Endoscopic signs of duodenal ulcer

Acute duodenal ulcers. Develop, as a rule, again, while the necrotic process captures the mucosa and the submucosa. Clinically manifested mainly in complications. Of the complications most often bleeding - in 10-30% of cases. Endoscopy gives a positive result in 98%. It should be done in all patients with the risk of acute ulcer formation.

Acute ulcers can be in any part of the duodenum, but more often in a bulb. They can be single and multiple. Often there is a combination - both in the stomach and in the duodenum. Isolated lesions in the duodenum are 5 times less frequent than in the stomach.

Endoscopic picture of acute duodenal ulcer. Ulcers of small size - up to 1.0 cm, round in shape, but can merge and take the wrong outlines. The bottom is shallow, smooth, without granulation, covered with fibrin or hemorrhagic plaque. The edges are sharp, even, soft, clearly outlined, hyperemic, with petechiae. Edema and hyperemia are not pronounced. Conversion of folds is absent. At a biopsy - the expressed bleeding.

Stages of acute duodenal ulcers.

1. Hyperemia and hemorrhage in the mucous membrane (the first hours, several days).
2. Surface erosion.
3. Formation of one or more ulcers.
4. Bleeding from an ulcer.

For acute ulcers, the prevalence of necrobiotic processes over inflammatory processes is characteristic. Healed quickly - within 2-4 weeks with the formation of a gentle epithelial scar, which by the process of stagnation becomes invisible.

Chronic ulcers of the duodenum. Chronic ulcer of the duodenum is a local manifestation of peptic ulcer. They affect the muscular, submucosal and mucous layer. Most often localized in a bulb, within 3 cm from the place of passage of the pyloric canal of the stomach into the duodenum. They mainly develop at working age. Compared with gastric ulcers are formed faster. Most often located on the front wall - in 60%. Vnutrikovichnye ulcers occur in 2-7% of cases and are located mainly in the upper bend of the duodenum or in the upper third of the descending branch. Multiple ulcers occur in 5-25% of cases.

Stages of development of chronic duodenal ulcer.

1. The acute stage.
2. The stage of the beginning of healing.
3. The stage of complete healing (the stage of the scar).

The acute stage. Defect of mucous round or oval. In case of recurrent exacerbation, more often irregular forms - linear, polygonal, etc. The bottom of the ulcer is shallow, covered with a white or yellow coating of fibrin. Edges edematous, uneven, with granular bulging, easily bleed. Dimensions more often in the range from 0.3 to 1.0 cm. The mucous membrane around the ulcer is hyperemic, edematous, easily vulnerable. Convergence of folds is characteristic. Inflammatory changes can be limited to one zone, several zones and to capture the entire bulb.

The stage of the beginning of healing. It is analogous to the stage of the stagnation of the inflammatory process. The size of the ulcer decreases. It can retain shape, and can acquire linear, polygonal or slit. Its edges become shallow, smoother, less edematous, the ulcer is flattened, the bottom is cleaned of plaque. Epithelialization comes from the edges or from the bottom. After epithelization, a red spot remains on the spot of the ulcer, the phenomena of duodenitis subsided, and erosion can remain.

The stage of complete healing. On the site of the former ulcer a scar of bright red color of linear or stellate form with convergence of folds and a zone of moderate hyperemia is formed - a fresh scar. After 2-3 months, the scar becomes whitish, there are no inflammatory phenomena, convergence of folds and deformation decrease. Heals ulcers on average from 4 to 12 weeks. A favorable morphological sign is the restoration of the intestine in the white stage of the former ulcerative defect of the villous epithelium or epithelialization of the scar. If a non-epithelialized fibrous scar is formed and inflammatory changes are preserved - an unfavorable sign - the ulcer can reopen after 4-6 months.

Giant duodenal ulcers. Gaps are considered to be more than 2 or 3 cm in different authors. They are found mainly in the elderly, mainly on the back wall.

There are 2 types of giant duodenal ulcers.

• I type. With a deep niche of a large size resembling a diverticulum.
• II type. The bottom of the ulcer is the pancreas due to penetration. The wall of the duodenum is absent here. There may be massive bleeding.

With both types of cicatricial changes are noted up to the stenosis of the duodenum. The duration of the course and frequent relapses are characteristic. Giant ulcers are subject to surgical treatment.

Complications of peptic ulcer.

1. Bleeding - 12-34% of patients.
2. Penetration and perforation - 5-10%.
3. Stenosis of the pylorus - in 10-40% of patients with a long course of the disease.

In the acute stage, ulcers located in the proximal areas of the bulb and in the pylorus can give rise to obstruction. When the inflammation subsides, the passage is restored. With relapses, when fibrotic changes occur, the true stenosis of the pylorus develops.

Among patients with ulcers occurs in 1% of cases, and in the long course - in 10% of cases. It was first described in 1955. It is characterized by a tumor overgrowth of the islet zone of the pancreas. The tumor produces mainly gastrin - gastrinoma. It is a rounded formation, most often of small dimensions - 0.3-0.5 cm, located in the pancreas tissue, but can be located in the submucosal layer of the wall of the stomach and duodenum. Morphologically, the tumor is similar to a carcinoid. Benign in 30-40% of cases, malignant in 60%.

Clinically manifested as an untreatable ulcer, located in the distal part of the bulb or in the postbulbarnom department, combined with a high production of hydrochloric acid. Ulcers can be in the stomach, duodenum, esophagus, small intestine. They can develop and stormy, but often exist for years.

Endoscopic picture. The stomach has a large amount of fluid, its folds are hypertrophied, and atony of the stomach is noted. Ulcers are often multiple, large in size with a deep bottom, surrounded by a large inflammatory shaft.

[1], [2], [3], [4], [5], [6], [7], [8], [9]