Stomach syphilis

　　How is stomach syphilis caused? Briefly described as follows:

　　1. Etiology

　　Stomach syphilis is caused by invasion of Treponema pallidum.

　　2. Pathogenesis

　　Lesions begin in the submucosal layer of the stomach. Early syphilis can affect the gastric wall, but most are transient. The pathological changes of the gastric mucosa in the secondary stage of syphilis are not specific. Gastric lesions are mainly caused by tertiary syphilis, manifested as inflammatory infiltration and the formation of gummatous lesions, which can be solitary or multiple, showing granulomatous changes in histology, with centrally necrotic lesions surrounded by epithelioid cells, fibroblasts, and giant cells.

　　Gastric lesions are mainly caused by late-stage syphilis. Typical gummas can form in the gastric wall, but they are not common. After the gumma breaks down, it can form ulcers, scars, or penetrate the gastric wall. Due to the formation of scars, the stomach can deform into an hourglass shape.

　　What are the symptoms of stomach syphilis? Briefly described as follows:

　　The symptoms of this disease develop slowly but worsen progressively. They become apparent with the shrinkage of the stomach volume and concurrent ulcers, often starting with upper abdominal pain or discomfort after meals, accompanied by abdominal distension, nausea, vomiting, weight loss, and fatigue. Due to the formation of gastric scars and obstruction of the pylorus, abdominal pain and vomiting intensify. Some patients may have symptoms similar to peptic ulcer disease, and in a few cases, a mass can be palpated during abdominal examination.

　　How to prevent stomach syphilis? Briefly described as follows:

　　1. Within 3 months, anyone who has been in contact with infectious syphilis should be examined, diagnosed, and treated.

　　2. Sexual partners who have had contact with infectious syphilis within 3 months should be examined, diagnosed, and treated.

　　What examinations should be done for gastric syphilis? Briefly described as follows:

　　I. Laboratory examination

　　The康瓦reaction is mostly positive. There is no significant change in gastric acid in the early stage of gastric syphilis, and a decrease in gastric acid secretion can occur in the late stage.

　　II. Other auxiliary examinations

　　1. Gastric barium meal X-ray examination can suggest:

　　(1) Sandglass stomach.

　　(2) Diffuse involvement of the gastric wall, forming a leather stomach.

　　(3) There is a defect in the stomach filling.

　　(4) The stomach volume decreases and becomes tubularly narrow.

　　(5) Most are superficial ulcers, which are not easily detected by X-ray examination; if it is a large ulcer, it resembles a cancerous ulcer in X-ray examination.

　　2. In the early stage of gastric syphilis, endoscopy can show gastritis changes, including congestion, erosion, and scattered hemorrhagic spots of the gastric mucosa, and superficial ulcers can be seen in the gastric antrum. In the late stage of syphilis, narrowing of the gastric antrum, weakening of gastric wall peristalsis, and formation of large irregular ulcers after the rupture of gumma are difficult to distinguish from cancerous ulcers in appearance.

　　What should be paid attention to in the diet care of gastric syphilis patients? Briefly described as follows:

　　1. Pay attention to light diet, and it is better to choose easily digestible and absorbable foods such as vegetable porridge and noodle soup.

　　2. Fresh fruits and vegetables can be eaten more to ensure the intake of vitamins.

　　3. Provide liquid or semi-liquid foods, such as various porridge, rice gruel, etc.

　　What are the treatment methods for gastric syphilis? Briefly described as follows:

　　1. Treatment

　　Treatment can use penicillin 2 to 4 million units, intravenous infusion, once every 4 hours, for 10 consecutive days. If allergic to penicillin, erythromycin or tetracycline 2g/d can be used, infused twice, for 30 consecutive days. If the lesion is widespread, incomplete pyloric obstruction, persistent pain does not improve, and the nutritional status is very poor, surgical treatment can be considered.

　　2. Prognosis

　　Patients who have been fully treated should be followed up for 2 to 3 years. In the first year after treatment, a review should be conducted once every 3 months, including clinical and serum (non-spirochetal antigen test), and then a review should be conducted every six months. During the follow-up period, the decline in serum reaction titer and clinical changes should be observed strictly, and observation can be terminated if there is no recurrence.