Etiology and pathogenesis of peptic ulcer of the stomach and duodenum

Peptic ulcer occurs under the influence of various causes and predisposing factors. Peptic ulcer can develop with significant deviations in the rhythm and quality of nutrition, contributing to a violation of the neurohumoral regulation of the function of the alimentary canal and its trophism. The digestion of the mucosa and other membranes is facilitated by the observed increase in the secretory-pepsic activity of the digestive juices and a decrease in the stability of the mucous protective barrier, which depends on the peculiarities of the peristalsis of the stomach and duodenum, their vascularization , insufficient synthesis of prostaglandins E and low adrenal cortex activity with resulting epileptic regenerative cells. It should be borne in mind that neurohumoral regulatory disorders can worsen and even occur primarily against the background of negative emotions, allergies, and the protective properties of the mucous barrier decrease when certain drugs are used (acetylsalicylic acid, butadione , steroid hormones, etc.).
A certain role in the implementation of the ulcerative process can play constitutional and hereditary factors. It is enough to indicate that diseases of the alimentary canal, and first of all peptic ulcer disease, were observed in parents of more than half (68.7%) of the examined sick children.
The size and depth of ulcerative defects of the stomach and duodenum can be different: in some cases, their healing is accompanied by the formation of gross scars, deformation and narrowing of the lumen of the organ.

Clinic of peptic ulcer of the stomach and duodenum

Despite the usually gradual unfolding of the clinical picture of peptic ulcer disease and the extreme rarity of the sudden appearance among its full health of its formidable symptoms and complications (perforation, massive bleeding, etc.), the correct diagnosis is often made late. A significant part of sick children for a long time (sometimes years) is observed due to biliary dyskinesia, hepatocholecystitis , chronic gastritis, falsely mistaken for the underlying disease. This is primarily due to the lack of awareness of pediatricians about the features of the clinic and the patterns of the course of peptic ulcer in childhood.
The first signs of peptic ulcer in children and its exacerbation usually occur in spring and autumn. The most striking and constant symptom of the disease is abdominal pain: usually intense, having a paroxysmal character, localized in the epigastric region, less often in the umbilical region and clearly associated with food intake. With the localization of ulcers in the stomach, pain often occurs shortly after eating; A duodenal ulcer is characterized by the Moynitan formula for the rhythm of pain (hunger – pain – eating – relief – hunger – pain). A thorough analysis of the internal picture of the disease reveals just such a sequence of pain development in most patients, including the smallest. Ng should also forget about the diagnostic significance of attacks of abdominal pain in connection with emotional stress, increased physical exertion. Neglect of these complaints in some cases leads to a late diagnosis of the disease.
The next group of symptoms of peptic ulcer is a characteristic dyspeptic syndrome. In many ways, it is similar to that described in chronic superacid gastritis. This is due to a clear increase in the secretion and acidity of gastric juice in most children with peptic ulcer. Patients very often experience nausea and especially vomiting, followed by temporary relief and relief of pain . Heartburn and belching are somewhat less common. A significant decrease in appetite is rare and is combined with a reduced active acidity of the gastric juice. Inclination to constipation is one of the most common symptoms and pathogenetic factors of peptic ulcer disease, further exacerbating the violation of the function of the alimentary canal. An attempt to link the occurrence of constipation with the use of an appropriate antiulcer diet seems insufficiently justified, since it often persists even after exacerbation with a sufficiently wide or completely unlimited diet.
A significant part of sick children is characterized by an unbalanced nature, increased excitability, emotional instability, the presence of signs of dystopia of the autonomic part of the sympathetic nervous system (sweating, rapidly occurring persistent red dermographism, etc.). Some children, especially those in family conditions, where excessive anxiety about the state of health is manifested, develop suspiciousness, constant depressed mood, and “going into illness”.
Peptic ulcer of the stomach and duodenum almost never affects the growth of children. Noticeable emaciation is observed only in individual patients during the period of exacerbation with severe pain and sleep disturbances.
An objective study usually draws attention to the intense texture of the tongue. In some cases, during an exacerbation, slight bloating is noted. The area of ​​pain in the epigastric region to the right of the midline is often determined only with deep palpation. One of the most persistent symptoms is soreness in this area when striking with a bent finger (Mendel symptom). Some patients have an enlarged liver, soreness in the gallbladder, which sometimes gives rise to incorrect diagnosis and late detection of peptic ulcer.
The state of the secretory function of the stomach is characterized by an increase in a significant number of patients with active acidity of gastric juice, debit hour of free hydrochloric acid and pepsin not only at the height of digestion, but also on an empty stomach (basal secretion); the release of uropepsinogen is equally increased . Unlike adults, this applies not only to patients with duodenal, but also to the gastric location of the ulcer.
After an exacerbation, pain and dyspeptic symptoms gradually decrease and completely disappear. As for secretory changes, they do not disappear in all cases, which emphasizes the need for constant observance by convalescents of the proper general and nutritional regimen.
During X-ray examination, in addition to the “niche”, which is a direct sign of peptic ulcer, indirect radiological symptoms are observed – fasting hypersecretion, deformation of the duodenal bulb, symptom of “irritated bulb” (its immediate emptying from barium sulfate), etc. In some cases, ulcers can be detected to prevent spasm, inflammatory swelling of the gastric mucosa, significant mucus layering, etc. An endoscopic method for diagnosing peptic ulcer disease is a highly informative one. examination of the stomach and duodenum.

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