Diagnosis of peptic ulcer disease

Anamnesis

When collecting an anamnesis, it is necessary to pay attention to heredity, the nature of nutrition, bad habits and accompanying diseases, the spectrum of medications used, which is burdened with gastroduodenal pathology.

Physical examination

Inspection, palpation, percussion, auscultation is carried out according to the traditional method. In addition to the data obtained, the diagnosis is based on the results of instrumental, morphological and laboratory methods of investigation, including esophagogastroduodenoscopy, pH-metry and diagnosis of H. Pylori infection.

Laboratory research

Obligatory laboratory tests: clinical analysis of blood, urine and feces, examination of feces for latent blood, biochemical analysis of blood (concentration of total protein, albumins, cholesterol, glucose, amylase, bilirubin, iron, transaminase activity).

The algorithm for diagnosing H. Pylori infection in children with duodenal ulcer corresponds to that of gastroduodenal pathology and is described in the previous chapter.

Considering the variety of clinical symptoms of duodenal ulcer, esophagogastroduodenoscopy is considered to be the main method in diagnosing the disease, which allows not only to detect ulcerative inflammatory changes in the gastrointestinal mucosa, but also to track the dynamics of the ulcer process, diagnose complications, and determine the character of motor-evacuation disorders. In addition, with esophagogastroduodenoscopy, it is possible to perform a targeted biopsy of the gastrointestinal mucosa under visual control to conduct a morphological examination of the biopsy specimen and to diagnose contamination with microflora, including H. Pylori. Morphological research allows us to clarify the features of the course of peptic ulcer, according to some scientists, it plays the role of the main method for determining the activity of the inflammatory process.

Ultrasound of the abdominal cavity in case of peptic ulcer is indicated for the diagnosis of concomitant pathology of the hepatobiliary system and pancreas.

X-ray method is used, first of all, to search for complications of ulcerative process (scar deformity of organs, stenosis, convergence of folds, motor-evacuation disorders of gastroduodenal zone). Detection of the ulcer niche serves as a direct sign of the disease and allows you to determine the localization, size, depth of the ulcerative defect. In children, the use of X-ray methods is limited by the high radiation load and the relatively lower diagnostic significance of these methods.

To assess the state of gastric secretion, probe and non-probe methods are used.

Fractional sounding makes it possible to reliably estimate the secretory, acid and enzyme-forming functions of the stomach. The study is carried out in 3 phases of the secretory cycle: muscle, basal (inter-digestive) and stimulated (digestive). Various pharmacological preparations (histamine, pentagastrin) are used as stimulants. Simultaneously, the method does not allow to estimate the pH in real time, to determine the parameter in isolation in one or another part of the stomach, in the esophagus or duodenum, which reduces the diagnostic value of fractional sounding.

Daily pH monitoring is carried out with the help of the following instruments: compact wearable recording unit, pH-metric probe with cutaneous silver chloride reference electrode, computer with software. Daily monitoring of pH makes it possible to study the acid-producing function of the stomach under conditions closest to physiological conditions, to study the effect on acid production of various endogenous and exogenous factors, including medicinal preparations, and also accurately record duodenogastric and gastroesophageal refluxes. This technique allows not only to determine the rhythm of gastric secretion, but also to individually select the dose of antisecretory drugs under the control of the pH level. The daily pH-metry should preferably be performed twice: for the first time without medication administration, and for the second time against treatment to assess the effectiveness of the correction.

Differential diagnostics

At the initial clinical examination of a sick child, clear criteria for peptic ulcer are absent, and therefore it is necessary to conduct differential diagnosis of pain abdominal and dyspeptic syndromes with a clinical picture of other diseases of the gastrointestinal tract, lungs, heart:

• esophagitis, including erosive;
• exacerbation of chronic gastroduodenitis;
• stomach ulcer and duodenal ulcer;
• erosive gastroduodenitis, duodenitis:
• acute cholecystitis and exacerbation of chronic cholecystitis;
• acute pancreatitis and exacerbation of chronic pancreatitis;
• heart disease (rheumatism, cardialgia, cardiomyopathy);
• pneumonia, pleurisy.

Differential diagnosis of peptic ulcer is also performed with symptomatic (acute) ulcers.

Acute ulceration of the mucous membrane of the digestive tract does not have typical clinical manifestations, are very dynamic and, on the one hand, they quickly cicatrize, and on the other, often lead to severe complications - bleeding, perforation. Depending on the cause of ulceration, acute ulcers:

• Stress ulcers are more often localized in the body of the stomach, occur with burns, after injuries, with frostbite;
• Allergic ulcers most often develop with food allergies;
• drug ulcers that occur after taking drugs that disrupt the barrier functions of the mucosa (non-steroidal and steroidal anti-inflammatory drugs, cytostatics, etc.);
• endocrine ulcers in children are rare - with hyperparathyroidism, with diabetes, with Zollinger-Ellison syndrome (hyperplasia of gastrin-producing cells in the antrum of the stomach or pancreas).

The latter disease is manifested by symptoms similar to peptic ulcer. Characterized by pronounced intragastric hypersecretion, hypertrophy of the gastric mucosa, rigidity to conventional therapy Screening test is the detection of an increase in fasting serum gastrin concentration in the blood serum.

Secondary ulcers can be:

• hepatogenic - with a decrease in inactivation in the liver of gastrin and histamine;
• pancreatogenic - with a decrease in the production of bicarbonates and an increase in the production of kinins;
• hypoxic - with pulmonary heart failure;

• at diffuse diseases of connective tissue - as a result of microcirculation disorders;
• with chronic renal failure - due to a decrease in the destruction of gastrin in the kidneys and violation of the protective barrier of the stomach.

Indications for consultation of other specialists

All patients are shown consultation of a dentist, otorhinolaryngologist, hematologist - with signs of gastrointestinal bleeding or anemia, a surgeon - with severe pain syndrome and the possibility of complications.

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