Symptoms of peptic ulcer disease

The clinical symptoms of peptic ulcer and duodenum are manifold, and a typical picture is not always formed, which greatly complicates the diagnosis.

The classic picture of peptic ulcer is characterized primarily by the typical pain syndrome, which was described for the first time in the early 20th century by Moinigan:

• pain hungry (on an empty stomach or 1.5-2 hours after eating), often - night;
• stubborn paroxysmal, cutting, stitching;
• irradiate in the back, right shoulder, shoulder blade;
• are localized in the epigastrium and to the right of the midline;
• pass after eating, taking antacids or antispasmodics;
• exacerbations seasonal (autumn-spring).

Characteristic dyspeptic phenomena:

• vomiting at the height of pain without previous nausea, heartburn, belching;
• The appetite is usually preserved, even elevated;
• constipation.

Often, signs of autonomic dystonia of the vagotonic type are revealed - fatigue, increased sweating, emotional lability, arterial hypotension, bradycardia.

The leading complaint for duodenal ulcer is a pain of varying severity, depending on the age, individual characteristics of the patient, the state of his nervous and endocrine systems, the anatomical features of the ulcerative defect, and the severity of functional disorders of the gastrointestinal tract. Usually the pain is localized in the epigastric or para-ulbical area, sometimes spilled throughout the abdomen. Typically, the pain is intense, occurs regularly, takes a nightly and "hungry" character, decreases with food intake. There is a so-called Moinigan rhythm of pain (hunger - pain - eating - light interval - hunger - pain, etc.).

Dyspeptic disorders in the form of vomiting, belching, nausea, heartburn in children are less common than in adults. With increasing duration of the disease, the frequency of dyspeptic symptoms increases. In some patients, a decrease in appetite, a delay in physical development, an inclination to constipation or an unstable stool are noted.

As the duodenal ulcer progresses, emotional lability is aggravated, pain is disturbed by sleep, increased fatigue, an asthenic condition can develop.

It is established that the relationship between clinical symptoms and the stage of duodenal ulcer is not even in a typical clinical picture of the disease in 50% of patients, and in a quarter of patients the course is asymptomatic. In this case, the equivalent of exacerbation of peptic ulcer disease is a variety of neurovegetative symptoms.

Most often, the first episodes of abdominal pain in 43% of patients occur between the ages of 7 and 9 years, almost in all cases without an obvious cause. Most children have nonsystematic and fuzzy pains. Complaints on dyspeptic disorders at the first admission mark in 24% of children. When palpation of the abdomen, soreness is found in 70% of patients, more often in the epigastric region.

Recurrence of duodenal ulcer has a similar clinical picture, but complaints of abdominal pain occur less frequently (less sick), and palpation of the abdomen is painful in about 2/3 of the children.

Some children with a late diagnosis of the disease or a recurrent course of the disease there is a relatively rapid development of complications: deformation of the duodenal bulb, bleeding, perforation and penetration. In children with complications of duodenal ulcer, clinical symptoms can be erased.

Gastrointestinal bleeding may be preceded by epigastric pain or other symptoms, but "asymptomatic" bleeding may become the only symptom (in 25% of children with primary duodenal ulcers). Hidden bleeding, which does not affect the tactics of treatment and is not fixed, happens almost with every relapse of the disease.

Perforation is a serious complication of peptic ulcer, requiring urgent surgical treatment. The most frequent (about 80%) perforation occurs in the anterior wall of the duodenal bulb. Clinical symptoms of perforation are acute ("dagger") pain in the epigastric region, a sharp strain of the muscles of the anterior abdominal wall ("dart-shaped stomach"), signs of pneumoperitoneum and peritonitis with rapid deterioration of the patient's condition. At a roentgenologic research in 75-90% of cases the free gas in an abdominal cavity is found out.

Penetration is the spread of an ulcer beyond the walls of the stomach and duodenum to surrounding tissues and organs. Due to the lack of direct endoscopic signs indicating the penetration of ulcers, this complication is often not recognized in children or adults. Possible changes in the clinical picture, the appearance of shingles or irradiation in the back (penetration into the pancreas), in the right hypochondrium (penetration into the small omentum), up and to the left with imitation of pain in the heart (penetration of ulcers of the subcardial and cardiac parts of the stomach) indicate possible penetration. When X-ray examination for penetration indicate an additional shadow of the suspension of barium sulfate next to the silhouette of the organ, three layers of ulcer "niche", the presence of an isthmus and a prolonged retention of barium.

Deformation of the bulb of the duodenum can lead to stenosis, most often seen in the doorkeeper and postbulbarnomu department of the duodenum. The appearance of stenosis in the period of exacerbation of the ulcerative process against the background of edema of tissues and spasmodic contractions of smooth muscles is considered functional stenosis, and the presence of persistent constriction of the organ lumen due to Cicatricial deformities is characterized as organic stenosis. Establishment of a "splash noise" in the patient during palpation in the epigastrium on an empty stomach indicates a marked pylorobulbar stenosis.

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