How is peptic ulcer disease treated?

Some children develop a pronounced resistance to being in the hospital. The emergence of such a response does not depend on the child's gender or age. In this case, the child's very stay in the hospital becomes a stress factor, contributing to the persistence of complaints and the progression of the disease.

Thus, the following patients are subject to mandatory hospitalization:

• with newly diagnosed peptic ulcer disease in the acute stage;
• in complicated and frequently recurring course of the disease;
• in case of significant severity or difficulty in relieving pain during a week of outpatient treatment;
• if it is impossible to organize treatment and monitoring in a polyclinic setting.

General principles of treatment of peptic ulcer disease include adherence to diet and a protective regimen.

Therapeutic nutrition is an important area of complex treatment. Currently, the advisability of prescribing a "gentle" diet, provided that there is adequate drug correction, is disputed. The inappropriateness of using tables No. 1a and No. 16 according to Pevzner is associated with their aphysiological content of proteins, fats, carbohydrates and microelements, as well as an adverse effect on the psychoemotional state of the child. In case of exacerbation of peptic ulcer disease, accompanied by severe abdominal pain, it is advisable to prescribe bed rest and a diet based on mechanical, thermal and chemical sparing of the mucous membrane of the stomach and duodenum. Research results show that peptic ulcer disease is characterized by disturbances in the processes of lactose utilization, progressing as morphological changes in the gastroduodenal zone deepen, the duration and severity of the inflammatory process. The use of diet No. 1, which includes significant amounts of milk, is limited by the incompatibility of the product with the intake of bismuth preparations. In such cases, a dairy-free diet is indicated (table no. 4).

The prescription of medications for the correction of gastroduodenal pathology, described in the previous chapter, is completely consistent with that for peptic ulcer disease.

Based on the above concepts of the pathogenesis of duodenal ulcer, the following treatment directions are distinguished:

• eradication of H. pylori infection;
• suppression of gastric secretion and/or neutralization of acid in the lumen of the stomach;
• protection of the mucous membrane from aggressive influences and stimulation of reparative processes;
• correction of the state of the nervous system and mental sphere.

The advisability of anti-Helicobacter treatment for peptic ulcer disease is determined by the following factors.

• In 90-99% of patients with duodenal ulcers, scarring of the ulcer defect is accelerated.
• Eradication of H. pylori leads to a decrease in the frequency of recurrence of peptic ulcer disease from 60-100 to 8-10%.
• Eradication helps reduce the frequency of recurrence of gastrointestinal bleeding in complicated peptic ulcer disease.

When H. pylori infection is first detected, a triple therapy regimen based on proton pump inhibitors or bismuth tripotassium dicitrate (first-line treatment) is prescribed. Indications for quadruple therapy in this category of patients include large or multiple ulcers, as well as the threat or presence of gastrointestinal bleeding. Quadruple therapy is also indicated for patients with peptic ulcer disease if eradication as a result of first-line treatment has failed.

The issues of supportive treatment of duodenal ulcer are currently widely discussed. Seasonal treatment of patients with duodenal ulcer (in spring and autumn) is considered by many researchers to be ineffective and economically unjustified.

To prevent exacerbations of duodenal ulcer, clinical and endoscopic monitoring is necessary (in the first year after diagnosis - once every 3-4 months, in the second and third - once every 6 months, then every year).

If eradication treatment is ineffective for healing mucosal defects, preventing frequent relapses of the disease (3-4 times a year) and complications of peptic ulcer disease and concomitant diseases requiring the use of NSAIDs, maintenance administration of antisecretory drugs in half the dose is indicated. Another option is preventive treatment "on demand", in the event of clinical symptoms of exacerbation, which involves taking one of the antisecretory drugs in a full daily dose for 1-2 weeks, and then in half the dose for the same period.

A modern approach to the treatment of duodenal ulcer in children allows achieving complete reparation of the ulcer defect in 12-15 days, significantly reducing the frequency of relapses of the disease. Clinical and endoscopic remission in 63% of children with duodenal ulcer who received adequate anti-Helicobacter treatment lasts an average of 4.5 years. The transformation of the course of ulcer disease under the influence of modern methods of treatment is also evidenced by the frequency of complications of the disease, which over the past 15 years has decreased by half in deformation of the bulb of the duodenum, from 8 to 1.8% - in gastrointestinal bleeding.

Surgical treatment of peptic ulcer disease is indicated for:

1. perforations;
2. ulcer penetration that does not respond to conservative therapy;
3. persistent massive bleeding;
4. subcompensated cicatricial pyloroduodenal stenosis.

Forecast

Early detection of peptic ulcer disease in children, adequate therapeutic treatment, regular dispensary observation and prevention of relapses make it possible to achieve stable clinical and endoscopic remission of the disease for many years, which significantly improves the quality of life of patients.

Prevention of peptic ulcer disease along with the exclusion of external factors of its formation involves timely detection and treatment of pre-ulcer condition. The presence of hereditary morphofunctional features of the stomach and duodenum in a child, capable of transforming into peptic ulcer disease under certain conditions, is considered as a pre-ulcer condition. Criteria have been established, with the combination of which the formation of peptic ulcer disease is very likely:

1. a burdened heredity for peptic ulcer disease, especially cases of peptic ulcer disease among first-degree relatives;
2. increased acid-peptic, especially basal, aggression of the stomach;
3. increased levels of pepsinogen I in the blood and urine;
4. dominance of the Pg3 fraction in the pepsinogen phenotype;
5. decrease in mucin and bicarbonates in duodenal juice.

Belonging to blood group I (ABO) and signs of vagotonia are also important.

Since the realization of hereditary predisposition in peptic ulcer disease occurs through HP-associated gastroduodenitis, the latter should also be considered an important criterion of the pre-ulcer condition.

Preulcerative condition requires the same diagnostic, therapeutic and dispensary approaches as peptic ulcer disease.

Outpatient observation is carried out for life, in the first year after exacerbation of peptic ulcer disease it is carried out 4 times a year, from the second year - 2 times a year. The main method of dynamic observation, in addition to questioning and examination, is endoscopic. It is also necessary to evaluate HP infection in dynamics and achieve eradication.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]