Diffuse ulcer of jejunum and ileum

　　1. Etiology

　　The etiology is unknown and is common in celiac disease patients, and some patients also have lymphoma and intestinal adenoma. However, whether these diseases are the etiology of this disease requires further clarification.

　　2. Pathogenesis

　　The ulcers in this disease are all multiple, most commonly involving the jejunum, followed by the ileum, and occasionally occurring in the duodenum or colon. The ulcers are generally deep, reaching the muscular layer, so they are prone to perforation or cicatricial contraction of the serosal surface. Microscopically, there is atrophy of the small intestinal villi, and the base and surrounding area of the ulcer show infiltration of lymphocytes, plasma cells, histiocytes, and neutrophils. The edge of the ulcer may show metaplasia of the gastric mucosa. The intestinal mucosa between ulcers is normal or shows inflammatory changes.

　　Perforation of the ulcer can occur, often with intermittent abdominal colic, followed by severe abdominal pain. Intestinal obstruction is also a common complication, and occasionally there may be intestinal bleeding.

　　About 70% of patients with acute perforation of ulcer disease have a long history of ulcer disease. Before perforation, the symptoms of ulcer disease often worsen; about 10% of patients have no history of ulcer disease and suddenly develop perforation. Before perforation, there are often triggering factors such as overeating, consuming刺激性 foods, emotional excitement, or overfatigue.

　　Diffuse jejunoileal ulcer commonly occurs in the elderly, with symptoms such as diarrhea, abdominal pain, malabsorption, and protein-losing enteropathy. Common complications include intestinal perforation and gastrointestinal bleeding, while intestinal obstruction is less common.

　　1. Rest:Rest is greatly beneficial to patients' recovery, especially for patients in the active stage who should be emphasized on having adequate rest. Because a quiet and comfortable rest environment can reduce the mental and physical burden on patients, especially before going to bed, it is necessary to relax mentally to ensure the quality of sleep, and sedatives may be taken if necessary. Patients can gradually increase their activity level after their condition improves, but generally heavy physical activities should be reduced or avoided.

　　2. Intestinal inflammation diet and nutrition:Due to diarrhea with blood, long-term insufficient intake and malnutrition, patients may have iron deficiency, folic acid deficiency, or anemia, and should receive appropriate supplementation. Generally, supplementation can be oral or injectable, and using traditional Chinese medicine for tonifying Qi and spleen, nourishing blood and kidney can also achieve the purpose of strengthening the physique and supplementing nutrition, but do not over-supplement and use medicine dialectically. Long-term diarrhea patients should supplement calcium, magnesium, and trace elements such as zinc.

　　3. While supplementing nutrition, also be aware of the damage some foods can cause to the digestive system:

　　(1) Pay attention to food hygiene.

　　(2) Avoid greasy foods.

　　(3) Avoid milk, sheep milk, and excessive sucrose.

　　(4) Avoid eating raw garlic.

　　(5) Avoid盲目 using anti-diarrheal drugs.

　　(6) Avoid high-fiber foods.

　　4. Correct electrolyte balance disorders:Severe patients may experience dehydration, water and salt metabolism disorders, and hypokalemia due to severe diarrhea, fever, and easy dehydration, especially when treated with large amounts of hormones. Increased urinary potassium excretion can easily lead to hypokalemia, which can trigger toxic megacolon. Therefore, patients should take medication under the guidance of a doctor and pay more attention to post-medication reactions. Outpatient patients who experience exacerbation of the condition and electrolyte imbalance should be hospitalized in a timely manner for timely intravenous fluid replacement, sodium chloride, and potassium salts to correct water and acid-base balance disorders. Pay attention to the care of the perianal skin: protect the anus and its surrounding area and keep it dry. The toilet paper should be soft, and the wiping action should be gentle to reduce mechanical stimulation. After defecation, wash the anus and surrounding skin with alkaline soap and warm water to reduce local irritation and discomfort from acidic excretions, digestive enzymes, and skin contact. Apply antibiotic ointment if necessary to protect the integrity of the skin.

　　The diagnosis of diffuse jejunoileal ulcer relies not only on clinical manifestations but also on examinations: X-ray barium contrast examination or endoscopic examination may find small intestinal ulcers, and oral jejunal mucosal biopsy may sometimes yield specimens of diagnostic value.

　　While supplementing nutrition, also pay attention to the damage some foods may cause to the digestive system:

　　1. Pay attention to food hygiene.

　　2. Avoid greasy foods.

　　3. Avoid milk, goat's milk, and large amounts of sucrose.

　　3. Avoid eating raw garlic.

　　5. Avoid盲目 using anti-diarrheal drugs.

　　6. Avoid high-fiber foods.

　　1. Treatment

　　There is no satisfactory drug treatment plan for this disease. Only some patients may respond to a gluten-free diet, while most scholars still recommend that all patients with the disease should follow a gluten-free diet. Adrenal corticosteroids may have some efficacy, but the long-term efficacy is yet to be evaluated. For those with concurrent intestinal perforation or massive hemorrhage who are ineffective with medical treatment, surgical treatment can be performed.

　　2. Prognosis

　　There is no satisfactory drug treatment plan for this disease. Adrenal corticosteroids may have some efficacy, but the long-term efficacy is yet to be evaluated.