Cinical features

The leading symptom of peptic ulcer is abdominal pain. In peptic ulcer the pain is localized in epigastric region, may radiate to the back and is of variable quality: gnawing, burning, boring, or hunger like. The pain is intermittent, last from a few minutes to many hours, be worse when your stomach is empty. Food, antacids or other antisecretory drugs often bring relief. The seasonal character of pain is very typical of peptic ulcer disease.

In patients with peptic ulcer the main complaints are abdominal pain and displays of dyspeptic syndrome. Heartburn, vomiting, belching, regurgitation, and salivation are frequent symptoms. Vomiting relieves pain of gastric ulcer and some patients force themselves to vomit after eating to relieve symptoms. Heartburn is a specific burning sensation behind the sternum, associated with regurgitation of gastric contens into the inferior portion of lie esophagus. The mechanism of heartburn is associated with motor dysfunction of the esophagus (in addition to the acid fact of the gastric contents, which was formerly believed to be decisive). Appetite is often increased. The intestinal symptoms of peptic ulcer disease are constipations, which are closely connected with the character of nutrition and bed-rest during exacerbations, and are mainly connected with reflex dyskinesia of the intestine.

Objective examination. General patient's condition is usually from moderate grave to extremely grave. The consciousness is clear, the posture usually active or may be forced in cause of complications development. The color of the skin and visible mucosa has corporeal color. With disease progression and prolonged duration may occurs pale color and loss of weight. The tongue is usually clean. The data of inspection, palpation, percussion and auscultation of respiratory and cardiovascular systems are without peculiarities.

In superficial tentative oriental palpation and percussion of the abdomen may be distinguish pain in epigastrium and umbilical regions with local muscular resistance.

Additional methods of examination

Endoscopy (fibroesophagogastroduodenoscopia) is the procedure of choice for diagnosis of peptic ulcer. Endoscopy with biopsy and the subsequent morphological research of a bioptates - confirms presence of ulcer defect and specifies of its localization, depth, the form, the sizes, condition of the bottom and edges of the ulcer.

Barium meal (or X-ray examination). A direct proof of peptic ulcer is a niche, which is found in 75-80 per cent of patients. The ulcer is usually located on the lesser curvature. In duodenal ulcer, the can be found inside the bulb or outside it (extrabulbar ulcer). Barium meal is less commonly used now. Endoscopy should be done if it shows gastric ulcer to rule out malignancy.

Gastric secretory function. The main method of study of gastric secretion is pH-measure (intragastral pH-metria). Normal basal pH in body stomach is 1.6-2.2. There is pH more than 2.2 – hyperacidity. There is pH less than 1.6 – hypoacidity. If the ulcer is found in the stomach, hydrochloric acid, pepsin, mucoprotein and albumin fractions of the gastric juice vary within normal limits. In duodenal ulcer all these indices significance exceed normal values.

Determining of Helicobacter pylori. Blood test or Serological test - determine antibodies of H. pylori in blood. Breath test. You drink a solution that contains a radioactive carbon atom. If H. pylori is in your body, it will break down the solution and release the carbon. Your bloodstream carries the carbon to your lungs, where it's exhaled and can be detected in your breath. Stool test – determine antigen of H. pylori in feaces. H. pylori can be detected histologically on biopsy of gastric mucosa.

Rapid urease activity test. Culture. Biopsies obtained can be cultured on special medium.

Clinical blood analysis. May be determining of the signs of ferric deficiency anemia at chronic or acute bleeding.

Examination of faeces. Latent haemorrihage is almost always revealed on examination of faeces during exacerbation of peptic ulcer.