Peptic ulcer disease
General characteristics of the disease
stomach ulcer and duodenal ulcer - chronic, prone to progression of the disease, in the formation of which play the role of disorders of the functional state of the gastroduodenal zone (stomach - duodenum), nervous disorders, humoral, hormonal regulation, promoting commonand local changes trophism.The emergence and development of peptic ulcer disease is a complex process, in which a large part also belongs to the effects of environmental factors (such as mental overload, wrong mode and diet, infections), immunoallergic mechanisms, iatrogenic factors (ie. E. The reactions occurring as a complication ofdrugs such as acetylsalicylic acid, glucocorticoids, cytostatics), hereditary predisposition.
Prolonged exposure to negative factors (stress in the family, at school, learning a disproportionate burden, various trauma) contributes to child maladjustment of the organism, which in turn inevitably leads to dysfunction of the central and autonomic nervous system, which
prevalence of peptic ulcer
prevalence of peptic ulcer disease among people of different countries is extremely high, averaging 5%, ranging from 0.1 to 9%, with the trend in recent years to a rapid increase.The highest prevalence of peptic ulcer disease is observed in males (approximately 2-3 times more often than women), aged 45 years.
role of genetic factors in the development of peptic ulcer
heritability coefficient of peptic ulcer without subdividing into shape, without taking into account the location and age, as well as the onset of the disease is approximately 65%, which indicates a considerable contribution of genetic factors in the determination of a peptic ulcer.
is currently being debated hypothesis of genetic heterogeneity of peptic ulcer disease, whereby the disease is supposed group of diseases with similar phenotypic manifestations, but due to various reasons.This hypothesis is confirmed by the work on the study of the association with peptic ulcer disease, monogenic deterministic markers.Also we should not forget that one of the most important factors determining the development of peptic ulcer disease, is an infection with H. Pylori patient.
Comparison of the prevalence of duodenal ulcer disease among relatives of patients in the control group showed that the incidence of the disease among relatives of I degree of kinship equal to 9.5% (in the control group - 1,7%), II degree - 2.9% (incontrol group - 0.5%) and III degree - 1.4% (control group - 0.22%).These data support the hypothesis of multifactorial peptic ulcer.
Comparison of the prevalence of peptic ulcer disease among relatives of patients and primarily studies on twins support the hypothesis of multifactorial inheritance of a peptic ulcer.
conducted clinical and genetic analysis of familial form of peptic ulcer judgment confirms the heterogeneity of peptic ulcer disease within its adult form.Youth duodenal ulcer is the most severe form of not only clinical symptoms, but also on the extent of its hereditary otyagoshennosti.The accumulation of repetitive cases in families not only increases the risk of re-occurrence of peptic ulcer disease, but also complicates the course of the disease.Notable features of the disease in parents predict an individual for a child's illness.
association between gastrointestinal disease and marker signs examined more fully by the example of blood groups AB0 system.Among patients with 0 (I) blood group duodenal ulcer occurs in 30-40% more often than among people with other blood types.There were no significant differences in patients with Rh + and Rh- groups were observed.Patients with ulcerative process localization in the duodenum with belonging to blood group 0 (I) was not observed increased frequency of complications of peptic ulcer disease.However, it is shown that in people with blood group 0 (1) the risk of developing duodenal ulcer is increased by reducing the concentration of hydrochloric acid in gastric juice.
Thus, at present two hypotheses may explain the observed in families of probands with peptic ulcer patients distribution.The first, more common, involves the joint, "multifactorial" the influence of hereditary and environmental factors on the development of peptic ulcer disease as a common genetic disease with a wide range of phenotypic manifestations.Another, more recent, and does not exclude the first hypothesis, the concept of the existence of various reasons in the determination of a number of separate, independent forms nosologically ulcer disease with a common phenotypic expression, was not confirmed in twin studies.Therefore, to address the issue of genetic heterogeneity of this disease more research is needed.
Clinic and diagnosis of peptic ulcer
leading complaint at a peptic ulcer is pain.Intensity of pain symptoms varies depending on age, individual differences, state of the nervous and endocrine systems of the patient, the anatomical features of the ulcer, severity of functional disorders of the gastroduodenal zone.Most localized pain above the navel or around the navel.At the beginning of the pain of the disease is uncertain, then it becomes a constant, more intense, is night and (or) "hungry" character.Dyspeptic disorders (nausea, vomiting) in children are less frequent and less pronounced than in adults.Even rarer are heartburn, belching, and excessive salivation.Appetite for most patients is not affected, but in some cases it is reduced, while noting the delay in physical development.If a peptic ulcer is typical emotional lability, sleep disturbances due to significant pain.There is fatigue, can develop asthenic condition.There tendency to constipation or unstable chair.There are signs of dysfunction of the autonomic nervous system, manifested in the form of a local hyperhidrosis (local increase sweating), hypotension, bradycardia, headaches.Typical symptoms of the disease are coated tongue and determined by palpation (feeling) abdominal tenderness in specific areas (piloroduodenalnoy area, sometimes in the right upper quadrant).
so-called protection of muscle symptoms (tension of the abdominal muscles), there is relatively rare in children, often during severe pain attacks.The secretory function of the stomach more than half of children with peptic ulcer disease is characterized by the increase in secretion of gastric acid, increasing the activity of pepsin and others. Normal and reduced gastric acidity is less common than high.After treatment, the pain disappeared, normal secretory function.Hypersecretion (increased secretion) usually disappears earlier than hyperchlorhydria (increased production of hydrochloric acid).When bleeding from the ulcer is a positive reaction in fecal occult blood.
confirmation of peptic ulcer disease are ulcerative defect detection fibrogastroduodenoscopy, and identifying niche convergence folds, scar body deformation in X-ray examination.The diagnosis of peptic ulcer disease is made on clinical data, as well as the history and instrumental methods (such as endoscopic, radiological studies, gastric intubation, pH-meter and so on.).
Treatment and prevention of peptic ulcer disease
Treatment should be comprehensive, taking into account the individual mechanisms of the disease.Treatment should be carried out in the acute phase in a hospital bed, or in compliance with polupostelnogo mode for 2-3 weeks.Persons suffering from peptic ulcer disease, should be in a state of complete physical and mental rest.The leading role is health food.The basis of the diet therapy based on the principle of maximum chemical and mechanical schazheniya, excluding thermal stimulation, sufficient caloric content, the optimal content of all food ingredients based on their age and balance the needs of the growing child's body.Meals should be fractional, frequent, small meals.For non-drug methods of treatment of peptic ulcer disease include psychotherapy, reflexology, laser treatments gastroluodenalnyh ulcers, physiotherapy.Of the drugs used anticholinergics, H2 receptor antagonists of histamine (cimetidine);gastrotropnye drugs that enhance mucosal resistance, coating agents, antacids;metoclopramide (Reglan, Raglan), psychotropic drugs, antidepressants;local treatment of ulcers (rosehip oil, sea buckthorn).
Prevention of peptic ulcer disease is the proper organization of the daily routine, diet, holding treatment courses for the prevention of exacerbations (required diet, antacids, sedatives, vitamins, herbal medicine).