for complications of peptic ulcer- stenosis. Stenosis is not always organic. Swelling and inflammation of the tissue in the area of ​​the ulcer located near the pylorus can often be accompanied by a clinical picture of stenosis, which is eliminated as the inflammatory process subsides. Stenosis is characterized by regular vomiting. Periodically, vomiting can occur with peptic ulcer disease that is not accompanied by stenosis, especially during exacerbations. Bleeding is a complication of peptic ulcer disease and is more common in callesis and penetrating ulcers. It may present as vomiting blood or bloody (tarry) stools. Often, bleeding is detected only when a special reaction is carried out for occult blood in the stool.

Heartburn, regurgitation and belching, which may be observed for peptic ulcer disease, contrary to popular belief, are not signs of peptic ulcer disease, but serve as a manifestation of cardia failure. Cardiac hiatal hernia is often combined with peptic ulcer disease. With complicated peptic ulcer disease, patients are often exhausted. Pain in the area of ​​the duodenum or stomach may be detected. In the case of pyloric stenosis, a “splashing noise” may be noted.

From laboratory research methods, in addition to general clinical ones, a reaction is used to detect hidden blood in the stool. Be sure to study gastric secretion. X-ray examination allows you to identify a niche or suspect its presence based on a number of indirect signs (ulcerative stomach, duodenitis, deformation of the bulb, etc.). The radiologist expresses an opinion on the nature of the ulcer (callous, penetrating, with signs of malignancy, etc.).

Important is gastric emptying assessment. If the radiologist has doubts about the diagnosis, gastroduodenoscopy is mandatory for gastric ulcers. For gastric ulcers, the endoscopist must take several pieces of the ulcer (from different places) for histological examination. This is necessary in order not to miss the malignant transformation of the ulcer.

Stomach and duodenal ulcers can rightfully be called one of the most common diseases of our time.

Many people suffering from stomach ulcers put up with this disease, considering it an annoying and unpleasant, but inevitable feature of the life of a modern person. This approach not only leads to worsening of the disease, but can also threaten the patient’s life. Indeed, without timely and adequate treatment of stomach and duodenal ulcers, the disease can be complicated by sudden bleeding, perforation, peritonitis, and the long-term existence of a stomach ulcer can lead to malignant degeneration.

In this article we will talk about the symptoms, the causes of the development of this disease, preventative and first aid measures, and the treatment of gastric and duodenal ulcers in our clinic.

Reasons for development

From the point of view of modern concepts of gastroenterology, gastric ulcer in most cases is of an infectious nature. At the end of the twentieth century, American scientists Warren and Marshall were awarded the Nobel Prize for their discovery of the role of the microorganism Helicobacter Pylori in the development of gastritis and stomach ulcers.

These bacteria, penetrating into the protective layer of mucus covering the inner surface of the stomach, destroy it, leaving the stomach wall unprotected from the acid that is part of the gastric juice with the development of gastritis and peptic ulcers.

This microorganism was identified in the gastric contents of most patients suffering from gastric and duodenal ulcers. However, in some cases there is reason to believe that gastric ulcers can be a consequence not only of Helicobacter infection, but also be triggered by stress (acute stress ulcers) or taking non-steroidal anti-inflammatory drugs (gastropathy).

Symptoms and signs of stomach ulcers

Stomach ulcers often have symptoms similar to gastritis. First of all, these are pain in the epigastric region and stomach, especially hunger and night pain, a feeling of heaviness, a feeling of fullness in the stomach or a burning sensation, often nausea and vomiting. Heartburn and belching of acidic stomach contents are often observed.

Sometimes the disease is almost asymptomatic. This happens in cases where the patient has a fairly high pain threshold. Often in such cases, a person does not receive the necessary treatment and develops a complication that manifests itself suddenly in the form of symptoms such as bleeding or sharp, unbearable pain during perforation.

Esophagogastroduodenoscopy is the main method for diagnosing gastric and duodenal ulcers. Sometimes (if it is impossible to perform gastroscopy), they resort to X-ray examination with barium. In addition, abdominal pain requires an ultrasound examination of the abdominal cavity to exclude calculous cholecystitis and pancreatitis. Laboratory tests include a complete blood count, ESR, and blood enzyme tests.

Diagnosis of Helicobacter infection is carried out during gastroscopy (help test, rapid urease test) and is confirmed by the detection of microorganisms during histological examination of biopsy material.

Treatment of stomach and duodenal ulcers at GMS Clinic

The treatment of gastric and duodenal ulcers is aimed at eliminating the causes that caused its formation (eradication therapy - eliminating H/pylori), reducing the irritating effect of hydrochloric acid (antacids), proton pump inhibitors (preventing high formation of HCL), as well as targeted drugs for ulcer healing (sucralfate).

Why GMS Clinic?

At the gastroenterology center GMS Clinic, gastric and duodenal ulcers are treated by specialists who have been trained and have experience in Europe. But this is not the main thing.

The main reason why you should choose GMS Clinic is that we use our own unique treatment programs, developed under the guidance of a world-renowned specialist, Doctor of Medical Sciences, Professor Boris Vasilyevich Kirkin.

Diet for stomach ulcers

Patients must follow a fairly strict diet. In the stage of exacerbation of peptic ulcer disease and during treatment, it is necessary to completely exclude alcoholic beverages, strong coffee and tea, fried, smoked and spicy foods, and fresh bread, especially white bread, from the diet. Smoking should be limited as much as possible and, if possible, stopped. You need to eat in moderation, in small portions, including boiled, low-fat foods rich in fiber in your diet. Avoid eating and drinking foods and drinks that are too hot or too cold.

Prevention

Since peptic ulcer disease often develops as a consequence or against the background of an unhealthy lifestyle, to prevent this disease you should streamline your life, try to make it less stressful, and eliminate situations that lead to strong negative emotions. You should also pay close attention to your diet and diet: not everything that tastes good is healthy!

Prevention of peptic ulcer is a timely visit to the doctor with the appearance of symptoms of dyspepsia: hungry and night pain in the abdomen, heaviness in the abdomen, a feeling of rapid fullness, nausea, vomiting.

If these symptoms appear, contact the Gastroenterology Clinic at GMS Clinic, and we will provide you with modern, effective treatment.

Peptic ulcer(peptic ulcer) is a chronic, recurrent disease, clinically manifested by functional pathology of the gastroduodenal zone, and morphologically by a violation of the integrity of its mucous and submucosal layers, and therefore the ulcerative defect always heals with the formation of a scar

Clinic. The clinical picture of peptic ulcer is polymorphic. Symptoms depend on the gender and age of the patient, time of year, location and size of the ulcer, personal and social characteristics of the patient, and his professional qualities. The clinic is determined by a combination of symptoms: the chronic course of the disease from the moment of its onset, the presence of signs of exacerbation and remission of the disease, healing of the defect in the gastric and duodenal mucosa with the formation of a scar.

Peptic ulcer disease is represented by two clinical and morphological variants: gastric ulcer and duodenal ulcer. Traditionally, a distinction is made between pain and dyspeptic syndromes. The leading clinical sign is pain in the upper abdomen. Based on the nature of the pain syndrome, it is almost impossible to distinguish between chronic bacterial gastritis and peptic ulcer disease. Pain in the epigastric region, on an empty stomach, mainly in spring and autumn, is equally common in both peptic ulcer disease and chronic bacterial gastritis. Pain relief with food and medicinal antacids is achieved in both chronic bacterial gastritis and peptic ulcers. The only distinctive feature of duodenal ulcer is the presence of pain in the epigastric region at night.

Vomiting with peptic ulcers is rare. Nausea is much more common with gastric ulcers and duodenal ulcers. Constipation accompanies chronic duodenal ulcers.

The symptoms of peptic ulcer disease are determined by the number of ulcerative defects and their location.

Multiple stomach ulcers are 3 times more common in men. The clinical picture in this case depends on the localization of peptic defects. With ulcers in the body of the stomach, dull pain in the epigastrium without irradiation, occurring 20–30 minutes after eating, and nausea are noted. Subcardial ulcers are characterized by dull pain under the xiphoid process, radiating to the left half of the chest.

Combined gastric ulcers and duodenal ulcers are a combination of an active gastric ulcer and a healed duodenal ulcer. They are characterized by long-term persistence of pain, persistent course of the disease, frequent relapses of the disease, slow scarring of the ulcer and frequent complications.

Extra-bulbous include ulcers located in the area of ​​the bulboduodenal sphincter and distal to it. Their clinical picture has its own characteristics and has much in common with duodenal ulcers. They occur predominantly in patients aged 40–60 years. Postbulbar ulcers are severe and prone to frequent exacerbations, accompanied by massive bleeding. Pain localized in the right upper quadrant of the abdomen, radiating to the back or under the right shoulder blade, occurs in 100% of cases. The intensity and severity of pain, which subsides only after taking narcotic analgesics, leads patients to severe neurasthenia. Seasonality of exacerbations of extra-bulb ulcers is recorded in almost 90% of patients. In many patients, gastrointestinal bleeding becomes a cardinal symptom.

Ulcers of the pyloric canal are characterized by a symptom complex called pyloric syndrome: epigastric pain, nausea, vomiting and significant weight loss. The exacerbation of the disease is very long. With intensive antiulcer therapy, the ulcer heals within 3 months. The abundant blood supply to the pyloric canal causes massive gastric bleeding.

Diagnostics. For uncomplicated peptic ulcers

There are no changes in the general blood test; a slight decrease in ESR and slight erythrocytosis are possible. When complications occur in blood tests, anemia appears, leukocytosis - when the peritoneum is involved in the pathological process.

There are no changes in the general urine analysis.

In a biochemical blood test in cases of a complicated course of peptic ulcer, changes in the parameters of the sialic test, C-reactive protein, and DPA reaction are possible.

The traditional method of research for gastric pathology is to determine the acidity of gastric contents. Various indicators are possible: increased and normal, in some cases even decreased. A duodenal ulcer occurs with high acidity of gastric juice.

On X-ray examination, a peptic ulcer appears as a “niche” – a depot of barium suspension. In addition to this direct radiological symptom, indirect signs of a peptic defect are important in diagnosis: hypersecretion of stomach contents on an empty stomach, evacuation disorders, duodenal reflux, cardia dysfunction, local spasms, convergence of mucosal folds, cicatricial deformation of the stomach and duodenum.

Gastroduodenoscopy with biopsy is the most reliable method for diagnosing peptic ulcer disease. It allows you to assess the nature of changes in the mucous membrane in the edge of the ulcer, in the periulcerous zone and guarantees the accuracy of the diagnosis at the morphological level.

Endoscopic and morphological studies have established that most gastric ulcers are located in the area of ​​the lesser curvature and antrum, much less often - on the greater curvature and in the area of ​​the pyloric canal. 90% of duodenal ulcers are located in the bulbar region.

A round or oval shape is typical for a peptic ulcer. Its bottom consists of necrotic masses, under which there is granulation tissue. The presence of dark spots on the bottom indicates bleeding. The ulcer healing phase is characterized by a decrease in hyperemia of the mucous membrane and inflammatory shaft in the periulcerous zone. The defect becomes less deep and gradually clears of fibrinous plaque. The scar has the appearance of a hyperemic area of ​​the mucous membrane with linear or stellate retractions of the wall. Subsequently, during endoscopic examination, various disturbances in the relief of the mucous membrane are determined at the site of the former ulcer: deformations, scars, narrowings. During endoscopy, a mature scar due to the replacement of the defect with granulation tissue has a whitish appearance, there are no signs of active inflammation.

A morphological examination of a biopsy obtained from the bottom and edges of an ulcer reveals cellular detritus in the form of an accumulation of mucus with an admixture of decaying leukocytes, erythrocytes and desquamated epithelial cells with collagen fibers located underneath them.

Complications of peptic ulcer:

Gastrointestinal bleeding,

Perforation,

Penetration,

Malignization,

Pyloric stenosis.