Anastomotic ulcer

　　Patients with a history of peptic ulcer resection. In the stomach cavity, gastric acid and pepsin are important digestive substances in the gastric juice. Gastric acid is a strongly acidic substance with strong corrosiveness; pepsin has the function of hydrolyzing proteins and can destroy proteins on the gastric wall. However, under the existence of these erosive factors, the gastrointestinal tract can still resist and maintain the integrity of the mucosa and its own function, mainly because the mucosa of the stomach and duodenum still has a series of defense and repair mechanisms. We call the harmful erosive action of gastric acid and pepsin the injury mechanism, and the defense and repair mechanism of the gastrointestinal tract itself the protective mechanism. It is currently believed that the protective mechanism of the normal gastric and duodenal mucosa is sufficient to resist the erosion of gastric acid and pepsin. However, when certain factors damage a link in the protective mechanism, it may lead to the erosion of the mucosa by gastric acid and pepsin, resulting in the formation of ulcers. When excessive gastric acid secretion far exceeds the defensive and reparative action of the mucosa, it may also lead to the occurrence of ulcers. Recent research has shown that Helicobacter pylori and non-steroidal anti-inflammatory drugs are the most common causes of damage to gastrointestinal protective mechanisms and the occurrence of ulcer diseases, and gastric acid plays a key role in the formation of ulcers. In addition, drugs, stress, hormones can also lead to the production of ulcers, and various psychological factors and unhealthy dietary and lifestyle habits can induce the appearance of ulcers.

　　It is easy to develop complications such as perforation, obstruction, and bleeding.

　　1. Blood loss:Blood loss is caused by the erosion of the blood vessels around the ulcer to a certain extent during the occurrence of the ulcer, leading to vessel rupture. The amount of blood loss and the degree of harm to the patient's life depend on the size of the damaged blood vessel. When the ulcer damages the capillaries, the harm to the patient is generally small, and it is not easy to be discovered, and it is only found during the hidden blood test in the stool; while when larger blood vessels are damaged, it may lead to hematemesis or black stools, or even bright red stools. Generally, patients may experience the exacerbation of various gastrointestinal symptoms before bleeding, but after the bleeding stops, the pain in the upper abdomen may be reduced or even disappear.

　　2. Perforation:General ulcer injuries occur in the mucosal and muscular layers of the gastrointestinal tract. When the ulcer progresses continuously and reaches the serosal layer of the gastrointestinal tract, there is only the outermost layer, which is similar to a thin piece of paper, and it can cause acute gastrointestinal perforation at any time. After perforation, the contents of the gastrointestinal tract flow into the abdominal cavity, causing acute diffuse peritonitis. It is manifested by sudden severe upper abdominal pain, nausea, vomiting, a rigid abdomen with marked tenderness and rebound pain, disappearance of liver dullness and bowel sounds, free air under the diaphragm on abdominal X-ray, and some patients may even develop shock. In this situation, the patient should receive emergency surgery immediately, otherwise there is a risk of death at any time. Of course, with the improvement of medical conditions and timely medical treatment, the incidence of perforation is not very high, and it can be classified into acute, subacute, and chronic in clinical practice. Only acute perforation requires surgical treatment.

　　Patients with a history of peptic ulcer resection and symptoms similar to but different from preoperative peptic ulcers, the most common symptom is abdominal pain, which is mostly episodic and more pronounced at night, often radiating to other places. The pain episode is long, and the remission period is short. Eating or taking antacids can temporarily relieve the pain, and symptoms such as loss of appetite, nausea, vomiting, and weight loss are common. Some patients may have complications such as perforation, obstruction, and bleeding. The site of abdominal tenderness is often consistent with the site of abdominal pain, and sometimes there may be abdominal muscle tension. In patients with a long course of disease, a mass may be palpable in the abdomen.

　　This disease should pay attention to the prevention of gastric diseases, have a balanced diet, and moderate in food texture. At the same time, appropriate physical exercise should be carried out to strengthen the body's immunity.

　　For doctors, the goal is to control and alleviate the symptoms of ulcers through means such as medication and surgery, while for patients, it is important to maintain an optimistic attitude, develop good living habits, eat a balanced diet, and actively cooperate with treatment. Only in this way can the occurrence of ulcers be prevented to the greatest extent.

　　Specifically, the following points should be noted:

　　1. Adjust your mindset, pay attention to rest, and avoid excessive anxiety and fatigue;

　　2. Quit smoking and drinking, maintain regular eating habits, and do not overindulge;

　　3. Avoid eating刺激性 foods, such as coffee, strong tea, chili, etc.;

　　4. Reduce the intake of overly sweet and sour foods and fruits, such as chocolate, ice cream, apples, and oranges;

      5. Reduce the intake of easily bloating foods, such as sweet potatoes, lotus roots, potatoes, etc. with high starch content.

　　1. Occult blood in stool:When the ulcer is active, it can be persistently positive.

　　2. Endoscopic examination:Common ulcers are located on the small intestinal side of the anastomosis, most of which are single ulcers, accompanied by mucosal erosion, congestion, edema, and biopsy can exclude malignant ulcers.

　　3. Gastric Acid Secretion Test:BAO is increased, and MAO is significantly increased after pentagastrin or increased histamine method, serum gastrin determination can be increased, X-ray barium meal examination shows that about half of the cases show anastomotic deformity, stenosis, barium residue, indentation, and local tenderness.

　　Precautions for oral ulcers:

　　1. Try to eat less spicy seasonings such as chili, vinegar, and ginger, and eat less fried foods and other rough and hard foods. These foods will stimulate the ulcer surface to further expand.

　　Eat more foods that are abundant in autumn or rich in vitamin C, such as lotus seeds, lotus root, and oranges, which have a very good effect on the treatment of oral ulcers.

　　After each meal, you can rinse your mouth with warm water with a little salt to prevent secondary infection caused by food residue.

　　The most commonly used drugs are divided into the following categories:

　　1. Acid Secretion Inhibitors:Currently, the main drugs used in clinical practice are H2 receptor antagonists (H2-RA) and proton pump inhibitors (PPI). H2-RA can inhibit the secretion of gastric acid under both baseline and stimulated conditions, commonly used drugs include cimetidine, ranitidine, famotidine, and nizatidine; PPI acts on the key enzyme H+-K+ATPase in the final step of parietal cell gastric acid secretion, causing irreversible inactivation, with stronger and more lasting acid-suppressing effects. PPI promotes the healing of ulcers quickly and has a higher healing rate, suitable for the treatment of various refractory ulcers or NSAID ulcers where NSAID cannot be discontinued, and can also be used in synergy with antibiotics for the eradication of Helicobacter pylori, making it the first-line drug for gastric ulcers. Common PPIs include omeprazole, lansoprazole, rabeprazole, esomeprazole, and eprazolam.

　　2. Mucosal Protective Agents:They are no longer the first-line drugs for treating ulcers, but when used in combination with acid-reducing drugs, they can improve the quality of ulcer healing, reduce the recurrence of ulcers, and are commonly used drugs such as sucralfate, colloidal bismuth, potassium bismuth citrate, misoprostol, and others.

　　3. Gastrointestinal Motility Drugs:Mainly used for patients with symptoms such as nausea, vomiting, and bloating to promote gastrointestinal emptying and relieve symptoms.