Gastric ulcer or gastric ulcer is a common pathology of the digestive system, occurring in almost 1/10 of the population. More than 70% of patients are men, mostly young - from 20 to 45 years. Although this disease is much less common than duodenal ulcer, it has a more severe course, is more difficult to treat and is fraught with the development of serious complications.

Peptic ulcer of the stomach has its own general code according to ICD10 - K25, which is divided into subparagraphs, depending on the type and stage of the ulcer:

What is a stomach ulcer?

Peptic ulcer is a defect in the gastric mucosa, which is formed under the influence of various external and internal factors. It is considered not as a disease of a separate organ of the stomach, but as a whole organism for two reasons:

• the development of an ulcer contributes to a number of disorders in the body;
• the presence of an ulcer has a negative impact on other organs and systems, leads to the development of complications and deterioration of health.

From these considerations, it is more correct to speak not about an ulcer - a defect in the mucous membrane, but about a peptic ulcer - a pathology of the body as a whole.

What are the causes and risk factors for developing the disease?

The inner shell of the stomach is covered with a layer of mucus, which protects against damage by gastric juice, food. It becomes unprotected when, for any reason, the function of the mucous glands is insufficient. There are many such reasons.

1. The presence in the stomach of a pathogenic bacillus of Helicobacter is detected in 80% of patients with an ulcer. This bacterium invades the mucous membrane and destroys its cells. The infection can enter the stomach with saliva and mucus when using shared utensils, close contact. This allows us to classify the ulcer as a contagious disease.
2. Stress leading to impaired blood circulation in the stomach.
3. Systematic exposure to alcohol, tobacco smoke products.
4. Long-term use of drugs from the NSAID group (aspirin, paracetamol, ibuprofen, diclofenac and other analogs).
5. Rough and spicy food, dry food.

Predisposing factors that increase the risk of developing the disease are heredity, chronic hyperacid gastritis, especially with the presence of erosions, as well as diseases of other organs - the liver, pancreas, intestines, diabetes mellitus, tuberculosis, cancer, decreased immunity.

Development mechanism

The pathogenesis of the development of peptic ulcer occurs as follows. Damaged by bacteria or other factors, the mucous membrane is constantly exposed to hydrochloric acid, the protein enzyme pepsin and food. Initially, superficial ulceration is formed, which gradually deepens, forming an ulcer.

In response to this, a pain reaction occurs, a spasm of smooth muscles, the process of digestion and evacuation from the stomach is disturbed. As a result, the entire gastrointestinal tract (gastrointestinal tract) suffers, duodenitis, enterocolitis may develop. Reflex occurs biliary dyskinesia, pancreatic ducts, cholecystitis, pancreatitis may develop.

Varieties of the disease

Classification of peptic ulcer is carried out according to several criteria.

According to the nature of the secretion of the stomach:

• with high and normal acidity;
• with reduced acid-forming function;

According to the localization of the ulcer:

According to the duration of the disease:

• acute stomach ulcer;
• chronic ulcer;

According to the phase of the disease:

• acute stage;
• subacute;
• remission.

According to the severity of the flow:

• latent(hidden);
• lung(exacerbations less than 1 time per year);
• moderate(exacerbations 1-2 times a year);
• heavy(exacerbations 3 or more times a year, the presence of complications).

Why is a stomach ulcer dangerous?

The disease leads to indigestion and gradually developing changes in all organs and systems associated with a lack of protein, vitamins, iron, and a decrease in hemoglobin levels. Such a pathology is especially dangerous during pregnancy - both for the mother and for the unborn child, and an exacerbation can provoke a miscarriage.

A threat to health and life are complications of peptic ulcer:

• perforation (perforation);
• bleeding;
• pyloric stenosis (pylorus);
• malignancy.

perforation

When the ulcer is deep, a through hole may appear in the wall of the stomach. Through it, gastric contents flow into the abdominal cavity, inflammation of the peritoneum develops - peritonitis.

Bleeding

If vessels are located in the defect zone, they can be corroded by gastric juice and burst, blood is poured into the stomach. Especially dangerous are ulcers of lesser curvature, where large vessels extend from the celiac artery - branches of the abdominal aorta. Such blood loss is very massive, often they are fatal.

Pyloric stenosis

Repeatedly scarred ulcer in the area of ​​the outlet of the stomach causes its stenosis - narrowing. Food stagnates in the stomach, inflammation develops.

Malignization

Long-term non-healing gastric ulcers, especially those with reduced or no acid-forming function, tend to turn into cancer. A dense tissue shaft is formed around the defect - the so-called callous ulcer, in which malignant degeneration of cells occurs.

Clinical symptoms

How a stomach ulcer is clinically manifested depends on its shape and location, the nature of gastric secretion, and the presence of complications. Common characteristic symptoms are:

• heartburn 1.5-2 hours after eating;
• epigastric pain after eating;
• belching after eating with sour contents, food;
• nausea 30-60 minutes after eating, vomiting;
• a feeling of heaviness in the epigastric region, a feeling of fullness in the abdomen;
• bloating, stool retention.

In the latent course, these manifestations are not expressed, and in the acute phase, the clinical picture can be very dramatic.

If there is a perforation of the ulcer, there is a strong "dagger" pain, tension in the abdominal muscles, vomiting, and the general condition is disturbed. With bleeding, pain is not characteristic, vomiting occurs like coffee grounds (blood mixed with gastric juice), there is a sharp pallor, dizziness, pressure decreases, and the pulse quickens. Hemorrhagic shock may develop.

With pyloric stenosis, frequent vomiting and rapid weight loss appear. A malignant ulcer causes constant pain in the abdomen, vomiting, loss of appetite, a sharp decrease in weight, enlarged lymph nodes (metastases) may appear on the neck on the left and above the collarbone.

Diagnostics

When examining the patient, attention is drawn to a white thick coating on the tongue, bloating, palpation pain in the epigastrium. An x-ray of the stomach with contrast is preliminarily prescribed, this allows you to identify a mucosal defect, deformation by scars, and the presence of a tumor.

The most reliable is FGDS - fiberoptic gastroscopy, when the entire stomach is examined from the inside with a probe with a video camera, it is possible to take a biopsy.

The diagnosis includes the study of gastric secretion by probing, clinical blood and urine tests, all biochemical studies. Be sure to test for the presence of Helicobacter by one of the methods (endoscopic, respiratory, laboratory).

Useful video

What causes the development of the disease and how to treat it are told by experienced specialists in this matter.

Treatment Methods

Treatment of peptic ulcer disease is complex, it includes:

• diet therapy;
• medicinal preparations;
• physiotherapy.

The diet should consist of well-digestible food that does not irritate the stomach, with multiple intake 5-6 times a day in small portions. The diet includes a sufficient amount of protein, vitamins, coarse fiber, spicy seasonings, salty, fried and canned foods are excluded.

The medical program is compiled individually. If Helicobacter is detected, antimicrobial drugs are prescribed. With increased acidity, antacids are given, with reduced acidity, hydrochloric acid, pepsin. In all cases, gastroprotectors, vitamins, biostimulants are prescribed to accelerate the epithelialization of the defect.

Of the physiotherapeutic procedures, magnetotherapy, iontophoresis, galvanization, electrosleep are prescribed, laser therapy gives a good effect - stimulating irradiation through a probe. The treatment course is carried out until the onset of scarring, which is detected at the control endoscopy.

Surgical treatment is indicated in cases of complications. In case of bleeding, perforation, the operation is performed according to vital indications. With pyloric stenosis, the patient is prepared and operated on in a planned manner. Malignant ulcers are treated in oncology.

Forecast and prevention

It is difficult to achieve a complete cure for an ulcer, with proper treatment it is possible to achieve long-term remissions, so the prognosis for health is relatively favorable. For life, it is unfavorable in the event of the development of severe complications that have a high mortality rate. Surviving patients after surgery often become disabled.

With regard to military service, depending on the nature and stage of the disease, a delay may be given, and after a second examination, the question of fitness for service is decided. Most often, in peacetime, such patients are not called up for service.

Prevention of peptic ulcer disease consists in proper nutrition, getting rid of bad habits, observing the rules of personal hygiene, and timely treatment of existing chronic diseases.

According to the international classification of diseases of the tenth revision (ICD-10), trophic ulcers are listed in different sections.

Causes

Trophic changes develop as a complication with:

• atherosclerosis;
• venous insufficiency;
• diabetes mellitus;
• peripheral polyneuropathy;
• filariasis;
• chemical damage;
• autoimmune diseases;

The main factor is a change in tissue nutrition and poor blood circulation.

Symptoms and stages

Trophic changes develop in stages:

1. Thinning and dry skin.
2. The affected area becomes shiny and tense.
3. Age spots and other changes in skin color appear.
4. In the changed place, papules and expressions are formed.
5. The edges are compacted, plaque appears inside.
6. Bleeding starts.
7. Pus appears.
8. On the surface of the wounds (in the absence of treatment) dead tissue areas (necrosis) are formed.
9. Granular areas appear (with proper treatment), the surface of the wound decreases.
10. Scars appear on the tissues (in the presence of adequate treatment and care).

Classification

Trophic ulcers according to ICD-10 are classified into different sections, based on the pathological processes that caused them.

Ulcers in atherosclerosis

Atherosclerotic plaques cause circulatory disorders, the skin becomes dry and groups of cells die. Any damage to the skin in atherosclerosis leads to trophic pathologies. This type is dangerous by the rapid development of tissue necrosis and gangrene, which ultimately leads to amputation of the limb. Trophic ulcers caused by atherosclerosis disease are referred to as L-98 code according to ICD-10.

• eliminate bad habits;
• diet to lower cholesterol
• physiotherapy exercises;
• surgical removal of necrotic areas;
• treatment of affected areas with antibacterial, drying and healing preparations;
• taking anticoagulants (to thin the blood);
• taking venotonics (for vascular elasticity and normalization of blood flow);
• use non-steroidal anti-inflammatory drugs;
• antibiotics inside, intramuscularly;
• medicines to lower cholesterol.

With hypertension, the vessels narrow, their spasm occurs, which is the cause of metabolic disturbances in them. This type is found in others, it is characterized by bilateral damage to the limbs. Most often, trophic changes affect the legs.

Mandatory stages of treatment:

• taking drugs to reduce pressure (after consulting a cardiologist);
• a diet with the exception of spicy, fatty and fried foods, with the advantage of dairy and plant foods with a low salt content;
• antibacterial therapy;
• antiplatelet drugs;
• local antiseptics for the treatment of damage;
• surgical removal of tissues (with a running process with necrosis);
• physiotherapy.

With diabetes, the level of sugar in the blood constantly changes, the metabolism in tissues is disturbed. Due to improper metabolism, the skin becomes dry, thin, insensitive. Small injuries, uncomfortable shoes lead to rapid infection and ulcerations occur. According to the ICD-10 code, diabetic lesions fall into different categories depending on the type of diabetes.

Treatment methods:

• taking medicines to control blood sugar levels;
• orthopedic shoes and bandages for unloading an injured limb;
• antibiotic therapy;
• antibacterial and healing treatment of wounds;
• drugs to improve the oxygen supply of tissues;
• ultrasound treatment;
• oxygen saturation;
• ultraviolet irradiation;
• laser therapy;
• surgical treatment (with necrosis).

In diabetes, it is imperative to control the level of sugar in the blood and follow the instructions of the endocrinologist. Treat all cracks, scratches and damage with antiseptics. If the wound does not heal, consult a doctor immediately.

A trophic ulcer related to the ICD-10 codes for diabetic is more often formed on the legs and feet (diabetic foot). Therefore, patients with diabetes need to carefully monitor the condition of the feet.

Varicose veins, if untreated, lead to ulcerative lesions of the extremities. Venous trophic ulcers according to ICD-10 are divided into two groups: with inflammation and without inflammation.

Treatment tactics:

• a diet with a restriction of salty, spicy with a preference for vegetables and fruits with a high content of vitamin C;
• exclusion of smoking;
• correction of the daily routine with a decrease in the time spent in a standing position;
• antibiotic therapy;
• phlebotropic (improving the condition of the veins) drugs;
• regular treatment of ulcers with antiseptics;
• laser therapy;
• surgical intervention (removal of necrotic areas and damaged veins);
• laser therapy;
• vacuum processing;
• compression therapy (stockings and bandages);
• healing ointments (at the last stage).

With trophic ulcers on the legs related to the ICD-10 code for venous, it is imperative to wear medical compression products to eliminate the cause of varicose veins (the outflow of venous blood from the legs is accelerated).

As a result of damage to the peripheral nerves (neuropathy), healing processes in the tissues are disrupted and the risk of ulceration increases. With neuropathy, the sensitivity of the limbs decreases. Microtraumas and friction degenerate into long-term non-healing wounds.

Complex therapy:

• treatment of the underlying disease;
• regular treatment of wounds with antiseptics, antibiotics and healing agents;
• orthopedic shoes (to unload the foot);
• reconstructive surgery (with extensive lesions).

A separate ICD-10 code identifies a decubitus or decubitus trophic ulcer, which is formed due to prolonged pressure.

Predisposing factors:

• elderly age;
• low systolic pressure;
• moist infectious environment in contact with the skin (enuresis);
• infections;
• vascular diseases;
• vitamin C deficiency;
• prolonged immobility lying or sitting in bed (in the hospital, with injuries and fractures);
• unsuccessfully applied plaster;
• spinal cord injury.

Specific treatment for bedsores:

• reduced pressure force (tires, circles, special beds);
• regular treatment with antiseptics, antibiotics, necrolytic, anti-inflammatory and healing drugs;
• drug treatment of the underlying disease;
• vitamin therapy;
• surgical removal of necrotic areas;
• laser therapy;
• electroacupuncture;
• ultrasonic treatment of ulcers;
• darsonvalization.

Not classified elsewhere

In cases where the cause of trophic ulcers is not established, the disease is referred to subsection L98.4 according to ICD-10.

Treatment in this case is complex, aimed at antiseptic and antimicrobial treatment of wounds. At the granulation stage, regenerating agents are used. In extreme advanced cases, surgical removal of dead areas is performed.

Complications

The wrong approach to treatment, alternative methods and untimely access to a doctor leads to serious consequences. Necrosis spreads to neighboring tissues, muscles, tendons, joints, bones are affected.

• accession of bacterial or fungal flora;
• blood poisoning;
• decay;
• erysipelas;
• damage to the joints and disruption of their work;
• amputation;
• fatal outcome.

Prevention

Long-term non-healing ulcers are not an independent disease, therefore, in the presence of predisposing factors, it is necessary to carefully monitor the state of health and regularly visit a doctor.

Prevention measures:

• exclusion of bad habits;
• control of the course of existing pathologies;
• avoid injury and damage to the skin;
• timely treatment;
• engage in physical therapy;
• eat a balanced diet;
• exclude fast food;
• avoid hypothermia and overheating;
• do not take medications without a doctor's prescription and do not change their dosage and duration of the course;
• rationally organize the mode of work and rest;
• regularly undergo examination by a doctor and take tests;
• wear comfortable clothes and shoes (if necessary, orthopedic and compression).

Any damage to the skin that does not heal for a long time (more than two weeks) should be examined by a doctor. If you self-medicate with folk methods, the consequences can be irreversible, up to disability and death. A healthy lifestyle, proper and rational nutrition, regular medical examinations will help to avoid the development of the disease.

The International Statistical Classification of Diseases and Other Health Related Problems (ICD) is a systematized document formed to classify, compare, interpret and compare information on mortality, the course of diseases and their main characteristics. The verbal definition of disease diagnoses is converted into alphanumeric codes for easy storage and retrieval of information. At the moment, the international classification of the 10th revision is valid (ICD 10). Ulcer of the stomach and duodenum belongs to the 11th class - diseases of the digestive system.

Etiopathogenesis of peptic ulcer

Gastric ulcer - damage to the epithelium of the stomach (in rare cases with deep damage to the submucosal layer), which occurs under the aggressive action of hydrogen chloride, drugs, pepsin, bacterial enzymes. Trophic disturbances occur at the site of exposure.

Factors that precede the development of peptic ulcer:

• decrease in protective functions;
• strengthening the aggressive impact of destructive substances.

Factors contributing to the development of the disease:

• infection with Helicobacter pylori (40% of all cases);
• excessive use of non-steroidal anti-inflammatory drugs (in second place);
• malignant and benign tumors (adenocarcinoma, sarcoma, leiomyoma, lymphoma);
• Crohn's disease;
• diabetes;
• tuberculosis;
• syphilis;
• HIV infection;
• addictions (smoking, alcoholism);
• psychosomatics and long-term stressful conditions;
• pain in injuries with the development of traumatic shock;
• unsystematic, excessive unbalanced nutrition, frequent use of fast food.

Depending on the cause, etiology and course, the disease is divided into several groups, each of which is assigned an ICD 10 code.

Ulcer according to ICD 10

The document is divided into classes, which in turn are divided into blocks. The ICD is being revised under the leadership of the World Health Organization (WHO). For gastric ulcers, additional subcategories are provided to clarify the course and form of exacerbation. Each section has exceptions and clarifications that refer to other categories and classes.

According to the microbial code 10, a stomach ulcer is classified as class 11, category 25 (K25), including erosion (including acute) of the stomach, and its pyloric part. If there is a need to classify according to the medicinal product that caused the lesion, use the external cause code (class 20). This category excludes disorders that are generalized to other rubrics and have their own separate code: acute hemorrhagic erosive gastritis, peptic ulcer NOS.

Duodenal ulcer according to the disease classifier code (ICD 10) is separated from gastric ulcer into category 26 (K26). This section includes erosion (including acute) of the duodenum (duodenum), peptic ulcer of the duodenum, peptic ulcer of the postpyloric part. Excluded from category peptic ulcer NOS. If necessary, isolate the cause of the disorder from the medication causing the disorder, use Class 20.

1. .0 - acute stage with a complication in the form of hemorrhage;
2. .1 - acute stage with perforation;
3. .2 - acute simultaneously with hemorrhage and perforation;
4. .3 - acute stage of the disease without perforation and hemorrhage;
5. .4 - unspecified in origin or in the chronic stage with hemorrhage;
6. .5 - unspecified or chronic ulcer complicated by perforation;
7. .6 - unspecified genesis or chronic course, or hemorrhage;
8. .7 - chronic course without complications;
9. .9 - acute course of unspecified genesis or chronic without complications.

Description by code 25.0

The complication of the acute stage of the disease occurs as a result of arrosion (violation of the integrity of the walls during necrotic and ulcerative processes) of the vessel, with violations of the outflow of venous blood.

Clinic complications:

• dizziness;
• pallor of the skin;
• weakness;
• collapse (sudden cardiovascular failure with loss of consciousness and death);
• melena (black shapeless stools and an unpleasant odor, a mixture of blood with the contents of the intestines and stomach);
• single or repeated vomiting, including masses of the type of coffee grounds;
• hypotension (lowering blood pressure);
• acute pain (may be absent).

Description by code 25.1

The acute phase of peptic ulcer with perforation (perforation) is a penetrating (through) hole at the site of manifestation. Occurs in silent (asymptomatic) after infections.

There are two forms:

• covered (by other organs, without a constant outflow of contents into the abdominal cavity);
• naked (constantly the contents of the stomach goes into the cavity between the organs).

Decoding 25.2

Acute stage of gastric ulcer, complicated by both bleeding and perforation of ulcers.

Symptoms:

• well-being at a consistently good level;
• weakness;
• confusion;
• dizziness;
• hematemesis;
• melena;
• hypotension (low blood pressure) or hypertension (high blood pressure);
• sharp growing pain.

Description 25.3

Acute (when epithelial damage is diagnosed for the first time) stage of the disease without complications in the form of bleeding and perforation. Most often localized on the anterior wall and lesser curvature. It begins acutely with severe pain and dyspeptic disorders. Foci of damage are oval or rounded up to 2 cm with clear hyperemic edges.

Characteristic code 25.4

With long-term non-healing ulcers on the gastric mucosa, a chronic form of the disease develops. According to ICD 10, a stomach ulcer, this code means a complication of profuse (profuse) bleeding in the chronic stage or with an unspecified genesis. Hemorrhage in such cases is severe, not subsiding. Urgent surgical care is required.

Code 25.5 according to ICD 10

This category is characterized by symptoms similar to other acute diseases of the abdominal cavity (pancreatitis, cholecystitis). The perforated hole with an unspecified or chronic course of the disease is exposed, peritonitis develops (inflammation of the abdominal cavity with a general severe condition of the body). There are all favorable conditions for the formation of a limited abscess (abscess, purulent inflammation of the abdominal cavity, enclosed in a pyogenic capsule).

Code description 25.6

The slow development of symptoms in a chronic course, the duration of the course with periods of exacerbation and attenuation of symptoms often leads to complications with bleeding and perforation at the same time. This group is classified according to the predominant symptoms or morphological features.

The clinic of a perforated ulcer complicated by bleeding is atypical:

• perhaps the absence of a pronounced pain syndrome, tension of the abdominal muscles;
• no symptoms of inflammation of the peritoneum.

A rare case of a combination of bleeding with perforation according to the international classification code 25.6 - a perforated ulcer of the anterior wall and hemorrhage on the back of the stomach (kissing ulcers) - the search for a place for perforated and wound ulcers in this case is difficult.

Characteristic code 25.7

A chronic gastric ulcer without perforation and hemorrhage of this code according to ICD 10 develops when an acute ulcer cannot heal. Symptoms develop slowly, sometimes without pain. For a long period, there are only common symptoms for diseases of the digestive system: nausea, heartburn, heaviness after eating. Gradually, the symptoms increase, complications develop at the same time, and the disease passes into another code.

Code description 25.9

An unspecified type of acute ulcer or chronic course without signs of perforation and bleeding is characterized by a sharp development of symptoms.

Dyspeptic disorders are noted:

• nausea;
• vomiting (rare);
• heartburn;
• pain 1.5 hours after eating;
• bloating, flatulence;
• discharge of gases through the oral cavity with specific sounds.

Endoscopic examination often reveals multiple small (up to 2 cm) ulcers. Damage to the epithelium heals with the formation of delicate light scars.

The choice of a conservative or surgical treatment method is chosen based on the presence of complications, the course of the disease and concomitant diseases. For each code according to the international classification, there are recommendations in the Orders of the Ministry of Health and Social Development on the methods and methods of medical care.

The goal of therapy for perforated gastric ulcer is not only to save the patient's life and eliminate the defect in the stomach wall, but also to treat gastric ulcer, diffuse peritonitis. In the practice of a gastroenterologist and a surgeon, there are cases of conservative management of a perforated gastric ulcer. Conservative treatment is used only in two cases: with decompensated somatic pathology and the patient's categorical refusal of surgery. Conditions for conservative treatment: less than twelve hours from perforation, age not more than 70 years, absence of tension pneumoperitoneum, stable hemodynamics. The complex of conservative treatment includes anesthesia, the introduction of antibiotics and antisecretory drugs, anti-Helicobacter and detoxification therapy.
In the surgical treatment of perforated gastric ulcer, there are three main approaches: perforation closure, gastric ulcer excision, gastric resection. In most patients, the perforation is closed by tamponade, omentum, or suturing. Indications for closure of a perforated gastric ulcer: asymptomatic perforation, duration of the disease for more than 12 hours, signs of peritonitis, extremely serious condition of the patient. Starting treatment later than a day after perforation increases mortality by a factor of three. Anti-helicobacter and antisecretory therapy in the postoperative period can improve the results of the operation to close the perforation.
Excision of a perforated gastric ulcer is performed only in every tenth patient. This operation is indicated in the presence of gastric stenosis, bleeding, ulcers with callous edges, large perforations, if malignancy of the ulcer is suspected (excision is necessary for pathomorphological examination).
Gastric resection can be performed in patients with a perforated ulcer if it is impossible to perform a simpler operation and conduct postoperative anti-Helicobacter and antisecretory therapy. Typically, such indications occur with a complicated course of peptic ulcer (calculus, penetrating and peptic ulcer; multiple ulcers), suspicion of a malignant process, re-perforation of a stomach ulcer, and a huge size of the perforated hole (more than 2 cm).
Approximately 10% of patients use minimally invasive surgical techniques: laparoscopic and endoscopic treatment of gastric ulcers. The use of laparoscopic operations can significantly reduce the incidence of postoperative complications and mortality. Various surgical techniques can be combined with each other (for example, laparoscopic with endoscopic) and with vagotomy (selective proximal vagotomy, stem vagotomy, endoscopic vagotomy).
If vagotomy was not performed during the operation, antiulcer therapy (proton pump inhibitors and H2-histamine receptor blockers, antihelicobacter drugs) is prescribed in the postoperative period.

Ulceration on the mucous membranes of the stomach is a pathological process that involves inflammation and submucosal layer to the very muscle tissue. Usually, an acute ulcer is diagnosed when the lesion is detected for the first time. With the repeated manifestation of acute attacks, it becomes chronic and begins to worsen periodically in the autumn and spring season.

Definition and code of the disease according to ICD-10

Ulcerative pathology of the stomach is an inflammatory disease of the mucous membranes of the stomach, accompanied by the development of ulcerative formations on them. An acute ulcer forms in a short time and is more often detected in young male patients up to 40 years of age.

Pathology proceeds with gastric pain and dyspeptic symptoms. According to the ICD-10, an acute stomach ulcer has the code K25.0-25.3.

Reasons for development

An acute ulcer has a fairly wide range of etiological factors, which include:

• hereditary predisposition;
• Violation of the diet and daily routine;
• infectious agents;
• Inclusion in the diet of unhealthy foods;
• Excessive stomach acid;
• Bacterial exposure to Helicobacter pylori;
• Irritants of an external nature;
• Taking non-steroidal anti-inflammatory drugs;
• Frequent psycho-emotional overload and stress;
• The presence of an inflammatory process on the gastric mucosa.

Bacterial etiology is far from the last importance in the development of the ulcerative process on the gastric mucosa.

It provokes the development of the inflammatory process, and then, in the absence of proper therapy, it develops into an ulcer. Helicobacteria are characterized by increased viability, they do not die in a hydrochloric acid environment, methodically destroying ever larger areas of mucous membranes.

Usually Helicobacter pylori is activated against the background of a sharp decrease in immunity. The penetration of a bacterial pathogen is almost impossible to prevent, since Helicobacter pylori enter the body with dirty hands, kisses or contaminated things.

Therefore, the best protection against this microorganism will be excellent immunity. Timely treatment of infectious lesions at the earliest stages of their development, while the mucous membrane has not yet undergone pronounced changes, will help prevent the formation of an ulcerative process.

Classification

Acute peptic ulcer has a fairly extensive classification and is divided into several groups according to various principles.

1. According to the type of ulcerative process, pathology is divided into multiple, single and combined with chronic ulcers form;
2. In size, an acute ulcer can be small (up to 5 mm), medium (6-10 mm), large (11-30 mm) and giant (more than 30 mm);
3. According to etiology, the disease is divided into Cushing's ulcer, Curling's, Helicobacter and non-Helicobacter pylori;
4. By localization, the ulcer can be located in the antrum, in the body of the stomach, in the pyloric or cardial section;
5. According to clinical characteristics, ulcers are divided into typical with severe symptoms or atypical without symptoms, but with severe pain (or without pain), but with signs that are not characteristic of the ulcerative process in the stomach.

According to morphological features, all ulcers of an acute nature practically do not differ from each other. Ulcerative formations have a wedge-shaped structure, in which the diameter of the edges of the wound is greater than the diameter of its bottom.

Symptoms

The acute form of peptic ulcer usually does not have a specific picture and is manifested by common symptoms:

• Pain symptoms in the upper part of the epigastrium, on an empty stomach the pain becomes sharper and more intense, and after eating the pain subsides;
• Heartburn and sour, and if the acidity is lowered, then air is burped;
• Hyperthermic reaction, irritability and unstable sleep;
• Constipation and flatulence,;
• Weight loss and.

The patient's mood changes dramatically, which often indicates an increase in pain. Distinguishing from ulcers is quite simple - with an ulcer, pain occurs half an hour to an hour after eating and lasts an hour or two, while food is present in the stomach cavity.

After digestion, the painful symptoms are reduced. Also, with peptic ulcer, spasms tend to increase at night and on an empty stomach.

Diagnostics

Often, pathology develops in patients who have previously been diagnosed with hyperacid gastritis and other lesions of the gastric mucosa. When diagnosing an acute ulcer, patients are prescribed:

• , in which the stomach cavity is filled with contrast, due to which thinned sections of the walls of the stomach can be detected in the light;
• helps to detect Helicobacter pylori antigens;
• FEGDS. With this procedure, a special probe with a camera is inserted into the esophagus, which allows the specialist to visually assess the degree of ulcerative damage to the walls of the organ;
• In the process of FEGDS, the doctor can take a biopsy of the tissues of the ulcerative focus, which is necessary to assess the composition of the destroyed tissues and identify traces of Helicobacter pylori activity;
• To detect the remnants of vital activity of bacteria, urine is also prescribed to patients;
• To assess the condition of the stomach is carried out.

If necessary, the doctor may refer to additional studies such as antroduodenal manometry, etc.

Treatment of acute stomach ulcer

Usually, patients are prescribed drugs from the group of antibiotics, painkillers and acid-lowering drugs, enzymatic agents to improve gastrointestinal activity.

1. The basis of therapy is proton pump inhibitors and histamine receptor blockers, which inhibit hydrochloric acid secretion. They are taken for about 3 weeks, depending on the reaction of the patient's body to such treatment.
2. Regardless of the form of peptic ulcer, patients are prescribed bismuth preparations that have a pronounced hepatoprotective and enveloping effect, which protects the stomach from the aggressive irritating effects of food and gastric secretions.
3. With Helicobacter pylori activity in the stomach cavity, patients are prescribed antibiotic therapy, and a complex of 3-4 different antibiotics, such as Metronidazole, Clarithromycin and Tetracycline, is selected.

The appointment of drugs is carried out only by a gastroenterologist and only a doctor should also cancel them. If the patient stops taking the medication on his own, he will simply drown out the disease, but will not achieve its cure, which will soon lead to a relapse.

Diet

Equally important in the treatment of acute ulcerative process in the stomach is the diet. Patients with a similar pathology are assigned dietary table No. 1.

According to this nutrition program, patients can eat neutral foods that do not contain hard-to-digest fats or coarse fibers of plant fibers.

On the first day after the onset of the acute period, patients are advised to use mucous decoctions of oatmeal or rice. It is recommended to eat jelly, pureed soups in chicken broth or water. Fish or meat dishes like steam cutlets, meatballs or meatballs. Porridge or mashed vegetable purees are perfect as a side dish for such dishes.

In the first 2-3 days of exacerbation, you can even starve, observing the drinking regimen. It is necessary to completely exclude from the diet smoked meats, salinity, fatty, sweets, spicy foods and foods with coarse fibers that cause flatulence.

Complications

Acute peptic ulcer disease is dangerous with the risk of developing massive internal bleeding.

• The acute ulcerative process, more than other varieties, is prone to penetration into the deep gastric layers, penetrated by vascular channels. This usually occurs with ulcerative formations that are located in the body or antrum of the stomach. Moreover, an attack in patients can begin suddenly and rapidly gain intensity.
• Acute ulcerative formations can lead to a pathology called the phenomenon of a suitcase handle. In this case, the acute process rapidly spreads to the omentum, which has large arteries. When its membranes are destroyed, the arteries are drawn into the stomach, break through and bleed heavily. If the picture develops unfavorably, then the bleeding becomes so intense that in an hour the patient can lose half of his blood.
• An ulcer is also dangerous by perforation, when the affected area is transformed into a through hole, from which food masses fall out into the peritoneal cavity. As a result of this situation, peritonitis develops, in which acute stomach pains begin, after a couple of hours there is a delay in feces and urine, bloating and acute pains.
• A complication of an ulcer can also manifest itself in the form of penetration. A similar condition also represents the formation of a through hole, but only at the point of contact of the stomach with any neighboring organ (gall bladder, pancreas, etc. The walls of the organs grow together, forming a through passage between them.

Timely contact with a specialist and proper treatment of peptic ulcer will help to avoid any complications.

Forecast

Forecasts for acute ulcers depend on the timeliness of seeking qualified gastroenterological care, as well as on the effectiveness of antibiotic therapy.

In every fifth patient, gastric ulcer pathology is complicated by bleeding, and 10-15% of ulcers experience ulcerative penetration or perforation. In children, peptic ulcer is practically not complicated. In ulcers, the risk of developing gastric malignant oncology is 3-6 times higher than in persons without ulcers.

If a patient has a gastric ulcer, then it will remain with him for life. In order to avoid exacerbations in the future, it is necessary to strictly follow the recommendations of a specialist, completely change the diet and lifestyle, exclude alcohol and cigarettes, protect yourself from all kinds of stressful and depressive situations that often provoke exacerbations.

It is necessary to observe the daily routine and work / rest regimen, because chronic fatigue quite often becomes the beginning for many pathologies. This is the only way to keep the ulcer under control and prevent the recurrence of the pathology.