Peptic ulcer. - Polietiologichesky chronic pathology occurs with the formation of ulcerative lesions in the stomach, a tendency to progression and development of complications. The main clinical symptoms of peptic ulcer disease include pain in the stomach and dyspepsia. Standard diagnostics is carrying out endoscopy with biopsy of pathological areas, stomach X-ray, revealing H. pylori. Treatment is complex: dieto- and physical therapy, eradication of H. pylori infection, operative correction of complications of the disease.
Gastroenterology combine the concept of gastric ulcer and duodenal ulcer, that is not quite correct - ulceration in 12 duodenal ulcer is diagnosed in 10-15 times more frequently than ulcers in the stomach. However, GU requires careful study and development of modern diagnostic and treatment methods, as this disease can lead to fatal complications.
About 80% of cases of primary detection of gastric ulcers accounted for working age (under 40 years). In children and adolescents are diagnosed with stomach ulcer is extremely rare. Among the adult population is marked predominance of men (women suffer GU 3-10 times less); but in old age the incidence of sexual differences are smoothed. In women, the disease is easier in most cases, symptoms are rarely complicated by bleeding or perforation.
Peptic ulcer disease is the second leading cause of disability in the population (after cardiovascular diseases). Despite a long period of study of the nosology (over a century), so the therapeutic effects of the methods that can stop the progression of the disease and the patient is completely cured yet to be found. The incidence of GU in the world is constantly growing, requiring the attention of physicians, gastroenterologists, surgeons.
gastric bleeding, perforated gastric ulcer, penetration, cicatricial stenosis of stomach ulcer.
Zollinger-Ellison Syndrome, HIV infection, connective tissue diseases, cirrhosis of the liver, heart and lung diseases, kidney disease, exposure to stress factors which lead to the formation of symptomatic ulcers.
The main importance for the formation of stomach ulcers is imbalance between the mucosal protective mechanisms and the impact of aggressive endogenous factors (concentrated hydrochloric acid, pepsin, bile acids) against the background of the disorder evacuation GI function (physical inactivity stomach, duodeno-gastric reflux and so on. D.) . Inhibition of protection and slowing mucosal recovery possible on the background of atrophic gastritis in chronic H. pylori infection, gastric tissue ischemia on a background of connective tissue, chronic administration of NSAIDs (prostaglandin synthesis occurs slowing, leading to a decrease mucus production).
Morphology of ulcers in the stomach undergoes a series of changes. The primary substrate of the emergence of ulcer is erosion - superficial damage of gastric epithelium, emerging against the backdrop of mucosal necrosis. Erosion is usually detected on the lesser curvature and pyloric stomach, these defects are rarely isolated. Dimensions erosion can range from 2 millimeters to several centimeters. Visually erosion is a defect in the mucosa did not differ in appearance from the surrounding tissue, the bottom of which is covered by fibrin. Complete epithelialization erosion with a favorable course of erosive gastritis occurs within 3 days, without the formation of scar tissue. If an unfavorable outcome erosion transformed into an acute gastric ulcer.
Acute ulcer formed in the propagation of the pathological process deeper into the mucosa (on her muscular plates). Ulcers are usually sporadic, becoming rounded shape at the cut have the form of a pyramid. In appearance ulcer edges also differ from the surrounding tissue, overlays the bottom covered with fibrin. The black color of the bottom of the ulcer with possible damage to the vessel and the formation of hematin (a chemical substance formed by the oxidation of hemoglobin from destroyed red blood cells). The favorable outcome of acute ulcer is scarring within two weeks, marked by an unfavorable process becomes chronic.
Progression and increased inflammation in ulcerative defect leads to increased formation of scar tissue. Because of this and the bottom edge of chronic ulcers become dense in color different from the surrounding healthy tissues. Chronic ulcer tends to increase and deepen during the exacerbation, during remission it is reduced in size.
dyspeptic symptoms - nausea, vomiting, heartburn, increased flatulence, unstable chair. Vomiting occurs mainly at the height of stomach pain relief. Some patients tend to induce vomiting to improve their condition, which leads to the progression of the disease and the appearance of complications.
Atypical forms of gastric ulcer may occur pain in the right iliac fossa (similar appendicular), in the region of the heart (cardiac type), lumbar (radikulitnaya pain). In exceptional cases, pain at GU is absent, then the first sign of the disease becomes bleeding, perforation or cicatricial stenosis of the stomach, due to which the patient and seek medical help.
esophagogastroduodenoscopy. Endoscopy allows visualization of ulcerative defect in 95% of patients, to determine the stage of disease (acute or chronic ulcer). Endoscopy allows you to quickly identify the complications of gastric ulcer (bleeding, scar stenosis), to conduct an endoscopic biopsy, surgical hemostasis.
X-ray of the stomach (gastrokinesograph) of paramount importance in the diagnosis of complications and scarring penetration ulcers located next to the organs and tissues. At impossibility of endoscopic imaging radiography allows to verify the gastric ulcer in 70% of cases. For more accurate results, we recommend the use of double contrast - with this defect is seen as a niche or a persistent contrast spots on the wall of the stomach, to which converge mucosal folds.
Given the enormous role of Helicobacter pylori infection in the development of GU, all patients with this pathology is a compulsory tests for detection of H. pylori (ELISA, PCR diagnostics, breath test, a study of biopsies and others.).
Auxiliary value for stomach ulcers have ultrasound OBP (identify comorbidities liver, pancreas), electrogastrography and antroduodenalnaya manometry (enables evaluation of motor activity of the stomach and its evacuation capacity), intragastric pH-meter (detects aggressive factors damage), the analysis of fecal occult blood (held for suspected gastric bleeding). If the patient is admitted to the hospital with the clinical picture of "acute abdomen", may require a diagnostic laparoscopy to exclude gastric perforation. Gastric ulcer should be differentiated from symptomatic ulcers (especially drugs), Zollinger-Ellison syndrome, hyperparathyroidism, cancer of the stomach.
paraffin, ozokerite, electrophoresis and microwave impacts), also advised to avoid stress, maintain a healthy lifestyle.
Drug treatment should be complex, affect all links in the pathogenesis of GU. H. pylori therapy requires the appointment of a number of drugs for eradication of H. pylori, since the use of monoskhem shown to be ineffective. The attending physician individually selects a combination of the following drugs: proton pump inhibitors, antibiotics (clarithromycin, metronidazole, amoxicillin, tetracycline, furazolidone, levofloxacin, etc.), Bismuth preparations.
With timely treatment for medical assistance and conduct a full circuit of H. pylori treatment the risk of complications of gastric ulcers is minimized. Emergency surgical treatment of gastric ulcer (hemostasis by clipping or stitching bleeding vessel, suturing of ulcer) is usually required only for patients with complicated disease: perforation or penetration of ulcers, bleeding ulcers, malignancy, stomach scar formation changes. In elderly patients with a history of gastric ulcer complications listed in the past, experts recommend to reduce the time of medical treatment up to one and a half months.
Absolute indications for surgery: perforation of the ulcer and malignancy, massive bleeding, scarring of the stomach in violation of its functions, the ulcer gastrojejunostomy. To conditionally absolute indications rank penetration ulcer, giant callous ulcers, recurrent stomach bleeding against the backdrop of ongoing conservative therapy, lack of repair ulcers after suturing. Relative reading - is the lack of apparent effect on drug therapy for 2-3 years.
For decades, surgeons discussed the effectiveness and safety of different types of surgery for stomach ulcers. To date, the most effective recognized gastrectomy, gastroenterostomy, various types of vagotomy. Excision and suturing the ulcer is applied only in extreme cases.
Prediction and prevention of peptic ulcerstomach.
The prognosis of gastric ulcer depends on timely access to medical care and the effectiveness of therapy of H. pylori. GU complicated gastric bleeding every fifth patient, from 5 to 15% of patients suffer perforation or penetration of ulcers, 2% of developing scar stenosis of the stomach. In children, the frequency of complications of gastric ulcer lower - no more than 4%. The likelihood of developing gastric cancer in patients with GU 3-6 times higher than among people not suffering from this disease.
Primary prevention of stomach ulcers includes a warning of H. pylori infection, exclusion of risk factors for this disease (smoking, crowded living conditions, low standard of living). Secondary prevention is aimed at relapse prevention and includes diet, stress elimination, the appointment of H. pylori drugs scheme when the first symptoms of GU. Patients with gastric ulcer require lifelong surveillance, endoscopy with compulsory tests for H. pylori once every six months.