Gastric ulcer: symptoms and manifestation

Peptic ulcer - the formation on the inner surface of the stomach of a poorly healing defect, the size of which can reach three cm or more. It is characterized by a relapsing course. Exacerbations occur in the fall and spring, usually when the patient does not follow the treatment regimen. Symptoms and manifestations of gastric ulcers directly depend on the size of the pathological focus and the presence of concomitant diseases.

Gastric ulcer: causes

Normally, the human stomach is constantly exposed to aggression factors, such as hydrochloric acid contained in the gastric juice, the effects of digestive enzymes, a change in the rate of food evacuation, and trauma to the mucous membrane with solid particles of products. In some cases, bile reflux into the stomach is possible (gastroduodenal sphincter failure), which can also be considered an aggression factor.

The negative impact of the above factors is fully compensated. The tissues of the stomach are protected by mucus, which does not allow aggressive media to contact the mucous membrane. The mucosa itself has certain structural features (including an extensive capillary network), which accelerate its regeneration when damaged by acids and digestive enzymes.

The development of peptic ulcer is based on the imbalance between pathogenetic and protective factors.

This may occur under the following circumstances:

• psychological distress;
• hereditary predisposition (0 (I) blood type):
• tobacco smoking;
• the use of strong coffee;
• the use of strong alcohol in large quantities;
• male gender;
• violation of the diet (food "dry food", quick snacks on the go, prolonged fasting);
• chronic gastritis;
• prolonged use of drugs such as hormones, NSAIDs, reserpine.

Another factor in the development of a peptic ulcer is considered pyloric bacteria, leading to increased aggressiveness of the gastric juice and weakening of the protective properties of the mucous membrane. Moreover, in the scientific world, disputes regarding how important these microorganisms play in the pathogenetic process still do not subside.

Note: according to official studies, bacteria of the Helicobacter pylori type are found in the pathological focus in 85% of patients suffering from gastric ulcers and in 90% of patients with duodenal ulcer.

Disease classification

The classification of gastric ulcer in accordance with ICD-10 is made according to the nature of its course and the presence of certain complications (bleeding, perforation). The common pathology code is K-25. There are also a number of separate classifications based on the presence of certain characteristics:

Gastric ulcer classification table

When making a clinical diagnosis, it is not necessary to use all types of classification. As a rule, a record in the medical history affects the localization, phase and course of the pathological process. When conducting an appropriate study, information on the presence or absence of HP is indicated.

Symptoms and signs of a stomach ulcer

The main signs of a stomach ulcer are composed of two syndromes: pain and dyspeptic. Pain syndrome occurs with an exacerbation of the disease. Sensations are localized in the upper abdomen, epigastric and epigastric regions. In the absence of complications in half of the patients, the pain is mild, in a third of patients the syndrome is pronounced. The remaining number of people suffering from an ulcer experience moderate-intensity pain, aggravated after exercise or dietary errors. A decrease in pain is achieved by taking antisecretory drugs (omez, ranitidine, famotidine).

Dyspeptic syndrome is expressed in the form of the following symptom complex:

• nausea;
• vomiting, which brings relief and arises at the height of pain;
• persistent heartburn, developing 1.5-3 hours after eating;
• bloating;
• constipation
• burping.

It should be remembered that the complete clinical picture does not develop in all patients. So, reflux of gastric contents into the esophagus is noted in 80% of patients, diarrhea occurs no more often than in 30-40% of cases. All the above symptoms simultaneously occur only in the first days of exacerbation.

Diagnostics

The diagnosis is made on the basis of the clinical picture and invasive examination methods. In the presence of the described signs of the disease, the doctor prescribes fibrogastroduodenoscopy and tissue biopsy of the pathological focus. Using these methods, the depth and transverse dimensions of the ulcer are studied, and the fact of its bacterial contamination is established.

Fibrogastroduodenoscopy is a research method based on the introduction of a gastroscope into the stomach and duodenum with a lamp and a video camera installed at the end.The procedure allows you to visually examine the pathological lesion, take a tissue sampling (biography) for examination for the presence of microflora, and make hemostasis if the patient shows signs of bleeding.

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Laboratory diagnostics are not critical. It is auxiliary in nature. In the study of blood in patients with uncomplicated ulcers, there is a slight increase in the level of hemoglobin and red blood cells, a slight lymphocytosis. The study of gastric juice allows you to establish the fact of an increase or decrease in its acidity. The number of both pathology variants occurs with the same frequency.

Stages of peptic ulcer

As mentioned above, peptic ulcer can have three stages of the course: exacerbation, incomplete remission and complete remission. With a favorable course, exacerbation and remission alternate among themselves throughout the patient's life. However, in some cases, the course of the disease may vary.

Read also:duodenal ulcer: symptoms and treatment

An ulcer without complications

With an uncomplicated ulcer, its external manifestations may be absent from several months to several years. The latter option is the most favorable for the patient, but in most cases the disease worsens 1-2 times a year (autumn and spring). The duration of the considered stage is 3-5 weeks with proper treatment and 4-8 weeks without the necessary therapy.

Note: the asymptomatic form of peptic ulcer is known, which proceeds against the background of the complete absence of significant clinical signs. During the life of a patient, an ulcer is not diagnosed in approximately 24% of cases.

The manifestation of a complicated form

Among the complications of peptic ulcer include:

• perforation;
• penetration;
• perivisceritis;
• malignancy;
• pyloric stenosis;
• bleeding.

A perforated ulcer (perforated) is characterized by a rapid increase in pain to an unbearable level. In the absence of surgical care, peritonitis develops within a few hours. Bleeding leads to vomiting of "coffee grounds" (blood converted to hematin hydrochloride) and stools of the melena type (black tar-like stool).

The symptoms of penetration are usually limited to some increase in pain, which rarely leads the doctor to think about a defect. Signs of perivisciritis are due to the function and features of the innervation of the affected organ. The pyloric stenosis leads to vomiting of food eaten the day before, and the appearance of belching with the smell of a rotten egg. A malignant ulcer does not have specific symptoms.

Third stage: special forms of course

The third stage of the disease is the stage of remission. In the classical course of the disease, the patient completely lacks its clinical signs. However, there are special forms of pathology when the symptoms do not completely disappear even at the remission stage. These include pyloric and extra-bulbous ulcers, as well as multiple foci of pathology and lesions larger than 30 mm (giant ulcers).

Perforated gastric ulcer

A perforated ulcer is the most frequent and severe complication of the disease in question. Its essence is through damage to the wall of the stomach and the ingestion of gastric contents into the abdominal cavity. The result of this is toxic-chemical peritonitis (acute inflammation of the peritoneum - the membrane lining the abdominal cavity). In addition, perforation is usually accompanied by damage to blood vessels and heavy bleeding, which puts the patient at risk of developing hemorrhagic shock.

The treatment of perforated ulcers is the lot of surgeons. Therapeutic techniques do not save the patient's life. Therefore, in the event of sharp abdominal pain in a patient suffering from peptic ulcer, he should be immediately transported to a specialized medical institution.The use of folk and therapeutic methods of correcting the condition in such situations is unacceptable.

Diet for the disease

Diet for gastric ulcer depends on the stage of the course of the disease. In the first days of exacerbation (1-10 days), table No. 1a is used, from day 10 to day 20, diet No. 16 should be used. Further, the patient can eat in accordance with the general principles of sparing nutrition.

In general, a stomach ulcer is a manageable disease. With timely medical care, it does not pose a direct threat to the life of the patient. That is why patients and their relatives should know what signs indicate the development of exacerbations or complications of the pathological process, as well as what errors in nutrition can cause them. If the first symptoms of worsening occur, you should seek help from a doctor.