Clinical symptoms of uncomplicated forms of stomach ulcers

Anamnesis. Perhaps in no other disease of the digestive system history does not play such a large role, as ulcers. Among the complaints of the patient leading place pain, which differ by a number of features. In order to evaluate all their originality, it is necessary first of all to focus on the mechanism of their origin.
The threshold of pain sensitivity may vary from one and the same patient, depending on his individual personality traits and external conditions.
You need to identify three main factors that determine the occurrence of pain in the ulcers: increased muscle tone gastroduodenal zone, increased blood pressure and spastic state of this section of the digestive system (C. B. korostovtsev, 1950; M. A. Cherkassky, 1951; A. I. the Gubergrits, 1968; Patterson, Landweiss, 1942). All these changes are the result of neuromuscular dysfunction that occurs in the stomach and duodenum as a result of violations of the nervous regulation. According to A. Ya. of Gubergrits (1968), causes smooth muscles of gastroduodenal system is the leading cause of pain. It can develop under the influence of strong impulses coming from the center of the vagus nerve, and reflex by other pathologically changed internal organs (pancreas, gall bladder and others).
It is impossible not to face the facts and totally rejecting the role of gastric hypersecretion in causing pain. Permanent increase of level of hydrochloric acid in the gastric lumen may be the cause of persistent regional spasms in the gastro-duodenal zone. In addition, swelling and inflammation of the mucous membrane around the ulcer may facilitate the penetration of hydrogen ions in the deep layers of the gastric wall, where the end of the spinal nerves. Thus the threshold of pain sensitivity may decline sharply, which facilitates the emergence of pain.
The pain is most often localized on the middle line between the xiphoid process and the navel. Some researchers still hold the view that stomach ulcers are accompanied by pain in the upper part of epigastria, left of the middle line, and ulcers duodenal ulcer - somewhat to the right of midfield. However, this distinction is conditional and is not significant.
Pain in the ulcers can irrationality. So, if the ulcer is the lesser curvature of the stomach, they can irrationality up and to the left, to the left half of the chest, with enough intensity of pain can lead to erroneous conclusions about the presence of angina. Pain when anthrax piloroduodenalnoy zone can irrationality in the back, chest, in the right hypochondrium, and under the shoulder blade. Pain ulcers body of the stomach, usually not iradionet.
Three features characterise the pain in this disease: the frequency of appearance, especially the rhythm, the nature and intensity.
The most important diagnostic attribute of the ulcer is the frequency of pain, which is the alternation of the periods of exacerbation in the weeks and remission for several months and even years. Then a new cycle of pain, alternating bright interval, and so on Periods of remission in the beginning are long, and later becoming shorter and shorter. This cyclical nature of peptic ulcer is a very significant and typical for this disease.
Acting Neimark (1969) describes some less common clinical variants of pain. The pain in his opinion, can be sometimes associated with the movement and physical stress, nervous and emotional tension. In some patients, pain occurs at a certain time of day, usually in the second half of the day, without any connection with the meal. Meet and pain standing type, not leaving the patient for several days or weeks, and then suddenly disappears. Some patients cramping pains are nature, reminiscent of colic, growing in intensity, last from 10 to 30 minutes and quickly cease.
The notion of periodicity of pain are observed not always and not all patients with peptic ulcer of seasonal aggravation. It is established the predominance of the spring-autumn of exacerbations. However, A. Ya. the Gubergrits notes that in the postwar years, especially in patients with duodenal ulcer, acute usually occur in late autumn, winter, early spring and relatively rare in the warm months of the year. At the same time, M. F. Sarkis (1965) was observed in more than 60% of cases of exacerbation of ulcers stomach summer. The reason seasonal exacerbations remains unclear. Perhaps have value varies during the year, the severity of neuro-hormonal disorders, barometric fluctuations and other factors.
Another characteristic feature of pain in the ulcers is a certain rhythm in their appearance and disappearance, are clearly associated with the reception and the nature of food. Moynihan (1912) paid attention to the existence of rhythm pain in uncomplicated form of peptic ulcer. In the case of duodenal ulcers alternation of pain occurred in the following order: hunger - pain - food - relief - hunger - pain, and so on, in other words, pain when eating replaced with relief, and then again in 1.5-4 hours. Therefore, frequent small meals can break this rhythm. When gastric ulcer is the rhythm of pain slightly different, namely: food - relief - pain - relief and so on, in Other words, eating brings relief for 30 minutes to 1.5 hours, after which the pain, ceasing only when happen gastric emptying. The severity of the pain stomach ulcers, to some extent depends on the amount of the accepted food. Obviously, these pains due to inadequate stretching of the stomach and increase intracavitary pressure. When duodenal ulcer often there are "hungry" and a night of pain.
According to the observations of the So-called. Cage (1967), in combination with ulcers with morphologically proven chronic gastritis pain can lose characteristic rhythm, to become permanent, or "early", in 10-15 minutes after eating, with a tendency to further strengthening through 1-1 .5 hours (the so-called two-pain). When the plague of the body of the stomach, accompanied by chronic duodenitis, installed when aspiration biopsy, pain may resemble those with duodenal ulcer. At last localization and chronic duodenitis night pains are particularly intense.
Thus, some deviations from the classical rhythm Moynihan can be caused by various morphological changes of the mucous membranes of the gastro-duodenal zone.
When combined, double localizations ulcers in the stomach and the duodenum is normally persists rhythm characteristic of the last localization.
Night and hungry pain, usually combined with a large hypersecretion, easily avoided by taking small amounts of food (biscuits, cake, a few SIPS of milk), and also by taking antacids.
Pain in the ulcers may have cutting, pricking, burning in nature, are rarely cramping. In different individuals, the nature and intensity of the pain varies substantially. Ulcers of the lesser curvature of the stomach differ less intense pain than cardiac and pyloro-duodenal ulcer. In the first group of pain tend to be blunt, the second one are paroxysmal character, and they are characterized by great urgency. Depth ulcer crater to some extent determines the intensity of pain. Superficial ulcers may not cause pain, while deep penetrating ulcers with the defeat of the serous membranes combined with intensive severe pain. The sharp increase in the intensity of the latter is a sign of complicated ulcers (reperforation state, cover perforation, perigastric and others).
It is necessary to remember about the existence of painless, "dumb" forms of this disease, which, according to Smith and others (1953), make up 6 to 17%, and the autopsy materials of 39.8% (!).


Other symptoms. Along with the pain, many patients with uncomplicated form of peptic ulcer disease has a number of dyspepsia symptoms, namely, heartburn, vomiting, nausea and belching.
Heartburn is the sensation of the intermittent and undulating burning sensation in the lower third of the sternum. This symptom is the most common and unpleasant companion ulcer disease, which occurs in the early stages of the disease, often precedes the appearance of pain. The peculiarity of heartburn ulcers serves as its rhythmic in nature. Heartburn may occur immediately after a meal or 2-3 hours after eating, sometimes it is the equivalent of pain. Often heartburn occurs when the change in body position during sleep. Painful persistent heartburn make patients in "Solomonov"resorting many times during the day for the reception of soda.
The mechanism of occurrence of heartburn complicated. First thought heartburn associated with excessively high acidity gastric content, which will regurgitate in the lower esophagus. However, this feeling arises and when ahlorgidrii (Century, Khlystov, 1947; Jones, 1961; Bockus, 1963). Apparently, on the one hand, there reflux of gastric contents into the esophagus due to reduced cardiac sphincter. In the occurrence of heartburn is of some significance esophagitis, which, according to Goldman and others (1967), found in 58% of patients. On the other hand, no less importance is the pathological discoordinated motor activity of the esophagus with the occurrence of periodic spastic contractions of its lower section.
Recently N. A. Yushchenko (1971) using radio telemetry traced a direct relationship the feeling of heartburn from throwing acid contents of the stomach into the esophagus. Along with this, if ezofagoskopia there were signs of esophagitis.
Nausea, vomiting, belching. These symptoms occur less frequently in patients with peptic ulcer. Nausea usually precedes vomiting, and both symptom of a more specific for stomach ulcers, especially located in the antrum.
Vomiting often occurs through 1-4 hours after eating, it is on an altitude of pain and the patient brings relief. Therefore, some patients artificially induce vomiting.
When duodenal ulcer vomit contain no residue that is composed of acidic gastric juice with significant admixture of saliva. Sometimes in most of these cases are the usual night vomiting.
In the mechanism of such vomiting primary importance is the increased tone of the vagus nerve, leading to abrupt breakdown of gastric secretion and motor skills, as well as abundant salivation. The latter is common and often in the absence of vomiting, especially at night.
Acting Neimark (1969) set aside the so-called diarrhoeal form of peptic ulcer disease in which the dominant complaints are heartburn and vomiting.
With a stomach ulcer, vomiting often occurs almost immediately after a meal consists of food residues and may be caused by transient nasal mucous sores around or spasm privratnika. With a concomitant chronic gastritis vomiting can be combined with other symptoms, decrease in appetite, a feeling of gravity in epigastria after eating, belching and nausea.
Ulcers can occur belching acid, food and air (empty burp). Some patients suffer from aerophagia. Acid burp is often combined with heartburn. When a large gastric hypersecretion night is a regurgitation of significant quantities of acidic content. The mechanism burps and acid reflux similar.
The appetite. Appetite in patients with uncomplicated form of peptic ulcer disease not only maintained, but even increased. One must distinguish sitofabio that caused by fear of pain after eating.
The preservation of appetite is more frequent in the patients with duodenal ulcer, in cases of stomach ulcers, combined with chronic gastritis, appetite may be reduced.
Intestinal symptoms. Many patients with duodenal ulcer observed constipation with no chair in 3-5 days or with a chair as dense lumps type "sheep" Kala.
Sometimes constipation are accompanied by pain, spastic nature around the abdomen. Constipation increase in the phase of deterioration, but continue in the period of remission.
The occurrence of intestinal symptoms due to neuromuscular dyskinesia of large intestine vagal origin. To some extent, constipation contributes to the composition of the food products included in the anti-ulcer diet, and limiting physical activity in the phase of deterioration.