Complications of peptic ulcer disease

Surgical complications of peptic ulcer disease

As long as the disease runs a course without acute deterioration, elective conservative treatment is managed by therapists and gastroenterologists. However, once complications arise, the patient immediately falls under the care of surgeons. It is the development of severe complications that is the main cause of mortality in this pathology.

The key surgical complications are considered to be:

• Perforated ulcer (perforation). This is an acute surgical emergency that occurs in the area of the ulcer defect due to transmural destruction of the stomach or duodenal wall. As a result, the aggressive contents of the gastrointestinal tract spill into the free peritoneal cavity, inevitably leading to severe peritonitis.
• Ulcerative gastroduodenal bleeding. This is the outpouring of blood directly into the lumen of the gastrointestinal tract. The source of blood loss is a damaged vessel in the base or edge of a gastric or duodenal ulcer. This complication is observed in 20–25% of patients.
• Decompensated stenosis. Pathological narrowing of the organ lumen resulting from ulcer scarring and hindering the normal passage of food masses.

Epidemiology and statistics

Statistical data show that the prevalence of peptic ulcer disease in the population continues to grow steadily. The incidence has pronounced demographic and geographical features that must be considered when taking a patient history.

Age and gender characteristics: The peak incidence traditionally occurs in adults aged 40 to 60 years. There is a distinct sexual dimorphism: men fall ill significantly more often than women, which is especially noticeable in the age group under 50.

Defect localization: Duodenal ulcer lesions overwhelmingly predominate over gastric lesions. In the general population, this ratio is three to one (3:1). In young patients, this gap becomes even more dramatic—ten to one (10:1) in favor of duodenal ulcers.

Environmental factors and infection: Urbanization leaves its mark on statistics: the incidence among urban residents is consistently higher than in the rural population. A crucial role is played by H. pylori infection, which reaches high rates (40–50%) even among children aged 5–7 years.

Gastric hypersecretion syndrome

The severe course of peptic ulcer disease is often accompanied by gastric hypersecretion syndrome. Excessive production of digestive juices leads to progressive mucosal damage and a whole cascade of pathological reactions.

Main side effects and complications of hypersecretory syndrome:

1. The emergence of peptic ulcers of the stomach and duodenum, which are often multiple and tend to constantly recur.
2. Direct triggering of the classic triad of surgical complications: perforations, massive bleeding, and stenosis.
3. Development of reflux esophagitis due to the pathological reflux of aggressive contents into the esophagus.
4. Ulcerative enteritis formation when the process spreads to the underlying parts of the small intestine.
5. Progressive deterioration of the patient's general condition, accompanied by pronounced pain syndrome and severe dyspepsia.

Class and exam questions

What else to study on this topic

• Pathogenesis of peritonitis development in perforated ulcer
• Mechanisms of decompensated stenosis formation
• Relationship between H. pylori infection and the development of hypersecretion
• Features of the clinical picture of ulcerative enteritis

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