Gastric and duodenal ulcer

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 an ulcer in the stomach and/or duodenum. The difference between erosion and ulcer is that erosions do not penetrate the muscular plate of the mucous membrane.

ICD-10 code

• K25 Gastric ulcer
• K26 Duodenal ulcer.

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

Prevalence: 5-10% of the adult population, mainly men under 50 years of age.

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Causes gastric and duodenal ulcers

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

Causes of gastric and duodenal ulcers

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Symptoms gastric and duodenal ulcers

It should be understood that anamnestic data on previously identified Helicobacter pylori infection and long-term use of NSAIDs by the patient cannot be a decisive factor in establishing the diagnosis of peptic ulcer disease. Anamnestic identification of risk factors for peptic ulcer disease in patients taking NSAIDs may be useful in establishing indications for FGDS.

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

Symptoms of gastric and duodenal ulcers

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Forms

By localization:

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

Types of gastric and duodenal ulcers

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Complications and consequences

• bleeding;
• perforation (breakthrough of the wall of the stomach or duodenum);
• stenosis (narrowing) of the pylorus - the outlet of the stomach;
• penetration (fixation of the ulcer bottom to the adjacent organ), perivisceritis (involvement of adjacent organs in the inflammatory process);
• malignancy (degeneration into cancer).

Complications of gastric and duodenal ulcers

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

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Diagnostics gastric and duodenal ulcers

There are no pathognomonic laboratory signs for peptic ulcer disease.

Research should be carried out to exclude complications, primarily ulcerative bleeding:

• complete blood count (CBC);
• fecal occult blood test.

Diagnosis of gastric and duodenal ulcers

Screening for peptic ulcer disease

Screening for peptic ulcer disease is not performed. FGDS in asymptomatic patients is not a potential preventive measure to reduce the likelihood of developing peptic ulcer disease.

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Treatment gastric and duodenal ulcers

Patients with uncomplicated peptic ulcer disease are subject to conservative treatment.

Treatment of peptic ulcer disease is carried out in two stages:

• active therapy of exacerbation or newly diagnosed ulcer,
• prophylactic treatment to prevent relapse (return).

At the beginning of an exacerbation, the patient needs physical and mental rest, which is achieved by maintaining a semi-bed rest regime and organizing a reasonable psycho-emotional environment. Then, after about 7-10 days, it is advisable to expand the regime in order to include the body's reserve capabilities for self-regulation.

Treatment of gastric and duodenal ulcers

• Diet for gastric ulcer and duodenal ulcer
• Gastric and duodenal ulcers - Phytotherapy
• Ulcer of the stomach and duodenum - Therapeutic gymnastics
• Gastric and duodenal ulcers - Treatment with medications
• Gastric and Duodenal Ulcers - Prevention

Prevention

In patients who require continuous NSAID use and who have an increased risk of ulcer formation and complications, misoprostol (200 mg 4 times daily), proton pump inhibitors (e.g. omeprazole 20-40 mg, lansoprazole 15-30 mg once daily, rabeprazole 10-20 mg once daily) or high doses of H2-histamine receptor blockers ₍ e.g. famotidine 40 mg twice daily) should be considered. However, it should be taken into account that proton pump inhibitors are more effective in preventing peptic ulcer disease and its exacerbations than high doses of H2-histamine receptor blockers.

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Forecast

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

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