Gastric Ulcer

　　Normal gastric mucosa has a perfect and effective defense and repair mechanism that is sufficient to resist the erosion of gastric acid and pepsin. Only when certain factors damage this mechanism is it possible for the erosion of gastric acid and pepsin to the mucosa to lead to the formation of ulcers. Recent research has clearly shown that Helicobacter pylori and non-steroidal anti-inflammatory drugs are the most common causes of damage to the gastric duodenal mucosal barrier, leading to the onset of peptic ulcer disease. When excessive gastric acid secretion far exceeds the defensive and repair functions of the mucosa, it may also lead to the occurrence of peptic ulcer disease.

　　(1) Helicobacter pylori infection

　　Helicobacter pylori is an important cause of gastric ulcer. It is generally believed that the infection of Helicobacter pylori causes gastric mucosal inflammation, which weakens the barrier function of the gastric mucosa, leading to damage to the barrier by gastric acid and erosive effects on the gastric mucosa.

　　(2) Non-steroidal anti-inflammatory drugs

　　Non-steroidal anti-inflammatory drugs, abbreviated as NSAIDs, are also common causes of gastric ulcers. The risk of ulcer formation and the occurrence of complications are related not only to the type, dose, and course of NSAID administration, but also to factors such as age, concurrent use of anticoagulant drugs, and corticosteroids. NSAIDs lead to the onset of peptic ulcer disease by weakening the defensive and repair functions of the mucosa.

　　(3) Gastric acid and pepsin

　　The basal acid output (BAO) and maximum acid output (MAO) of patients with gastric ulcer (GU) are mostly normal or low. This may be explained by the fact that GU patients often have multifocal atrophic gastritis, so the acid secretion function of the corpus gastric cells has been affected. In rare special cases, such as patients with gastrinoma, the aggressive effect of extremely increased gastric acid secretion far exceeds the defensive function of the mucosa and becomes the initiating factor for ulcer formation.

　　(4) Smoking

　　Smoking affects ulcer healing and promotes recurrence of ulcers, and its exact mechanism is unclear. It may be related to factors such as smoking increasing gastric acid secretion, reducing duodenal and pancreatic bicarbonate secretion, affecting the coordinated movement of the stomach and duodenum, and increasing mucosal-damaging oxygen free radicals.

　　(5) Emergency response

　　Acute stress can cause stress ulcers, but the pathogenic role of emotional stress and psychological disorders in chronic ulcer patients is not definite.

　　In summary, gastric ulcer is a multifactorial disease. Helicobacter pylori infection and the use of NSAIDs are known to be the main causes. The occurrence of ulcers is the result of unbalanced mucosal invasion factors and defense factors, with gastric acid playing a key role in the formation of ulcers.

　　Among most patients with gastrointestinal diseases, gastric ulcer is a common disease. However, according to regional differences, the incidence of gastric ulcer varies. If gastric ulcer is not treated in time, its harm is great.

　　Common complications of gastric ulcers include:

　　(1) Upper gastrointestinal bleeding

　　Gastric ulcers can erode surrounding blood vessels, causing bleeding. Upper gastrointestinal bleeding is the most common complication of peptic ulcers, and gastric ulcers are the most common cause of upper gastrointestinal hemorrhage.

　　(2) Gastric perforation

　　If the ulcer lesion penetrates the serosal layer, perforation may occur. After perforation, the leakage of gastric contents into the abdominal cavity causes acute peritonitis. Perforations near the posterior wall or small free perforations that only cause localized peritonitis are called subacute perforations, which are less severe than acute perforations in symptoms but more localized in signs.

　　(3) Pyloric obstruction

　　It can be caused by a pyloric ulcer. During an acute attack, temporary obstruction can occur due to inflammation, edema, and spasm of the pyloric area, which can be relieved as the inflammation improves; chronic obstruction is mainly due to scar contraction and is persistent.

　　(4) Gastric cancer

　　A small number of gastric ulcers can undergo canceration, which occurs at the edge of the ulcer. Patients with a long history of chronic gastric ulcers, over 45 years of age, or those with refractory ulcers should be vigilant.

　　The symptoms of gastric ulcers are often atypical, and can manifest as upper abdominal pain and discomfort. Most people can experience various symptoms of dyspepsia, but some may have no symptoms at all until complications occur. The common complications include bleeding, perforation, pyloric obstruction, and canceration. The common gastrointestinal symptoms and systemic symptoms include belching, acid regurgitation, upper abdominal distension, burning sensation behind the sternum, nausea, vomiting, loss of appetite, etc. Acid regurgitation and burning sensation behind the sternum are due to relaxation of the esophageal sphincter, and nausea and vomiting often reflect that the ulcer may be in an active phase. Frequent vomiting of undigested food may indicate pyloric obstruction. Some patients may have symptoms of autonomic nervous system dysfunction, such as insomnia and sweating.

　　Characteristics of upper abdominal pain in gastric ulcers:

　　1. Chronic processExcept for a few patients who seek medical attention early, the majority of patients have had the disease for several years, a decade or even longer.

　　2. CyclicMost patients experience recurrent episodes, and the onset and remission periods alternate with changes in factors such as seasonal changes, mental stress, emotional fluctuations, dietary imbalance, or taking medications related to the onset. This reflects the repetitive process of the ulcer cycle, including the acute active phase, gradual healing, and scarring. The onset period can last for several weeks or even months, while the remission period can last for several months or years. The frequency of onset and the duration of onset and remission vary due to individual differences among patients, the development of the ulcer, the effectiveness of treatment, and measures to consolidate the efficacy.

　　3. RhythmThe pain mechanism of ulcers is mainly related to the excessive secretion of gastric acid stimulating the ulcer surface, hence the pain patterns of ulcers in different locations have different regularities. The pain of gastric ulcers usually appears half an hour after a meal, lasting for 1 to 2 hours and gradually disappearing, only to reappear after another meal, forming a repetitive cycle. When the gastric ulcer is located at the pyloric canal or coexists with duodenal ulcer, the pain rhythm can be the same as that of duodenal ulcer. However, the pain rhythm of some special types of ulcer diseases is not very obvious, such as elderly ulcers and postbulbar duodenal ulcers. It is noteworthy that when the rhythm of pain suddenly changes, it should be considered that the condition is developing or other complications may occur.

　　4. Location of pain:The pain of gastric ulcer is usually located below the xiphoid process (i.e., the usual heart窝窝) in the center or slightly to the left, with a generally limited range of pain, local tenderness, but the site of pain is not necessarily the location of the ulcer. When the ulcer reaches the serosal layer or is a penetrating ulcer, the pain may spread to other parts of the body such as the chest, upper left abdomen, upper right abdomen, or back.

　　5. Nature and degree of pain:The tolerance to pain varies from person to person, so there is no objective standard for the degree of pain in ulcer disease, and its nature also depends on the patient's perception. It is usually described as a feeling of hunger, dull pain, belching, pressure, burning pain, severe pain, or pricking pain.

　　Gastric ulcer is a common gastrointestinal disease caused by the self-digestion of gastric acid and pepsin on the mucosa. Helicobacter pylori infection and irregular diet are the main reasons for the formation of ulcers. Paying attention to the prevention of factors that may cause gastric ulcer can reduce the occurrence of gastric ulcer. Daily preventive measures for gastric ulcer include:

　　(1) Rational diet

　　Drinks such as alcohol, coffee, strong tea, Coca-Cola, etc., can stimulate increased secretion of gastric acid, easily induce ulcer disease, and should be avoided in large quantities. Food should be chosen high in fiber, non-irritating, and easy to digest, with small and frequent meals.

　　(2) Quit smoking

　　Smoking can promote the secretion of gastric acid and pepsinogen, weaken the ability to neutralize the acidic fluid in the fundus, lead to bile reflux due to the dysfunction of the pyloric sphincter, damage the gastric mucosal barrier, and cause delayed gastric emptying and affect the motility of the stomach and duodenum. It reduces the amount of mucus and mucosal blood flow, thereby reducing the defensive function of the mucosa. Since smoking affects ulcer healing and can promote the recurrence of ulcers, smoking cessation is necessary to prevent gastric ulcers.

　　(3) Avoid psychological factors

　　People who are chronically stressed, anxious, or subject to emotional fluctuations are prone to ulcers. In a state of stress, the secretion and motility of the stomach may be enhanced, with increased gastric acid secretion and accelerated emptying of the stomach. At the same time, due to sympathetic nervous system activation, the blood vessels of the stomach and duodenum constrict, mucosal blood flow decreases, and the inherent defense function of the mucosa is weakened.

　　(4) Discontinue non-steroidal anti-inflammatory drugs

　　Long-term use of non-steroidal anti-inflammatory drugs is prone to cause gastric ulcers. In addition to the direct stimulating effect on the gastric mucosa, it is mainly due to the suppression of cyclooxygenase activity by these drugs, which reduces the synthesis of prostaglandins in the mucosa, weakening the protective effect on the mucosa.

　　The diagnosis of gastric ulcer mainly depends on imaging examinations, including gastroscopy and gastrointestinal barium meal, etc. Helicobacter pylori infection is an important factor in the occurrence and development of gastric ulcer, and detecting Helicobacter pylori is an important part of the etiological diagnosis of gastric ulcer.

　　(1) Gastroscopy

　　Gastroscopy is the preferred examination method for diagnosing gastric ulcer. Gastroscopy not only allows for direct observation of the gastric mucosa but also enables the direct collection of living tissue for pathological examination and Helicobacter pylori detection. Endoscopic gastric ulcers are often circular or elliptical, but can also be linear, with smooth edges and a base covered with grayish-yellow or grayish-white exudates. The surrounding mucosa may show congestion and edema, with wrinkles converging towards the ulcer.

　　(2) Barium Meal X-ray Examination

　　Barium meal X-ray examination is suitable for those who have contraindications for gastric endoscopy or do not want to undergo gastric endoscopy. The X-ray signs of ulcers include indentation and spastic resection on the greater curvature of the stomach.

　　(3) Helicobacter pylori Detection

　　Helicobacter pylori detection is a routine examination item for the diagnosis of peptic ulcer. The detection methods are divided into invasive and non-invasive categories. The former requires a gastric endoscopy to obtain gastric mucosal tissue for detection, mainly including rapid urease test, histological examination, and Helicobacter pylori culture; the latter mainly includes 13C or 14C urea breath test, fecal Helicobacter pylori antigen detection, and serological examination (qualitative detection of serum anti-Helicobacter pylori IgG antibody).

　　Gastric ulcer patients should strengthen their nutrition by choosing easily digestible, high in calories, rich in protein and vitamins. Such as congee, thin noodles, milk, soft rice, soy milk, eggs, lean meat, tofu, and soy products. Eat more foods rich in vitamins A, B, and C, such as fresh vegetables and fruits, etc. These foods can enhance the body's resistance, help repair damaged tissues, and promote ulcer healing.

　　Common dietetic recipes for gastric ulcer patients include:

　　(1) Lotus Seed Porridge

　　30g of lotus seeds, 100g of rice. Cook as usual, eat daily, and take for one month continuously. Suitable for ulcer patients with weak spleen and stomach.

　　(2)山药粥

　　100g of山药, 100g of glutinous rice. Cook together with water into a thin porridge, take one dose daily, divided into three servings. Suitable for ulcer patients with weak spleen and stomach and duodenum.

　　(3) Glutinous Rice Porridge

　　100g of glutinous rice or sticky rice, 7 dates. Cook as usual, until very soft, and eat regularly. Suitable for ulcer patients with weak spleen and stomach, and can treat gastric and duodenal ulcers.

　　(4) Sanqi Egg Pudding

　　3g of Sanqi powder, 30ml of lotus root juice, 1 egg, a little sugar. Break the egg and mix it in a bowl; mix with fresh lotus root juice and Sanqi powder, add sugar, and mix well with the egg, then steam until熟 and serve. It can treat blood stasis type gastric ulcer, duodenal ulcer, and hemorrhage.

　　(5) Silver Ear and Date Porridge

　　20g of silver ear, 10 dates, 150g of glutinous rice. Cook as usual. Suitable for ulcer patients with weak spleen and stomach.

　　(6) Peach Kernel and Pork Stomach Porridge

　　Ingredients and preparation: 10g of peach kernel (with the peel and tip removed), 10g of raw earth, 50g of cooked pork stomach slices, 50g of rice, and appropriate amount of seasoning. Cut the stomach slices into fine pieces; boil twice the amount of water to extract the juice, add the pork stomach and rice to cook into a thin porridge, season when cooked and serve. It can invigorate qi, activate blood, dissolve blood stasis and relieve pain.

　　(7) Steamed Egg with Sanqi

　　Ingredients and preparation: One egg, 30ml of honey, 3g of Sanqi powder. Beat the egg in a bowl and mix well with the Sanqi powder, steam until熟 and then mix with honey before serving.

　　Effects: It can soothe the liver and regulate qi, harmonize the stomach and invigorate the spleen, suitable for upper abdominal pain, vomiting, accompanied by nausea, belching, etc.

　　(8) Stir-fried beef with cactus

　　Ingredients and preparation: 50g of cactus, 100g of tender beef, appropriate amount of seasonings. Peel the cactus, wash it clean, and cut it into fine pieces; wash the beef, slice it, and fry it in a hot pan until it is cooked, then season and eat. Effect: It can promote blood circulation and remove blood stasis, relieve Qi and pain, suitable for fixed pain points or symptoms like needle pain.

　　The goal of treating gastric ulcers is to eliminate the cause, alleviate symptoms, heal ulcers, prevent recurrence, and prevent complications. Treatment for the cause, such as the eradication of Helicobacter pylori, may completely cure the disease and is a major progress in the treatment of peptic ulcers in recent years.

　　(1) General treatment

　　Patients with gastric ulcers should lead a regular life, avoid overexertion and mental stress. Pay attention to dietary regularity, quit smoking and drinking, discontinue NSAID drugs, and be cautious in their use in the future.

　　(2) Western medicine treatment

　　Medications for the treatment of peptic ulcers can be divided into two major categories: drugs that inhibit gastric acid secretion and drugs that protect the gastric mucosa, mainly acting to alleviate symptoms and promote ulcer healing. They are often used in conjunction with Helicobacter pylori eradication therapy. Antacids have a neutralizing effect on gastric acid and can quickly relieve pain symptoms; drugs that protect the gastric mucosa, such as sucralfate and colloidal bismuth, are now rarely used as first-line drugs for the treatment of peptic ulcers. Bismuth potassium citrate (colloidal bismuth subcitrate) due to its strong inhibitory effect on Helicobacter pylori, can be used as a component of the Helicobacter pylori eradication combined treatment plan; for peptic ulcers caused by Helicobacter pylori infection, eradication of Helicobacter pylori not only promotes ulcer healing but also prevents recurrence, thereby curing the ulcers completely.

　　(3) Prevention of ulcer recurrence

　　Effective eradication of Helicobacter pylori and complete cessation of NSAIDs can eliminate two common causes of peptic ulcers, thus significantly reducing the recurrence of ulcers. For patients with ulcer recurrence and recurrence of Helicobacter pylori infection (re-infection or relapse), eradication of Helicobacter pylori and further treatment can be provided.

　　(4) Indications for surgery

　　Surgical treatment of gastric ulcers is mainly limited to a few patients with complications, including:

　　① Large amounts of bleeding that are ineffective after internal medicine treatment;

　　② Acute perforation;

　　③ Scarred pyloric stenosis;

　　④ Gastric ulcer carcinogenesis;

　　⑤ Stubborn ulcers that are resistant to strict internal medicine treatment.