Pregnancy complicated by peptic ulcer

　　What are the causes of the onset of gestational peptic ulcer?

　　If the patient with gestational peptic ulcer does not receive timely treatment, complications such as the following may occur:

　　1. Upper gastrointestinal bleeding;

　　2. Ulcer perforation;

　　3. Pyloric stenosis.

　　The most common symptom of gestational peptic ulcer is upper abdominal pain. Most patients with peptic ulcer have chronic upper abdominal pain. In the early and middle stages of pregnancy, due to the reduction of gastric acid secretion, weakened gastric motility, and reduced congestion of gastric mucosa, the symptoms of peptic ulcer may be relieved. In the late stage of pregnancy, during delivery, and in the postpartum period, due to the enhancement of adrenal cortical function, the formation and secretion of milk, the secretion of gastric juice increases or decreases accordingly, the content of hydrochloric acid and protease in gastric juice increases, and the symptoms of a few gastric ulcer patients may worsen, even leading to ulcer bleeding or perforation. The pain is characterized by obvious rhythm and periodic发作, similar to that in non-pregnant periods. The pain is mostly burning pain or dull pain. Other common symptoms include hiccups, acid regurgitation, nausea, and vomiting. In the early stages of pregnancy, these symptoms may be confused with pregnancy reactions.

　　To reduce the incidence of gestational peptic ulcer, pregnant women should avoid fatigue and mental stimulation, and pay attention to keeping warm. During the exacerbation of ulcer disease, rest should be taken, and bed rest should be maintained when the pain is severe and accompanied by bleeding. Since the onset of the disease is closely related to mental factors, long-term depression can cause damage to the gastric mucosa, so it is necessary to maintain an optimistic mood, eliminate anxiety.

　　Generally speaking, the incidence of gestational peptic ulcer is relatively low, and it can be diagnosed by the following examination methods:

　　1. Laboratory examination

　　Merged gastrointestinal bleeding may cause anemia and positive occult blood in stool, 13C-14C-urea breath test and Hp serological test can assist in diagnosis.

　　2. Other auxiliary examinations

　　X-ray barium meal or upper gastrointestinal endoscopy has diagnostic value for peptic ulcers in pregnant women, but the former has adverse effects on pregnant women and fetuses and should not be used routinely.

　　Patients with peptic ulcers during pregnancy should have regular and quantified meals, eat less and more frequently, eat four to six times a day, prepare some biscuits, baked bread slices, and other foods for pain relief. The main food should be easily digestible and nutritious, and sufficient intake of vitamins and proteins should be ensured.

　　Patients with peptic ulcers during pregnancy should generally rest sufficiently, maintain a cheerful spirit, eat less and more frequently, and be given easily digestible food. At the same time, the following drug treatment methods should be adopted:

　　1. Antacids

　　Antacids can neutralize gastric acid, relieve pain, and promote ulcer healing, and are the first-line drugs for peptic ulcers during pregnancy. Currently, the commonly used ones are aluminum hydroxide and magnesium hydroxide mixture, 15-30ml each time, taken 1 hour after each meal and before bedtime. There is no reliable evidence of teratogenicity of antacids, and it is safe to use antacids during the middle and late stages of pregnancy.

　　2. H2 Receptor Antagonists

　　Cimetidine, ranitidine, and other H2 histamine receptor antagonists can be taken after meals or before bedtime, with doses of 200mg of cimetidine, 3 times a day, and an additional 400mg before bedtime; 150mg of ranitidine, 2 times a day, or 300mg at bedtime each night. 4-8 weeks is one course of treatment. The effects of these drugs on the fetus are not yet clear, and it is best to use them only for patients with severe reflux esophagitis during the middle and late stages of pregnancy or those who are ineffective against antacid drugs. Since these drugs are excreted in breast milk, breastfeeding should not be done during the medication period.

　　3. Sulfated Aluminum

　　Sulfated aluminum can combine with the exudate on the ulcer surface to form a protective film, making the ulcer immune to the erosion of gastric acid and pepsin. Take 1g each time, 1 hour before each meal and before bedtime. It can be used during pregnancy and lactation without adverse effects on the fetus.

　　If the condition is serious, surgical treatment should be considered. Surgical treatment is only used for patients with bleeding or perforation, and the surgical methods include subtotal gastrectomy and other radical ulcer surgery, and simple perforation suture or through-and-through suture ligation ulcer hemostasis.