Peptic ulcer

The causes of peptic ulcer disease

　　1. Helicobacter pylori infection:This bacterial infection is the main cause of chronic antral gastritis, and chronic antral gastritis is closely related to peptic ulcer disease. Most patients with peptic ulcers have concurrent chronic antral gastritis. The detection rate of Helicobacter pylori in gastric ulcers is 70% to 90%; in duodenal ulcers, the detection rate of Helicobacter pylori is as high as 95% to 100%. Therefore, all ulcers infected with Helicobacter pylori require combined antibiotic therapy to possibly achieve根治.

　　2. Drug abuse:Aspirin, indomethacin, phenylbutazone, and corticosteroids such as prednisone and dexamethasone all cause ulcerative disease, with aspirin being the most severe.

　　3. Mental factors:Poor mood and mental tension can increase the secretion of gastric acid through the nervous and endocrine system, which also affects the blood nutrition supply to the gastrointestinal mucosa, thereby causing ulcerative disease. Clinically, it is often encountered that some young people develop gastrointestinal ulcers or even bleeding when they are overworked and in a state of tension all day long.

　　4. Irregular diet:Overeating or irregular diet can affect the digestive function of the stomach, causing indigestion and malnutrition. Malnutrition can weaken the barrier function of the gastric mucosa, leading to the occurrence of ulcer disease, and can also affect the repair of the mucosa.

　　5. Snacking addiction:Because snacking stimulates the secretion of gastric acid, but since the amount of food intake is small and does not require a large amount of gastric acid to aid digestion, the excess gastric acid will digest the gastric and duodenal mucosa itself, causing peptic ulcer disease.

　　6. Smoking:The nicotine in tobacco has a damaging effect on the gastric mucosa. Long-term smoking can also cause excessive secretion of gastric acid, causing bile reflux into the stomach and destroying the gastric mucosa, inhibiting the secretion of HCO3 by the pancreas.₃^-. The ability to neutralize gastric acid decreases; and it can cause a decrease in the content of prostaglandins in the mucosa, while prostaglandins have a protective effect on the gastrointestinal mucosa. All these indicate that smoking is an important pathogenic factor for peptic ulcer disease.

　　7. Drinking:Alcohol can stimulate the secretion of gastric acid and also has a direct damaging effect on the gastric mucosa. Those who have a drinking habit and also frequently smoke or take drugs such as aspirin for a long time are more prone to ulcer disease.

　　8. Genetics:The risk of recurrence in families with ulcer patients is high. The probability of identical twins having ulcers at the same time is over 50%; in patients with duodenal ulcers, blood type O is more common than other blood types.

　　9. Geographical environment and climate:The incidence of ulcer disease varies in different regions. According to relevant gastroscopy data, the regional characteristics of peptic ulcer disease in China show that the south is higher than the north, and cities are higher than rural areas. Climate change is also one of the factors that trigger ulcer disease, with the autumn and winter and winter and spring transitions being the peak periods for peptic ulcer disease.

　　10. Other:The influence of chronic diseases. Patients with emphysema have a threefold higher incidence of duodenal ulcers than normal people; coronary heart disease and atherosclerosis can cause poor blood supply to the gastric mucosa, which can affect the healing of ulcers; the incidence of peptic ulcer disease in patients with liver cirrhosis is 2 to 3 times higher than that in the general population; patients with hepatitis B surface antigen positivity have a 33% incidence rate of gastric ulcers.

Complications of peptic ulcer disease

　　1. Massive bleeding

　　Bleeding is the most common complication of this disease, with an incidence rate of about 20% to 25% of patients with this disease, and it is also the most common cause of upper gastrointestinal bleeding. The occurrence of bleeding complications is more common in gastric ulcers than in duodenal ulcers, and it is even more common in post-pyloric ulcers. For those with bleeding complications, the history of peptic ulcer disease is usually within one year, but after one bleeding episode, it is easy to have a second or more bleeding episodes. Additionally, 10% to 15% of patients may have massive bleeding as the first symptom of peptic ulcer disease.

　　2. Perforation

　　Perforation through the serosal layer to the free peritoneal cavity can lead to acute perforation. If the ulcer perforates and adheres to adjacent organs or tissues, it is called a penetrating ulcer or chronic perforation of the ulcer; when the posterior wall perforates 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 inflammatory congestion, edema, or reflex spasm of the pylorus caused by the surrounding tissue of the ulcer during the active phase of the ulcer.

　　4. Carcinoma

　　Whether gastric ulcer can lead to cancer is still a controversial issue. Generally estimated, the incidence of gastric ulcer leading to cancer is not more than 2% to 3%, but duodenal bulb ulcer does not cause cancer.

　　Clinical manifestations of peptic ulcer disease

　　I. Characteristics of pain in peptic ulcer disease

　　1. Long-term:Since ulcers can heal spontaneously, but often recur after healing, there is often a characteristic of long-term and recurrent upper abdominal pain. The average course of the disease is 6 to 7 years, and some may last for one to two decades or even longer.

　　2. Periodicity:Recurrent periodic attacks of upper abdominal pain are one of the characteristics of this type of ulcer, especially more prominent in duodenal ulcers. The pain in the upper and middle abdomen may last for several days, weeks, or even longer, followed by a longer period of relief. It can occur throughout the year, but is more common in spring and autumn.

　　3. Rhythm:The relationship between ulcer pain and diet has a significant correlation and rhythm. In the morning, from 3 o'clock to breakfast, the secretion of gastric acid is at its lowest, so pain rarely occurs during this time. Duodenal ulcer pain occurs between meals and persists until eating or taking antacid medication before the next meal, when it is relieved. Some patients with duodenal ulcer may experience pain in the middle of the night due to higher gastric acid levels at night, especially if they have eaten before going to bed. The occurrence of gastric ulcer pain is irregular, often occurring within 1 hour after a meal, gradually subsiding after 1 to 2 hours, and then reappearing after eating again, following the same rhythm.

　　4. Location of pain:The pain of duodenal ulcer usually occurs in the upper and middle abdomen, or above the navel, or slightly to the right of the navel; the pain of gastric ulcer is also often in the upper and middle abdomen, but slightly higher, or below the xiphoid process and slightly to the left of the xiphoid process. The pain range 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, so the location of the pain does not necessarily accurately reflect the anatomical location of the ulcer.

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

　　6. Influencing factors:Pain is often induced or exacerbated by factors such as mental stimulation, overexertion, improper diet, drug effects, and changes in weather; it can be relieved or alleviated by rest, eating, taking antacid medication, pressing on the painful area with the hand, or vomiting.

　　II. Other symptoms and signs of peptic ulcer disease

　　1. Other symptoms:This disease, in addition to upper and middle abdominal pain, 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, there may be a fear of eating, leading to weight loss. General symptoms may include insomnia and other neuroses, or symptoms of autonomic nervous system imbalance such as bradycardia and excessive sweating.

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

Preventive measures for peptic ulcers

　　22. Maintain a regular lifestyle and ensure sufficient sleep. Pay attention to a balance between work and rest and avoid long-term stress.

　　21. Have regular meals three times a day, especially not skipping breakfast. Avoid overeating and overdrinking.

　　20. Consume a high-fiber diet. Reduce the intake of strong tea and coffee, and avoid spicy foods.

　　19. Reduce smoking and drinking. Excessive drinking and heavy smoking can cause damage to the gastric mucosa and increase the opportunity for Helicobacter pylori infection.

　　18. Pay attention to keeping warm during seasonal changes and eat easily digestible foods.

　　17. Treat symptoms such as abdominal distension, upper abdominal pain, frequent belching, and other upper abdominal discomfort promptly. Patients with melena or those over 45 years old should undergo gastroscopy as soon as possible.

　　16. Minimize the use of non-steroidal anti-inflammatory drugs such as indomethacin and phenylbutazone.

　　15. Patients with chronic obstructive pulmonary emphysema, chronic cholecystitis, decompensated liver cirrhosis, chronic renal failure, and chronic pancreatitis should be treated actively to reduce the incidence of ulcer disease.

Examination of peptic ulcers

　　One. Endoscopic examination

　　Whether using fiberoptic gastroscopy or electronic gastroscopy, both are considered the main methods for diagnosing peptic ulcers. Under direct vision of the endoscope, peptic ulcers are usually round, elliptical, or linear, with sharp edges, smooth in appearance, covered with grayish or grayish-yellow mucosa, with surrounding mucosa showing congestion, edema, and slight elevation.

　　Two. Barium meal X-ray examination

　　The main X-ray sign of peptic ulcer is the wall niche or niche shadow, which is caused by barium suspension filling the concave part of the ulcer. In the frontal view, the niche shadow is round or elliptical, with a neat edge. The annular lucency is formed due to inflammatory edema around the ulcer.

　　Three. Detection of Helicobacter pylori (HP) infection

　　1. Directly examine HP in gastric mucosal tissue, including bacterial culture, tissue smear, or stained section microscopic examination of bacteria. Bacterial culture is the most reliable method for diagnosing HP infection.

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

　　3. Conduct serological tests for anti-HP antibodies.

　　4. Determine HP-DNA using polymerase chain reaction (PCR) technology.

　　Four. Gastric juice analysis

　　The baseline acid output (BAO) of normal males and females is 2.5 and 1.3 mmol/h, respectively. The average BAO of male and female patients with duodenal ulcers is 5.0 and 3.0 mmol/h, respectively. When BAO exceeds 10 mmol/h, it often suggests the possibility of gastrinoma. The maximum acid output (MAO) in patients with duodenal ulcers is often over 40 mmol/h after injection of pentagastrin at a dose of 6 μg/kg. Due to the overlapping acid levels in various types of gastric juice analysis results with those of normal individuals, the diagnosis of ulcer disease is only for reference.

Diet for patients with peptic ulcers

　　1. Small and frequent meals

　　The term 'small amount' means not to eat too much in each meal to avoid overexpansion of the antrum and stimulate gastric acid secretion. Eating several small meals is to supplement the lack of small amounts. Eat 4-5 times a day, at regular times, to make the secretion of gastric acid regular.

　　2. Bread as the main food, and low-fat and moderate protein are required

　　Because bread is soft and alkaline, it is easy to digest and can neutralize gastric acid. For those not accustomed to bread, soft rice or rice porridge can be used instead. Low-fat foods can avoid stimulating the secretion of cholecystokinin, which can slow down gastric emptying, dilate the antrum, and thereby reduce gastric acid secretion.

　　3. Dietary taboos

　　Avoid刺激性 foods to reduce gastric acid secretion, such as alcohol, coffee, sour and spicy, fried foods, and legumes, etc. that produce gas. For patients with slight bleeding or after stopping massive bleeding for 24 hours, they can consume liquid food, such as noodle soup, soy milk, and rice gruel. Avoid meat soup, chicken soup, strong tea, etc. As the condition improves, gradually transition from semi-liquid to low-residue diet.

Treatment of peptic ulcers

　　1. General treatment

　　Life should be regular, work should combine labor and rest, avoid overwork and mental anxiety. Pay attention to dietary regularity, quit smoking and drinking. For those taking non-steroidal anti-inflammatory drugs such as aspirin, it is best to discontinue use, and even if not used, patients should be advised to use them cautiously in the future.

　　2. Medications for peptic ulcers and their applications

　　Medications for peptic ulcers can be divided into two major categories: drugs that inhibit gastric acid secretion and drugs that protect the gastric mucosa. They mainly play a role in alleviating symptoms and promoting ulcer healing and are often used in combination with the eradication of Helicobacter pylori treatment.

　　3. Eradication of Helicobacter pylori

　　Treatment plan for Helicobacter pylori eradication: There is currently no single drug that can effectively eradicate Helicobacter pylori, so it is necessary to use a combination of drugs.