The clinical symptoms

Leading symptom ulcer pain. Its distinctive features: the relationship with food intake, seasonality, reduction after vomiting, eating and alkalis, applying heat, holinoliticakih. Time after eating distinguish pain early (after 1/2-1 hour), late (2-5 hours, night and "hungry". The last decrease or disappear after a meal (sometimes at all); they are typical of duodenal ulcers. Seasonality pain (spring, autumn) so typical for peptic ulcer disease, that allows to distinguish it from other diseases. The periods of exacerbation of pain even without treatment, followed by periods of remission.

Fig. 1. Forced position of the patient in severe pain during exacerbation of ulcer disease.

Pain in the ulcers often on the median line of the abdomen between the xiphoid process and the navel. They can irrationality in the chest, left shoulder, in thoracic vertebrae of the spine. Sometimes during exacerbation of ulcer disease (with the powerful pain) patient takes a forced position (Fig. 1). Pain in the ulcers usually do not require the use of narcotic drugs.
The mechanism of pain in the ulcers associated with the spasm of the muscles, increase blood pressure, which are caused by disorders of the nervous regulation, acid fuelling motor function of the stomach and duodenum.
The second most common symptom ulcer disease is vomitingusually occur without prior nausea at the height of the pain and bring relief. Appetite ulcers saved and often reinforced. In the period of exacerbation observed constipation.
Objective research provides little data for uncomplicated peptic ulcer. In the period of exacerbation in some cases at a palpation can detect the right voltage direct abdominal muscles, pain in podlojecna area, positive symptom Mendel (pain effleurage in a limited area of the abdominal wall), "the sound of the lapping of the" right (symptom Vasilenko), indicating hypersecretion of gastric juice or on violation of evacuation function of the stomach.
Secretory function of the stomach significantly increased the localization of ulcers in the duodenum. At its localization in the stomach secretory function of stomach may be normal or decreased.
Motor function of the stomach in both locations ulcers raised, what explains these symptoms as nausea, vomiting, heartburn. Hidden bleeding detected in 50% of patients in the period of exacerbation.
Changes of blood in uncomplicated peptic ulcer disease do not occur. The decrease of hemoglobin level and the number of red blood cells is caused ulcer bleeding.
During periods of exacerbation of ulcer disease can be detected reversible changes in liver function. The long existence of ulcers in the duodenum may lead to the development of biliary dyskinesia, and further to the development of cholecystitis (see).
In periods of acute ulcers can disrupt the function of the pancreas.
General neurotic symptoms include irritability, unstable mood, the insomnia is often occupy a leading place in the patients with ulcer.
The clinical course there are peptic ulcer acute, chronic and atypical forms. Ulcers disease may be acute and end with scarring ulcers or complications (perforation, bleeding).
Typical chronic form of peptic ulcer disease characterized by a gradual beginning, increase in symptoms and recurrent course. The remission period lasts from several months to years, the period of exacerbation is 6-8 weeks.
Remission may occur without treatment. Atypical course of peptic ulcer due to several factors: change of the conditions of the external environment (ulcers wartime), some of age (youth and old age ulcers), features a floor (a kind of peptic ulcer disease in women), localization ulcers (ulcer pyloric canal and others).

Clinical presentation and course
Clinical manifestations of ulcerative disease is varied. Variability their associated with age, gender, and General health of the patient, the disease duration, frequency of exacerbations, localization of the ulcer, the presence of complications. Leading symptom ulcer pain. Its distinctive features: the relationship with food, its quality and quantity, seasonality, the growing nature, reduction after vomiting, meals (in the case of "hungry" pain), alkalis, applying heat, holinoliticakih.
At the time of their appearance after eating distinguish pain early (after 1/2-1.5 hours.), late (2-5 hours), night and "hungry". The last decrease or disappear after a meal (sometimes at all). The appearance of pain through different periods after eating many authors associated with the location of ulcers; the later, the pain, the closer to the gatekeeper or even behind it is the plague. "Hungry" pain is typical for the localization of ulcers in the duodenum. However, this characteristic is very conditional. Localization ulcers reliably set only by x-ray. Persistent pain is not typical of peptic ulcer disease and are usually associated with the development of complications (perivisceral, penetration).
Notes natural connection pain in the ulcers with the quality and quantity of food. Rich, spicy, sour, salty, rough food always causes intense pain.
The periodicity, seasonality pain (spring, autumn) is so typical of ulcer disease that distinguish it from other diseases. The periods of exacerbation of pain even without treatment, followed by periods of remission. In the initial stage of disease, the frequency of the pain is not clearly expressed. Then there is the growing pains. The reason for the recurrence of ulcers unclear; apparently, it is connected with seasonal changes in the General reactivity of the organism, barometric fluctuations, and in the spring, to some extent, can play a role and IMR.
With the exception of "hungry" pain calmed down after eating, pain in the ulcers reach the maximum power at the height of digestion. They are much easier, and sometimes completely stopped after vomiting that patients often called artificial. Not less than decreases, and the cessation of pain after bleeding, treatment with alkali.
Pain in the ulcers often on the middle line between the xiphoid process and the navel. On their localization is not always possible to judge about the location of ulcers. However, when ulcers stomach pain usually develop in podlojecna area above the navel, with ulcers duodenal ulcer - to the right of the middle line in the epigastric region, and ulcers cardia - xiphoid process. The radiation of pain is different and does not depend on the localization of ulcers. They can irrationality left nipple, sternum, the left shoulder and the breast section of the spine. At 1/4 of the patients have the radiation of pain in the lower back, buttock, simulating sciatica. The radiation of pain in the left half of the chest may be mistaken for angina. Pain in the ulcers usually do not require the use of narcotic drugs and decrease from applying heat and antispastic funds.

The pathogenesis of pain in the ulcers is unclear. The usual stimuli that cause the feeling of pain in effect on the skin, do not cause pain when exposed to the wall of the stomach and intestines. Adequate stimuli for these bodies are reinforced their muscle activity, especially spasm, increase in blood pressure (vnutriarterialno and stomach), which is caused by disturbance of nerve regulation. This explanation of the mechanism of pain makes clear the speed of their disappearance when conditions change, causing the nervous system. The origin of the pain in the ulcers should be taken into account and the value of acid factor affecting the motor activity of the stomach and duodenum, as well as modified on the mucous membrane of these bodies.
The second most common symptom ulcer disease is vomiting occurring without prior nausea at the height of pain, followed by relief. Vomit have a sour taste and smell; if vomiting occurred shortly after a meal, they contain the remains of the accepted food. Highlighting the active gastric juice fasting is often accompanied by vomiting. Morning vomiting remnants of food eaten the day before, reveal a violation evacuation function of the stomach. Vomiting in uncomplicated form of peptic ulcer disease occurs sporadically. When daily emerging vomiting should think about pilorospazm with hypersecretion, organic narrowing of the pyloric or penetration ulcers.
The third cardinal symptom ulcer disease previously thought bleeding - "no no bleeding ulcers" [Delfoi (G. Dieulafoy)]. This provision is now refuted. Explicit bleeding, manifested hematemesis (haematemesis or black stool (melaena), is a complication of peptic ulcer disease. Hidden bleeding, defined the laboratory examination of faeces, almost as a rule, are accompanied by periods of exacerbation of the disease, and during periods of remission are missing.
In addition to vomiting, dyspepsia ulcers often heartburn. There, she not only in the period of exacerbation of pain, but they may precede for many years and still have the same typical traits of that ulcer pain (periodicity, seasonality). Heartburn is connected, apparently, with impaired motor function of the esophagus and stomach, not secretory, as previously thought.
Belching occurs frequently and is associated with observed in some patients with peptic ulcer by aerophagia. Belching may be empty or sour, sometimes accompanied by regurgitation of large quantities of gastric juice. Regurgitation is more likely to occur at night in patients with abundant hypersecretion and salivation.
Appetite ulcers saved, sometimes even dramatically strengthened. Natural connection pain with food intake causes sometimes patients fear of food (sitophobia).
In most patients during exacerbations are constipation. They are caused by the nature of power, bed regime and mainly dyskinesia thin and thick intestines.