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Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society)

https://doi.org/10.22416/1382-4376-2020-30-1-49-70

Abstract

Aim. These clinical recommendations present up-to-date methods for the diagnosis and treatment of peptic ulcer. The recommendations are intended for gastroenterologists and general practitioners.

General provisions. Peptic ulcer (PU) represents a chronic relapsing disease occurring with alternating periods of exacerbation and remission. The main manifestation of the disease is the formation of a defect (ulcer) in the wall of the stomach and duodenum. Most cases of peptic ulcer are pathogenetically associated with the infection of H. pylori. PU can be an independent disease or represent symptomatic ulcers of the stomach and duodenum (medicinal, as a result of stress or endocrine pathologies, associated with chronic diseases of internal organs). In the absence of contraindications, esophagogastroduodenoscopy is recommended for all patients with suspected ulcer with the purpose of confirming the diagnosis. In order to determine indications for eradication therapy, all ulcer patients should be tested for the presence of H. pylori using a 13C-breath test or a stool antigen test. In the case of simultaneous endoscopy, rapid urease test can be used. For the prevention of subsequent relapses of ulcer, all PU patients with confirmed H. pylori should undergo eradication therapy. In addition, in order to achieve ulcer healing, 4–6 week antisecretory therapy with proton pump inhibitors is recommended. Clinical recommendations contain criteria for assessing the quality of medical care, an algorithm of the doctor’s actions, as well as information for patients.

Conclusions. These clinical recommendations present modern ideas about the etiology and pathogenesis of peptic ulcer disease, its clinical manifestations, methods of laboratory and instrumental diagnostics and basic approaches to conservative and surgical treatment.

About the Authors

V. T. Ivashkin
I.M. Sechenov First Moscow State Medical University
Russian Federation
RAS Academician, Dr. Sci. (Med.), Prof., Departmental Head, Department of Internal Disease Propaedeutics

119991, Moscow, Pogodinskaya str., 1, building 1



I. V. Maev
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

RAS Academician, Dr. Sci. (Med.), Prof., Departmental Head, Department of Internal Disease Propaedeutics and Gastroenterology

127473, Moscow, Delegatskaya str., 20, building 1



P. V. Tsar’kov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Dr. Sci. (Med.), Prof., Director, Clinic for Coloproctology and Minimally Invasive Surgery, University Clinical Hospital No. 2

119991, Moscow, Pogodinskaya str., 1, building 1



M. P. Korolev
St. Petersburg State Paediatric Medical University
Russian Federation
Dr. Sci. (Med.), Departmental Head, Department of General Surgery with an Endoscopy Course

119014, St. Petersburg, Liteiny prospect, 56



D. N. Andreev
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Cand. Sci. (Med.), Research Assistant, Department of Internal Disease Propedeutics and Gastroenterology

127473, Moscow, Delegatskaya str., 20, building 1



E. K. Baranskaya
I.M. Sechenov First Moscow State Medical University
Russian Federation

Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics

119991, Moscow, Pogodinskaya str., 1, building 1



S. G. Burkov
Polyclinic No. 3 of the Administrative Department of the President of the Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Deputy Chief Physician

119090, Moscow, Grokholsky per., 31



A. A. Derinov
I.M. Sechenov First Moscow State Medical University
Russian Federation
Cand. Sci. (Med.), Ass. Prof., Department of Surgery, Institute of Clinical Medicine

119991, Moscow, Pogodinskaya str., 1, building 1



S. K. Efetov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Cand. Sci. (Med.), Ass. Prof., Department of Surgery, Institute of Clinical Medicine

119991, Moscow, Pogodinskaya str., 1, building 1



T. L. Lapina
I.M. Sechenov First Moscow State Medical University
Russian Federation

Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics

119991, Moscow, Pogodinskaya str., 1, building 1



P. V. Pavlov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Cand. Sci. (Med.), Departmental Head, Department of Diagnostic and Therapeutic Endoscopy, University Clinical Hospital No. 2

119991, Moscow, Pogodinskaya str., 1, building 1



S. S. Pirogov
P.A. Gertsen National Medical Research Centre for Radiology, branch of the Moscow Research Institute of Oncology
Russian Federation

Dr. Sci. (Med.), Departmental Head, Endoscopy Department

125284, Moscow, 2nd Botkinsky pr., 3



A. V. Tkachev
Rostov State Medical University
Russian Federation

Doc. Sci. (Med.), Prof., Departmental Head, Department of Internal Diseases Propaedeutics

344022, Rostov-on-Don, Nakhichevansky per., 29



A. S. Trukhmanov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics

119991, Moscow, Pogodinskaya str., 1, building 1



E. D. Fedorov
Pirogov National Research University
Russian Federation
Dr. Sci. (Med.), Prof., Chief Researcher, Scientific and Educational Centre for Abnormal Surgery and Endoscopy, Department of Hospital Surgery No. 2 with the Research Laboratory of Gastroenterology and Endoscopy

119415, Moscow, Lobachevskogo str., 42



A. A. Sheptulin
I.M. Sechenov First Moscow State Medical University
Russian Federation

Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics

119991, Moscow, Pogodinskaya str., 1, building 1



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66. Evseev M.A., Klishin I.M. The effectiveness of antisecretory therapy with proton pump inhibitors in gastroduodenal ulcer bleeding. Rus J Gastroentorol Hepatol Coloproctol. 2010;20(3):55–62 (In Russ.).

67. Barkun, A.N., Martel M., Thomsen R.W., et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.

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72. Chatten K., Pursell H., Banerjee A.K., et al. Glasgow Blatchford Score and risk stratifications in acute upper gastrointestinal bleeding: can we extend this to 2 for urgent outpatient management? Clin Med (Lond). 2018;18(2):118–22.

73. Farrar F.C. Management of Acute Gastrointestinal Bleed. Crit Care Nurs Clin North Am. 2018;30(1):55–66.

74. Leontiadis G.I., Molloy-Bland M., Moayyedi P., Howden C.W. Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and metaanalysis. Am J Gastroenterol. 2013;108(3):331–45; quiz 346.

75. Moller M.H., Adamsen S., Thomsen R.W., Moller A.M. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systemati c review. Scand J Gastroenterol. 2010;45(7–8):785–805.

76. Elmunzer B.J., Young S.D., Inadoni J.M., et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008;103(10):2625–32; quiz 2633.

77. Tsoi K.K., Chan H.C., Chiu P.W. Second-look endoscopy with thermal coagulation or injections for peptic ulcer bleeding: a meta-analysis. J Gastroenterol Hepatol. 2010;25(1):8–13.

78. Barkun A.N., Martel M., Toubouti Y., et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with highrisk lesions: a series of meta-analyses. Gastrointest Endosc. 2009;69(4):786–99.

79. Morris D.L., Hawker P.C., Brearley S., et al. Optimal timing of operation for bleeding peptic ulcer: prospective randomized trial. Br Med J (Clin Res Ed). 1984;288(6426):1277–80.

80. Lagoo J., Pappas T.N., Perez A. A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease. Am J Surg. 2014;207(1):120–6.

81. Gurusamy K.S. Pallari E., Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database Syst Rev. 2016;3:CD011523.

82. Soreide K., Thorsen K., Harrison E.M. Perforated peptic ulcer. Lancet. 2015;386(10 000):1288–98.

83. Tomtitchong, P., Siribumrungwomg B., Vilaichone R.K. Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer. Helicobacter. 2012;17(2):148–52.

84. Sharma V.K., Sahai A.V., Corder F.A., Howden C.W. Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage. Aliment Pharmacol Ther. 2001;15(12):1939–47.

85. Gisbert J.P., Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(4):848–63.

86. Forman D., Graham D.Y. Review article: Impact of Helicobacter pylori on society-role for a strategy of “search and eradicate”. Aliment. Pharmaсol Ther. 2004;19 (suppl. 1):17–21.

87. Mayev I.V., Samsonov A.A. Duodenal ulcer: various approaches to modern conservative therapy. Consilium medicum. 2004; 1: 6–11 (In Russ.).

88. Burkov S.G. Digestive diseases in pregnant women. Moscow: CRON-Press Publ. H., 1996 (In Russ.).

89. Cappell M.S. The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterology clinics of North America. 2003;32:123–79.


Review

For citations:


Ivashkin V.T., Maev I.V., Tsar’kov P.V., Korolev M.P., Andreev D.N., Baranskaya E.K., Burkov S.G., Derinov A.A., Efetov S.K., Lapina T.L., Pavlov P.V., Pirogov S.S., Tkachev A.V., Trukhmanov A.S., Fedorov E.D., Sheptulin A.A. Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(1):49-70. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-1-49-70

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