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RISK FACTORS AND COMPLICATION RATES FOR PEPTIC ULCER DISEASE
Panjiyev Jonibek Abdumajidovich
Department of Fundamental Medical Sciences of the Asian International University, Bukhara,
Uzbekistan.
https://doi.org/10.5281/zenodo.14895151
Abstract.
Peptic ulcer disease (PUD) is characterized by discontinuation in the inner lining
of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. It extends into the
muscularis propria layer of the gastric epithelium. It usually occurs in the stomach and proximal
duodenum. It may involve the lower esophagus, distal duodenum, or jejunum. Epigastric pain
usually occurs within 15-30 minutes following a meal in patients with a gastric ulcer; on the other
hand, the pain with a duodenal ulcer tends to occur 2-3 hours after a meal. Peptic ulcer disease
(PUD) is a common digestive disorder that generally refers to an acid peptic injury in the stomach,
duodenum, Meckel’s diverticulum, or esophagus. Most studies on PUD focused on Helicobacter
pylori (H. pylori) infection, which afects gastrointestinal diseases, such as PUD and gastritis.
However, peptic ulcers are related to various risk factors other than H. pylori infection,
including socioeconomic, environmental, and psychological characteristics and other potential
factors. Besides, Peptic ulcer disease (PUD) if not diagnosed and treated promptly can lead to
serious complications.
Keywords:
peptic ulcer, risk factors, gastric cancer, penetration, perforation.
ФАКТОРЫ РИСКА И ЧАСТОТА ОСЛОЖНЕНИЙ ПРИ ЯЗВЕННОЙ БОЛЕЗНИ
Аннотация.
Язвенная болезнь (ЯБ) характеризуется нарушением внутренней
оболочки желудочно-кишечного тракта (ЖКТ) из-за секреции желудочной кислоты или
пепсина. Она распространяется на мышечный слой желудочного эпителия. Обычно она
возникает в желудке и проксимальном отделе двенадцатиперстной кишки. Она может
затрагивать нижнюю часть пищевода, дистальный отдел двенадцатиперстной кишки
или тощую кишку. Боль в эпигастрии обычно возникает в течение 15–30 минут после еды
у пациентов с язвой желудка; с другой стороны, боль при язве двенадцатиперстной кишки,
как правило, возникает через 2–3 часа после еды. Язвенная болезнь (ЯБ) —
распространенное расстройство пищеварения, которое обычно относится к кислотному
пептическому поражению желудка, двенадцатиперстной кишки, дивертикула Меккеля
или пищевода. Большинство исследований ЯБД были сосредоточены на инфекции
Helicobacter pylori (H. pylori), которая поражает желудочно-кишечные заболевания,
такие как ЯБД и гастрит. Однако язвенная болезнь связана с различными факторами
риска, помимо инфекции H. pylori, включая социально-экономические, экологические и
психологические характеристики и другие потенциальные факторы.
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Кроме того, язвенная болезнь (ЯБД), если ее не диагностировать и не лечить
своевременно, может привести к серьезным осложнениям.
Ключевые слова:
язвенная болезнь, факторы риска, рак желудка, пенетрация,
перфорация.
Peptic ulceration is a major public health problem. It is estimated that each year, peptic
ulcer disease (PUD) affects 4 million people around the world. Individuals with PUD are at risk
of developing complications such as gastroduodenal haemorrhage, perforation, penetration, and
obstruction, and mortality among patients with these complications is high. Peptic ulcer
perforation (PUP) is a frequent emergency condition worldwide associated with high mortality if
left untreated. It presents as an acute abdominal condition, with localised or generalised peritonitis
and a high risk for developing sepsis and death. PUP is a surgical emergency and carries
a mortality ranging from 1.3% to 20%. Thirty-day mortality rates reaching 20% and 90-day
mortality rates of up to 30% have been reported. Being closely related to advanced age, increased
burden of comorbidity may partially explain the higher mortality among elderly patients; however,
several other factors affect this high mortality. While Helicobacter pylori and use of non-steroidal
anti-inflammatory drugs (NSAID) are frequent causes of PUP, demographic differences in age,
gender, perforation location, and aetiology exist between countries, as do mortality rates, with
several risk factors potentially influencing the development of PUP and postoperative mortality.
Numerous studies of sociodemographic characteristics and peptic ulcers identifed various
risk factors, such as age, low education, low socioeconomic status or low salary, household
member crowding, unemployment, marital strain, a blue-collar household, meal intake regularity,
breakfast skipping, smoking, heavy alcohol intake, high div mass index (BMI), nonsteroidal anti-
infammatory drugs (NSAIDs), musculoskeletal pain, headache, psychological and physical stress,
and previous peptic ulcers. For example, an important risk factor for PUD is cigarette smoking.
Smoking is a risk factor for chronic active ulcers or asymptomatic PUD in the United
States, Israel, Taiwan, Denmark, and Norway and in American men of Japanese ancestry. Alcohol
intake was also associated with PUD. However, several studies disagreed with the association of
PUD with alcohol intake and smoking. Low education level is a risk factor for PUD because
education level was related to living conditions, such as lifestyle, diet, and social stress, and these
conditions are part of the multifactorial etiology of PUD. Similar to education level, low
socioeconomic class or status is associated with PUD. Populations in low socioeconomic class or
status are linked to heavy alcohol intake, smoking, hard physical work, hygiene, concerns about
dismissal, inadequate nutrition, use of painkillers, and psychological stress.
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Psychological stress and physical stress afect the development of ulcers because stress
aggravates gastroduodenal blood fow, reduces acid bufering in the duodenum, and diminishes
gastric hypersecretion. Stress tends to be uncontrolled and unpredictable, promotes the onset of
disease, and is one of the most common risk factors for PUD.
In addition, peptic ulcer disease (PUD) can lead to serious complications if left untreated.
The major complications include:
1. Gastrointestinal Bleeding (Most Common)
Due to erosion of blood vessels in the ulcer bed.
2. Perforation (Life-Threatening)
Full-thickness ulceration leads to perforation into the peritoneal cavity.
3. Penetration
Ulcer erodes into adjacent organs (e.g., pancreas, liver).
4. Gastric Outlet Obstruction
Due to chronic inflammation, edema, or scarring in the pyloric region.
5. Malignant Transformation (Rare)
Chronic gastric ulcers may undergo malignant changes, especially if H. pylori is present.
Gastric ulcer bleeding is a serious complication of peptic ulcer disease (PUD) and is a
major cause of upper gastrointestinal bleeding (UGIB). It occurs when an ulcer erodes into a blood
vessel, leading to acute or chronic hemorrhage.
Clinical Presentation:
Hematemesis – Vomiting fresh red blood or "coffee-ground" material.
Melena – Black, tarry stools (digested blood).
Hematochezia – Bright red blood per rectum (if severe, fast bleeding).
Epigastric pain – Often worsens with eating (gastric ulcers).
Signs of shock (in massive bleeding) – Hypotension, tachycardia, pallor, dizziness,
syncope.
Perforation is a life-threatening complication of peptic ulcer disease (PUD), occurring
when an ulcer erodes through the full thickness of the stomach wall, leading to peritonitis and
potential sepsis. It is a surgical emergency.
Clinical Presentation:
Sudden, severe epigastric pain – "Knife-like" pain, often radiating to the shoulders (due to
diaphragmatic irritation).
Rigid, board-like abdomen – Classic sign of peritonitis.
Absent bowel sounds – Due to paralytic ileus.
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Tachycardia, hypotension – Signs of shock if sepsis develops.
Fever, leukocytosis – In late stages.
Penetration occurs when a gastric ulcer extends beyond the stomach wall into adjacent
structures, such as the pancreas, liver, biliary tree, or colon. Unlike perforation, there is no free air
in the peritoneal cavity because the ulcer erodes into another organ rather than creating a hole into
the peritoneal space.
Clinical Presentation:
Persistent, intense epigastric pain – more severe than typical ulcer pain and radiates to the
back.
Pain unaffected by food or antacids – Unlike simple PUD, pain does not improve after
meals.
Weight loss & anorexia – Due to chronic discomfort.
Nausea & vomiting – If the ulcer affects gastric motility.
GI bleeding (less common) – Occult blood loss may lead to anemia.
Gastric outlet obstruction (GOO) is a complication of chronic peptic ulcer disease (PUD),
occurring due to edema, inflammation, or scarring (fibrosis) in the pyloric region. It leads to gastric
stasis, causing persistent vomiting and nutritional deficiencies.
Clinical Presentation:
Postprandial nausea & vomiting – Non-bilious, containing undigested food.
Early satiety & bloating – Due to gastric distension.
Epigastric pain – May improve after vomiting.
Weight loss & dehydration – Due to chronic vomiting and poor intake.
Visible peristalsis – "Succussion splash" on auscultation (due to retained gastric contents).
While most gastric ulcers are benign, some may undergo malignant transformation,
particularly in the presence of chronic inflammation, persistent ulceration, or underlying H. pylori
infection. Unlike duodenal ulcers, which are almost always benign, gastric ulcers have a higher
risk of being associated with malignancy, especially if they fail to heal despite treatment.
Clinical Presentation:
Persistent epigastric pain – Often dull and unresponsive to acid suppression therapy.
Unintentional weight loss – A red flag for malignancy.
Early satiety & bloating – Suggests gastric outlet involvement.
Occult GI bleeding (iron deficiency anemia, melena, or hematemesis).
Anorexia, nausea, and fatigue.
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Conclusions
: This study showed that decreased BMI, decreased Hb, increased age, and
smoking were independent risk factors for development of PUP. Thus, this group of patients needs
particular attention paid to suggestive symptoms with early diagnosis and optimal management of
peptic ulcer disease.
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