Chronic peptic ulcer

　　What complications are prone to occur in chronic peptic ulcer? Briefly described as follows:

　　1. Massive hemorrhage It is the most common complication of the disease, with an incidence rate of about 20% to 25% of patients with the disease, and it is also the most common cause of upper gastrointestinal bleeding. The occurrence of bleeding complications is more common in gastric ulcer with duodenal ulcer, and it is even more common in postbulbar ulcer. The history of peptic ulcer in patients with bleeding complications is usually within one year, but after one bleeding episode, it is easy to have a second or more bleeding episodes. There are also 10% to 15% of patients whose first symptom of peptic ulcer is massive bleeding.

　　2. Perforation If the ulcer penetrates the serosal layer and reaches the free peritoneal cavity, it can cause acute perforation; if the ulcer penetrates and adheres to adjacent organs or tissues, it is called a penetrating ulcer or chronic perforation of the ulcer. When the posterior wall perforation or the perforation is small and only causes localized peritonitis, it is called subacute perforation.

　　3. Pyloric obstruction Mostly caused by duodenal ulcer, but can also occur in prepyloric and pyloric ulcer. The cause is usually due to the active phase of the ulcer, inflammatory congestion, edema, or reflex pyloric spasm around the ulcer. This type of pyloric obstruction is temporary and can disappear with the improvement of the ulcer; effective in internal medicine treatment, hence called functional or medical pyloric obstruction. Conversely, those caused by ulcer healing, scar formation, contraction of scar tissue, or adhesion with surrounding tissues to block the pyloric passage are persistent and cannot be automatically relieved without surgical intervention, known as organic and surgical pyloric obstruction.

　　4. Cancer transformation Whether gastric ulcer can transform into cancer is still a controversial issue.

　　What are the typical symptoms of chronic peptic ulcer? Briefly described as follows:

　　I. Characteristics of pain in peptic ulcer

　　1. Long-term. Since ulcers can heal on their own, but tend to recur after healing, there is often a long-term and recurrent characteristic of upper abdominal pain. The average course of the disease is about 6-7 years, some can last for ten to twenty years or even longer.

　　2. Periodicity. The recurring periodic发作 of upper abdominal pain is one of the characteristics of this type of ulcer, especially prominent in duodenal ulcer. The onset of upper abdominal pain can last for several days, weeks, or even longer, followed by a longer period of remission. It can occur throughout the year, but it is more common in spring and autumn.

　　3. Rhythm. The relationship between ulcer pain and diet has a significant correlation and rhythm. In the period from 3 a.m. to breakfast, the secretion of stomach acid is at its lowest, so pain rarely occurs during this time. The pain of duodenal ulcer usually occurs between meals and continues to decrease until after eating or taking antacid medication. Some patients with duodenal ulcer may experience pain in the middle of the night due to higher stomach acid levels at night, especially if they have eaten before going to bed. The occurrence of gastric ulcer pain is irregular, often occurring within one hour after a meal, gradually subsiding after 1-2 hours, and reappearing after eating again, following the same rhythm.

　　4. Location of pain. The pain of duodenal ulcer usually appears in the upper middle abdomen, or above the navel, or slightly to the right of the navel; the pain of gastric ulcer is also often located in the upper middle abdomen, slightly higher, or below the sternum and slightly to the left of the sternum. The pain area is about several centimeters in diameter. Because the localization of pain from hollow visceral organs on the surface of the body is generally not very accurate, the location of the pain may not necessarily accurately reflect the anatomical location of the ulcer.

　　5. Nature of pain. It usually presents as dull pain, burning pain, or hunger pain, which is generally mild and tolerable. Persistent severe pain may indicate penetration or perforation of the ulcer.

　　II. Other symptoms and signs of peptic ulcer

　　1. Other symptoms. In addition to upper abdominal pain, this disease may also have other gastrointestinal symptoms such as increased saliva secretion, heartburn, regurgitation, acid regurgitation, belching, nausea, and vomiting. Appetite usually remains normal, but occasionally, due to pain after eating, people may fear eating, leading to weight loss. There may be symptoms of neuroses such as insomnia, or symptoms of imbalance in the autonomic nervous system such as bradycardia and excessive sweating.

　　2. Signs. During the attack of the ulcer, there may be localized tenderness in the upper middle abdomen, which is not severe and usually corresponds to the location of the ulcer.

　　How to prevent chronic peptic ulcer? Briefly described as follows:

　　1. Diet plays an important role in controlling or reducing the incidence of diseases. Avoid overeating and irregular meals, and eat at regular times. Distribute the three meals reasonably, eat less and more frequently, chew slowly and swallow; mainly consume foods made of flour, eat more light vegetables or fruits; limit the consumption of foods rich in crude fiber such as corn flour and seeds, to reduce the adverse stimulation to the stomach and duodenum; limit the intake of sweets, meat, and foods that are easy to cause bloating and oil-frying, as they can lead to mechanical expansion of the stomach and excessive secretion of stomach acid; avoid spicy foods, smoking, and drinking, as they can increase the risk of recurrence of the disease. The main cooking methods are steaming, boiling, frying, and stewing.

　　2. If symptoms such as abdominal pain, acid regurgitation, and discomfort occur, seek medical attention promptly. Those who have the condition should eat less and more frequently, generally 5 meals a day, with a snack between meals, which can be soda crackers or soy milk. Breakfast should include soy milk or milk with toast or steamed bun, and the midday and evening meals should include soft rice or noodles, without eating too fast or too full.

　　3. If black stools are found, it indicates a possible gastric hemorrhage, and immediate medical attention and hospitalization are required. A liquid diet is recommended, with 2-3 meals per day, 6-7 meals a day, 200 ml of soy milk or milk per meal, and 1 dose of alkaline medication between meals. Generally, the blood stops and stools turn yellow after about a week. At this time, it is advisable to adopt non-fibrous semi-liquid and soft rice-based foods.

　　4. Reasonably arrange study, work, and life. Establish good hygiene habits, maintain regular living and sleeping patterns, have regular meals, ensure sufficient sleep, pay attention to the combination of work and rest; appropriately participate in sports and exercise to improve the digestive function of the gastrointestinal tract, enhance the body's disease resistance, and reduce the incidence; actively prevent and treat chronic inflammation of the upper respiratory tract and oral cavity to prevent inflammatory secretions from being swallowed into the stomach; pay attention to dietary adjustment, have regular bowel movements, eliminate constipation, and maintain normal gastrointestinal function.

　　What laboratory tests are needed for chronic peptic ulcer? Briefly described as follows:

　　One, Endoscopic Examination

　　Whether choosing fiberoptic gastroscopy or electronic gastroscopy, they are both considered as the main methods for diagnosing peptic ulcer. Under the direct vision of the endoscope, peptic ulcers are usually circular, elliptical, or linear with sharp edges, smooth in appearance, covered with grayish or grayish-yellow film, with the surrounding mucosa congested, edematous, and slightly elevated.

　　Two, Barium Meal X-ray Examination

　　The main X-ray signs of peptic ulcer are ulcers or ulcer shadows, which are caused by the filling of barium suspension in the concave part of the ulcer. In the frontal view, the shadow is usually circular or elliptical with a neat edge. A circular transparent area is formed due to the inflammatory edema around the ulcer.

　　Three, Detection of HP Infection

　　The detection methods for HP infection are generally divided into four categories:

　　1. Directly examine HP from the gastric mucosal tissue, including bacterial culture, tissue smear or section staining for bacterial examination;

　　2. Determine the activity of gastric urease using methods such as urease test, respiratory test, and detection of urea nitrogen in gastric juice;

　　3. Conduct serological tests for anti-HP antibodies;

　　4. Determine HP-DNA using polymerase chain reaction (PCR) technology. Bacterial culture is the most reliable method for diagnosing HP infection.

　　Four, Gastric Juice Analysis

　　The baseline acid output (BAO) of normal males and females is average 2.5 mmol/h and 1.3 mmol/h, respectively, while for patients with duodenal ulcer, the BAO is average 5.0 mmol/h for males and 3.0 mmol/h for females. When BAO exceeds 10 mmol/h, it often suggests the possibility of gastrinoma. After the injection of pentagastrin at a dose of 6 μg/kg, the maximum acid output (MAO) in patients with duodenal ulcer often exceeds 40 mmol/h.

　　What should be paid attention to in the diet taboo for patients with chronic peptic ulcers? Briefly described as follows:

　　1. Develop good eating habits, eat three meals a day on time and in proper amounts, do not overeat or eat before going to bed;

　　2. Eat less spicy foods, avoid the damage to the stomach from smoking, drinking, cold foods, etc.;

　　3. Adjust work rhythm, ensure adequate sleep to relieve work stress. Relax and maintain a peaceful state of mind.

　　4. Eat less starchy foods, such as potatoes, taros, vermicelli, noodles, sweet potatoes, and other cold noodles. Do not eat soda crackers, etc., eat less and more meals, eat on time, and do not eat too hard and indigestible foods.

　　The drugs used to treat peptic ulcers mainly include drugs that reduce gastric acid, drugs that eradicate Helicobacter pylori infection, and drugs that enhance the protective effect of the gastric mucosa.

　　1. Histamine H2 receptor antagonist histamine H₂receptor antagonist selectively competes with H₂receptor, thereby reducing the production of cAMP7 in the parietal cells and the secretion of gastric acid, making it effective for the treatment of peptic ulcers.

　　2. Proton pump inhibitors The final step of gastric acid secretion is the secretion of intracellular protons by the wall cells driven by the intracellular proton pump H⁺with K inside the tubule⁺exchange, the proton pump is H^+_,K⁺, ATPase. Proton pump inhibitors can significantly reduce acid secretion stimulated by any stimulus.

　　3. Colloidal bismuth subcitrate (GBS) The trade name is De-Nol, Denol, and Dilu.

　　4. Prostaglandin E It is a class of drugs used in the treatment of peptic ulcers in recent years.

　　5. Sucralfate Sucralfate is a compound of sulfated disaccharide and aluminum hydroxide, which forms a paste-like viscous substance in acidic gastric juice, can adhere to the surface of the stomach and duodenum mucosa, and has a particularly significant adhesion effect on the ulcer surface.

　　6. Epidermal Growth Factor (EGF) EGF is a polypeptide secreted by salivary glands, Brunner's glands, and the pancreas.

　　7. Somatostatin Somatostatin can inhibit the secretion of gastrin, and inhibiting the secretion of gastric acid can synergistically protect the gastric mucosa with prostaglandins. It is mainly used for the treatment of gastric and duodenal ulcer hemorrhage.