Features of the course of gastric ulcer in different age groups

Introduction. The problem of gastric ulcer is of particular socio-economic importance and has a tremendous impact on the quality of life of people. The relevance of our study is due to an increase in the incidence of peptic ulcer in the population, the variability of the clinical picture depending on the age category of patients, and the peculiarities of the treatment of this gastrointestinal pathology.

The aim of the study is to study the features of the course of gastric ulcer in different age groups of patients under dispensary supervision in the outpatient department of the State Budgetary Healthcare Institution of the Republic of Moldova “Republican Clinical Hospital No. 5” in the period from 2017 to 2020.

Materials and methods. A retrospective analysis of outpatient records of 100 patients of different age groups with gastric ulcer who were under dispensary observation at the outpatient clinic of the Republican Clinical Hospital No. 5 in Saransk in 2017– 2020 was carried out. Statistical analysis of the data obtained was carried out using the Microsoft Office Excel program.

Results and discussion. It was found that gastric ulcer is more often observed in middle-aged and elderly patients and is accompanied by blurring of the clinical picture of the disease, in contrast to young people, who have vivid clinical manifestations of this disease. Ulcerative defects in  young and middle-aged patients are more often small in  size and are located mainly in the area of the stomach angle, and in elderly and senile patients, ulcers are localized mainly in the cardiac region, can be gigantic and often lead to the development of complications (primarily gastrointestinal intestinal bleeding).

Conclusions. The blurring of the clinical picture, the absence of pathognomonic symptoms in elderly patients determine the late diagnosis of gastric ulcer, which ultimately leads to a high incidence of complications requiring surgical intervention. In clinical practice, it is necessary to take into account these features of the course of peptic ulcer disease in elderly patients and to prescribe the necessary complex of laboratory and instrumental studies and preventive therapy in a timely manner. 

1. Ivashkin V.T., Sheptulin A.A., Mayev I.V., Baranskaya Y.K., Trukhmanov A.S., Lapina T.L. et al. Diagnostics and treatment of peptic ulcer: clinical guidelines of the Russian gastroenterological Association. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(6):40–54. (In Russ.) doi: 10.22416/1382-4376-2016-26-6-40-54.

2. Baryshnikova N.V. Treatment of Helicobacter pylori-associated diseases. In: H. pylori infection in clinical practice. St Petersburg: InformMed; 2011, pp. 531–533. (In Russ.).

3. Gabbasova L.B. Gastroduodenal ulcer as a psychosomatic disease. In: Issues of theoretical and practical medicine: proceedings of the 76th Republican Student and Postdoctoral Academic Conference. Ufa; 2011, pp. 93–94. (In Russ.).

4. Gabbasova L.V., Volevach L.V., Paltusov A.I., Kryukova A.Ya., Khismatullina G.Ya., Kamalova A.A. Duodenal ulcer in adolescents. Tambov: Ucom Consulting Company; 2017. 48 p. (In Russ.) Available at: https://ukonf.com/doc/mon.2017.11.01.pdf.

5. Ivanov L.A., Sysoev K.V., Mardanov D.N., Solov’eva N.V. Morphofunctional state of the gastric mucosa in torpid course of chronic erosions. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2010;20(5):27. (In Russ.) Available at: https://www.gastroscan.ru/literature/authors/3992.

6. Malfertheiner P., Megraud F., O’Morain C.A., Atherton J., Axon A.T., Bazzoli F. et al. Management of Helicobacter pylori infection – the Maastricht IV/Florence Consensus report. Gut. 2012;61(5):646–664. doi: 10.1136/gutjnl-2012-302084.

7. Pugacheva M.G., Shchapkova M.M., Kondrashov V.A. A contemporary view of etiology of gastroduodenal ulcer. Science Time. 2019;8(68):35–37. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=41039749&.

8. Sherieva A.Yu. Modern diagnosis and treatment of peptic ulcer. In: International scientific review of the problems and prospects of modern science and education. Collection of scientific articles LIV International correspondence scientific and practical conference. 2019, pp. 97–103. (In Russ.) Available at: https://scientific-conference.com/h/sborniki/meditsinskie-nauki89/1633-sovremennaya-diagnostika.html.

9. Malfertheiner P., Megraud F. O’Morain C.A., Gisbert J.P., Kuipers E.J., Axon A.T. et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6–30. doi: 10.1136/gutjnl-2016-312288.

10. Maslovskiy L.V., Minushkin O.N. Challenges in gastroduodenal ulcer cicatrization. Lechashchiy vrach = Attending Doctor. 2011;(7):25–28. (In Russ.) Available at: https://www.lvrach.ru/2011/07/15435232.

11. Burkov S.G. Diagnostic and drug treatment strategy for diseases of the digestive system in pregnancy. Ehksperimentalnaya i klinicheskaya gastroehnterologiya = Experimental and Clinical Gastroenterology. 2009;(7):72– 78. (In Russ.) Available at: https://cyberleninka.ru/article/n/strategiyadiagnostiki-i-medikamentoznogo-lecheniya-zabolevaniy-organovpischevareniya-u-beremennyh/viewer.

12. Evseyev M.A., Klishin I.M. Antisecretory treatment efficacy by proton pump inhibitors at gastroduodenal ulcer bleedings. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2010;20(3):55–62. (In Russ.) Available at: http://old-gastro-j.ru/article/218-effektivnost-antisekretornoy-terapiiingibitorami-protonnoy-pompyi-pri-gastroduodenalnyih-yazven/.

13. Tsimmerman Ya.S. Ulcer disease: challenging problems of etiology, pathogenesis, differential treatment. In: Unsolved and Debatable Issues of Modern Gastroenterology. Мoscow: MEDpress-inform; 2013, pp. 85–107. (In Russ.) Available at: https://www.gastroscan.ru/literature/authors/6864.

14. Shirinskaya N.V. Stomach and duodenum peptic ulcer of Russian Federation. Mortality and incidence. Dalʹnevostochnyy meditsinskiy zhurnal = Far East Medical Journal. 2016;(3):105–109. (In Russ.) Available at: http://eport.fesmu.ru/dmj/20163/2016324.aspx.

15. Osadchuk M.A., Osadchuk A.M., Sibrya A.A. H. pylori-negative peptic ulcer: state-of-the-art. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2014;24(1):4–9. (In Russ.) Available at: http://old-gastro-j.ru/article/543-i-h8239-pylori-i-negativnaya-yazvennaya-bolezn-sovremennoe-sostoyanieproblemyi-nbsp-nbsp-nbsp/.

16. Ivashkin V.T. Гастроэнтерология. Национальное руководство: краткое издание. Мoscow; 2015. 480 p. (In Russ.) Available at: https://www.rosmedlib.ru/book/ISBN9785970434086.html.

17. Laine L., Takeuchi K., Tarnawski A. Gastric mucosal defense and cytoprotection: bench to bedside. Gastroenterology. 2008;135(1):41–60. doi: 10.1053/j. gastro.2008.05.030.

18. Ivashkin V.T., Sheptulin A.A., Baranskaya E.K., Trukhmanov A.S., Lapina T.L., Kalinin A.V. et al. Clinical guidelines for diagnosis and treatment of peptic ulcer disease. Moscow; 2013. 39 p. (In Russ.) Available at: https://mzdrav.rk.gov.ru/file/Jazvennaja%20bolezn.pdf.

19. Skvortsov V.V., Fateeva O.V., Skvortsova E.M. Lansoprazole in treatment of duodenal ulcer desease. Meditsinskiy sovet = Medical Council. 2019;(3): 125–129. (In Russ.) doi: 10.21518/2079-701X-2019-3-125-129

20. Pimanov S.I., Makarenko E.V. Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori infection treatment. Consilium Medicum. 2017;19(18.1 Gastroenerology):8–27. (In Russ.) Available at: https://cyberleninka.ru/article/n/rekomendatsii-maastriht-v-florentiyskogokonsensusa-po-lecheniyu-helikobakternoy-infektsii/viewer.

21. Tkachenko E., Uspenskiy Yu., Baryshnikova N. Optimization of treatment for helicobacter pylori-associated diseases. Vrach = The Doctor. 2012;(1):36– 38. (In Russ.) Available at: https://elibrary.ru/item.asp?id=17632284.

22. Isaeva G.Sh. Antimicrobial resistance of H. pylori and susceptibility determination methods. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy. 2010;12(1):57–66. (In Russ.) Available at: https://cyberleninka.ru/article/n/rezistentnost-h-pylori-k-antibakterialnym-preparatam-i-metodyee-opredeleniya/viewer.

23. Bugaeva L.I., Dubodelova N.G., Goncharova O.M., Soluyanova I.P., Kruglyakova L.V. Peptic ulcer. Results of the out-patient treatment. Amurskiy meditsinskiy zhurnal = Amur Medical Journal. 2019;(1):10–15. (In Russ.) Available at: https://www.amursma.ru/upload/iblock/04b/2._Bugaeva_L.I.,_Dubodelova_N.G.,_Goncharova_O.M.,_Soluyanova_I.P.,_Kruglyakova_L.V._Yazvennaya_bolezn._Rezultaty_ambulatornogo_lecheniya.pdf.

24. Osipova A.S. Gastroduodenal ulcers and their complications. Voprosy nauki i obrazovaniya = Challenges in Science and Education. 2017;(9):66– 69. (In Russ.) Available at: https://elibrary.ru/item.asp?id=30468075.

25. Privalova I.B. Complications of gastroduodenal ulcer. Irkutsk; 2015. 26 p. (In Russ.) Available at: https://www.irgups.ru/sites/default/files/mkzht/uchebnoe_posobie_yab.pdf.

26. Skvortsov V.V., Emel’yanov D.N., Lun’kov M.V., Kuznetsova E.V., Bessonov A.A. Modern antibiotic regimens and proton pump inhibitors in the treatment of duodenal ulcer. Lekarstvennyy vestnik = Drug Information. 2019;13(2):44–52. (In Russ.) Available at: https://www.volgmed.ru/uploads/journals/articles/1567509385-drugs-bulletin-2019-2-3403.pdf.

27. Minushkin O.N. Experience with eradication regimen (sequential therapy) of duodenal ulcer. Meditsinskiy alfavit = Medical Alphabet. 2016;(34): 50–52. (In Russ.).

28. Vasilev Yu.V. Modern therapy of Helicobacter pylori-associated peptic ulcer disease. Trudnyy patsient = Difficult Patient. 2007;(6–7):5–8. (In Russ.) Available at: https://www.gastroscan.ru/literature/authors/1586.

29. Zhang Z., Liu Z.Q., Zheng P.Y., Tang F.A., Yang P.C. Infuence of pump inhibitors on the multidrug resistance of Helicobacter pylori. World J Gastroenterol. 2010;16(10):1279–1284. doi: 10.3748/wjg.v16.i10.1279.