Peptic Ulcer
General description of the disease
Peptic ulcer of the stomach and duodenum is a chronic, progressive disease, in the formation of which play the role of disorders of the functional state of the gastroduodenal zone( stomach-duodenum), disorders of nervous, humoral, hormonal regulation contributing to general and local changes in trophism. The emergence and development of peptic ulcer is a complex process, in which the influence of environmental factors( such as mental overloads, improper regimen and feeding patterns, infections), immunoallergic mechanisms, iatrogenic factors( i.e., reactions arising as complications fromdrugs, such as acetylsalicylic acid, glucocorticoids, cytostatics), hereditary predisposition.
The long-term impact of negative factors( stress in the family, on education, disproportionate workload, various mental traumas) contributes to maladaptation of the child's body, which in turn inevitably leads to violations of the central and autonomic nervous system, which is most vulnerable in adolescent periods. As a result of the violation of the physiological relationships between the cortex and the subcortical formations of the brain, as well as the violation of the interrelations between the cerebral cortex and internal organs in the stomach and duodenum, various disorders can arise.
Prevalence of peptic ulcer
The prevalence of peptic ulcer among the populations of different countries is extremely high and averages 5%, fluctuating from 0.1 to 9%, with a trend in recent years to a rapid increase. The greatest prevalence of peptic ulcer is observed in males( approximately 2-3 times more often than women) at the age of 45 years.
The role of genetic factors in the development of peptic ulcer
The coefficient of heritability of ulcer disease without subdivision into forms, without regard to localization and age, and the onset of the disease is approximately 65%, which indicates a significant contribution of genetic factors to the determination of peptic ulcer.
The hypothesis of genetic heterogeneity of peptic ulcer is currently under discussion, according to which the disease is supposed to be a group of diseases with similar phenotypic manifestations, but due to various causes. This hypothesis is confirmed by works on the study of association of peptic ulcer with monogeneously-determined markers. Also, one should not forget that one of the most important reasons determining the development of peptic ulcer is the infection of the patient N. Pylori.
Comparison of the prevalence of duodenal ulcer among relatives of patients and in the control group showed that the incidence of the disease among relatives of the first degree of kinship is 9.5%( in the control group - 1.7%), grade II - 2.9%( in the controlgroup - 0.5%) and III degree - 1.4%( in the control group - 0.22%).These data support the multifactorial hypothesis of peptic ulcer disease.
Comparison of the prevalence of peptic ulcer among relatives of patients and, first of all, studies on twins confirm the hypothesis of multifactorial inheritance of peptic ulcer.
The clinical and genetic analysis of the family form of peptic ulcer confirms the judgments about the heterogeneity of peptic ulcer within its adult form. Juvenile duodenal ulcer is the most severe form not only in clinical manifestations, but also in the degree of its hereditary burden. Accumulation of repeated cases in families not only increases the repeated risk of ulcer disease, but also increases the course of the disease itself. Known features of the disease in the parent predict the individual course of the disease in the child.
Associations between diseases of the gastrointestinal tract and marker signs were studied most fully on the example of blood groups of the ABO system. Among patients with 0( I) blood group, duodenal ulcer occurs 30-40% more frequently than among people with another blood group. There were no significant differences in persons with Rh + and Rh-groups. In patients with localization of the ulcerative process in the duodenum with membership in the blood group 0( I), there was no increase in complications of peptic ulcer. However, it is shown that in individuals with a blood group of 0( 1), the risk of developing duodenal ulcer increases with a decrease in the concentration of hydrochloric acid in gastric juice.
Thus, at present two hypotheses can explain the distribution of patients observed in families of probands with peptic ulcer. The first, more common, suggests a joint, "multifactorial" influence of hereditary and environmental factors on the development of peptic ulcer as a genetic single disease with a wide range of phenotypic manifestations. Another, later and not excluding the first hypothesis, the concept of the existence of various causes in the determination of a number of separate, nosologically independent forms of peptic ulcer having a common phenotypic manifestation, has not been confirmed in twin studies. Therefore, to solve the problem of genetic heterogeneity of this pathology, additional studies are needed.
Clinic and diagnosis of peptic ulcer
The leading complaint for peptic ulcer is pain. The severity of the pain symptom is different depending on the age, individual characteristics, the state of the nervous and endocrine systems of the patient, the anatomical features of the ulcerative defect, the degree of manifestation of functional disorders of the gastroduodenal zone. More often the pains are localized over the navel or around the navel. At the beginning of the disease, the pain is of an uncertain nature, then it becomes permanent, more intense, has a nocturnal and / or "hungry" character. Dyspeptic disorders( vomiting, nausea) in children are less common and less pronounced than in adults. Even more rarely are heartburn, eructations and excessive salivation. Appetite is not disturbed in most patients, but in some cases it decreases, with a delay in physical development. With peptic ulcer, emotional lability is typical, sleep is disturbed due to significant pain sensations. There is increased fatigue, may develop asthenic condition. There is a tendency to constipation or unstable stool. There are signs of dysfunction of the autonomic nervous system, manifested in the form of local hyperhidrosis( local increase in sweating), arterial hypotension, bradycardia, headaches. Typical signs of the disease are lagging of the tongue and soreness in the characteristic zones( pyloroduodenal region, sometimes in the right hypochondrium), which is determined by palpation( palpation) of the abdomen.
The so-called symptom of muscular protection( tension of abdominal muscles) is observed in children relatively rarely, more often during severe pain attacks. Secretory function of the stomach in more than half of children with peptic ulcer is characterized by an increase in the volume of secretion, acidity of the gastric juice, increased activity of pepsin, etc. Normal and decreased acidity of gastric juice is observed less often than high. After treatment, the pain disappears, the secretory function is normalized. Hyper secretion( increased secretion) usually disappears somewhat earlier than hyperchlorhydria( increased production of hydrochloric acid).With bleeding from the ulcer, a positive reaction appears when examining feces for latent blood.
Evidence of peptic ulcer disease is the detection of a ulcerative defect in fibro-gastroduodenoscopy, as well as the identification of a niche, convergence of folds, and cicatrical deformity of the organ during X-ray examination. The diagnosis of peptic ulcer is based on clinical data, as well as data of anamnesis and instrumental methods( such as endoscopic, radiology, gastric sounding, pH-metry, etc.).
Treatment and prevention of peptic ulcer
Treatment of the disease should be comprehensive, taking into account individual mechanisms of the disease. Treatment should be carried out in the acute phase in a hospital with a bed or half-bed regime for 2-3 weeks. Persons suffering from peptic ulcer disease should be in a state of complete physical and mental rest. The most important is the therapeutic diet. The basis of dietotherapy is the principle of maximum chemical and mechanical shining, the elimination of thermal irritation, sufficient caloric content, the optimal content of all food ingredients, taking into account their balance and age requirements of the growing body of the child. Food should be fractional, frequent, small portions. Non-pharmacological methods of treatment of peptic ulcer include psychotherapy, reflexotherapy, laser treatment of gastroduodenal ulcers, and physiotherapy. From drugs use anticholinergics, antagonists of H2-receptor histamine( cimetidine);gastrointestinal drugs that increase the resistance of the mucous membrane, enveloping agents, antacids;metoclopramide( cerulek, raglan), psychotropic drugs, antidepressants;local treatment of ulcers( rose hips oil, sea buckthorn).
Prevention of peptic ulcer disease consists in the proper organization of daily routine, diet, treatment courses for the prevention of exacerbations( diet, antacids, sedatives, vitamins, phytotherapy) are required.