Gastric and duodenal ulcers

Peptic ulcer of the stomach and duodenum is a chronic relapsing disease that occurs with alternating periods of exacerbation and remission, the main morphological sign of which is the formation of ulcers in the stomach and / or duodenum. The difference between erosion and ulcers is that erosion does not penetrate the muscular plate of the mucous membrane.

ICD-10 code

• K25 Stomach ulcer
• K26 Ulcer of the duodenum.

With additional codes:

• 0 Acute with bleeding,
• 1 Acute with perforation,
• 2 Acute with bleeding and perforation,
• 3 Acute without bleeding or perforation,
• 4 Chronic or unspecified with bleeding,
• 5 Chronic or unspecified with perforation,
• 6 Chronic or unspecified with bleeding and perforation,
• 7 Chronic without bleeding or perforation,
• 9 Unspecified as acute or chronic, without bleeding or perforation.

Epidemiology

The prevalence is 5-10% of the adult population, mostly men under the age of 50 years.

[1], [2], [3], [4]

Causes of the gastric and duodenal ulcers

• the presence of Helicobacter pylori;
• increased secretion of gastric juice and reduced activity of protective factors of the mucosa (mucoproteins, bicarbonates).

Causes of stomach and duodenal ulcers

[5], [6], [7], [8]

Symptoms of the gastric and duodenal ulcers

It should be understood that the anamnestic data on the previously identified Helicobacter pylori infection and long-term admission to patients with NSAIDs can not be a decisive factor in establishing the diagnosis of peptic ulcer. Anamnestic identification of risk factors for peptic ulcer disease in patients taking NSAIDs may be useful in establishing evidence for conducting FGDS.

The main manifestations of peptic ulcer - pain ( pain in the left side ) and dyspeptic syndromes (syndrome - a stable set of symptoms characteristic of the disease).

Symptoms of stomach and duodenal ulcers 

[9], [10], [11], [12],

Forms

By localization:

• stomach ulcers;
• ulcers of the duodenum;
• combined ulcers of the stomach and duodenum.

Types of stomach and duodenal ulcers

[13]

Complications and consequences

• bleeding;
• perforation (breakdown of the wall of the stomach or duodenum);
• stenosis (constriction) of the pylorus - the outlet of the stomach;
• penetration (fixing the bottom of the ulcer to the neighboring organ), perivyscritis (involvement in the inflammatory process of nearby organs);
• malignancy (degeneration into cancer).

Complications of gastric and duodenal ulcers

• Bleeding from gastric and duodenal ulcers
• Perforation of gastric and duodenal ulcer
• Penetration of gastric and duodenal ulcers
• Stenosis of the pylorus and duodenum
• Malignancy of the stomach ulcer

[14], [15],

Diagnostics of the gastric and duodenal ulcers

Pathognomonic for peptic ulcer laboratory signs are not present.

It should be done to avoid complications, especially ulcer bleeding:

• a general blood test (OAK);
• analysis of feces for occult blood.

Diagnosis of gastric and duodenal ulcers

Screening for peptic ulcer disease

Screening for peptic ulcer disease is not performed. Carrying out PHEGS in asymptomatic patients does not act as a potential preventive measure, which reduces the likelihood of developing a peptic ulcer.

[16], [17], [18], [19], [20], [21], [22],

Treatment of the gastric and duodenal ulcers

Patients with an uncomplicated course of peptic ulcer are subject to conservative treatment.

Treatment of peptic ulcer is carried out in two stages:

• active therapy of exacerbation or a newly diagnosed ulcer,
• preventive treatment to prevent recurrence (return).

At the beginning of an exacerbation, the patient needs physical and mental rest, which is achieved by observing the semi-fast regime and organizing a reasonable psycho-emotional environment. Then, after about 7-10 days, the regime should be expanded to include reserve capabilities of the organism for self-regulation.

Treatment of gastric and duodenal ulcers

• Diet with gastric ulcer and 12 duodenum
• Ulcer of stomach and duodenum - Phytotherapy
• Gastric and duodenal ulcer - Medical gymnastics
• Gastric and duodenal ulcers - Drug treatment
• Gastric and duodenal ulcers - Prevention

Prevention

In patients with the need for continuous intake of NSAIDs and an increased risk of ulceration and the development of their complications, consideration should be given to the use of misoprostol (200 mg 4 times daily), proton pump blockers (eg, omeprazole 20-40 mg, lansoprazole 15-30 mg 1 time per day, rabeprazole 10-20 mg once a day) or high doses of H ₂ -receptor blockers (eg famotidine 40 mg twice daily). Nevertheless, one must take into account that the blockers of the proton pump more effectively prevent peptic ulcer and its exacerbation than high doses of histamine H2-receptor blockers.

[23], [24], [25], [26], [27], [28], [29]

Forecast

Prognosis favorable for uncomplicated peptic ulcer. In case of successful eradication relapses of peptic ulcer during the first year occur in 6-7% of patients. The prognosis worsens for a long time of the disease in combination with frequent, long-term relapses, with complicated forms of peptic ulcer.

[30], [31], [32], [33], [34], [35]