Gastrointestinal ulcers

　　Recent experimental and clinical studies have shown that factors such as excessive gastric acid secretion, Helicobacter pylori infection, and weakened protective effect of gastric mucosa are the main links causing gastrointestinal ulcers. Delayed gastric emptying and bile reflux, the role of gastrointestinal peptides, genetic factors, drug factors, environmental factors, and mental factors are all related to the occurrence of gastrointestinal ulcers.

　　The main complications of gastrointestinal ulcers are the following three types.

　　1. Bleeding:Bleeding is a common complication of gastrointestinal ulcers. Bleeding is caused by the erosion and rupture of vessels by the ulcer. When larger vessels are damaged, black stools and hematemesis may occur.

　　2. Perforation:When the ulcer reaches the serosal layer, acute gastric perforation may occur. The contents spill into the abdominal cavity, causing acute diffuse peritonitis. Patients may present with sudden severe upper abdominal pain, nausea, vomiting, a rigid abdomen, and marked tenderness and rebound pain.

　　3. Pyloric obstruction:Pyloric ulcers can cause pyloric sphincter spasm. The surrounding tissue of the ulcer becomes congested and edematous, obstructing the通畅 of the pyloric passage, causing temporary pyloric obstruction. After the ulcer heals, persistent organic pyloric stenosis may occur due to scar formation or adhesion of surrounding tissues.

　　The symptoms of gastrointestinal ulcers are mainly divided into the following types.

　　1. Chronic, periodic, rhythmic upper abdominal pain:The common clinical manifestation of duodenal ulcer is localized abdominal pain in the upper abdomen. The localized pain of gastric ulcer is often located in the middle or slightly to the left of the xiphoid process. The onset is often gradual, with a long course of several years or even decades. The pain usually occurs 1/2 to 2 hours after a meal and relieves after 1 to 2 hours of gastric emptying. When the ulcer is deep, especially in perforative ulcers, the pain may involve the back. The ulcer of the duodenal bulb starts with upper abdominal pain 1 to 3 hours after breakfast and persists until lunchtime if not treated or eaten. The pain recurs 2 to 4 hours after eating and requires a meal to relieve it. About half of the patients have nocturnal pain, and the patient may wake up from pain. The rhythmic pain usually lasts for several weeks, with缓解 lasting for several months, and can recur. The disease has periodic发作, related to the season. The most common in late autumn and early winter, followed by spring, and rare in summer. The nature of the pain is often hidden, burning, dull, hunger pain, or severe pain, which can be relieved by alkaline drugs. In some special types of ulcers such as pyloric channel ulcer, gastric fundus cardia ulcer, giant ulcer, multiple ulcers, compound ulcers, or complications, the pain may not be typical.

　　2. Other gastrointestinal symptoms:In addition to pain, other gastrointestinal symptoms are often present, such as belching, acid regurgitation, heartburn, nausea, and vomiting.

　　3. General symptoms:Patients may have symptoms of neurosis such as insomnia. Those with severe pain affecting eating may have weight loss and anemia.

　　The formation and development of duodenal ulcer are related to the digestive action of gastric acid and pepsin in gastric juice, so it is forbidden to work or go to bed on an empty stomach. It is not difficult to heal the ulcer to the scar stage in a short period of time (2-4 weeks), but the key is to prevent the recurrence of the ulcer. Abstaining from bad habits, reducing the stimulation of smoking, alcohol, spicy food, strong tea, coffee, and certain drugs, is of great significance for the healing of the ulcer and the prevention of recurrence.

　　In the diagnosis of duodenal ulcer, in addition to relying on its clinical manifestations, it is also necessary to rely on chemical examination. The main examination methods are as follows:

　　1. X-ray barium meal examination

　　X-ray barium meal examination is one of the important examination methods. Gastric ulcers often protrude outside the cavity on the lesser curvature, and the shadow of the fundus ulcer often presents as a circular density increase of barium, surrounded by a crescent-like faint shadow or transparent area. Sometimes, the concentration sign of folds can be seen. Indirect signs are often caused by inflammation, spasm, or scar around the ulcer, and local deformation, irritation, spastic notch, and local tenderness can be seen during barium meal examination.

　　2. Endoscopic examination

　　Fiberoptic and electronic gastroscopy and duodenoscopy can not only clearly and directly observe the changes in the gastric and duodenal mucosa and the size and shape of the ulcer, but also can directly brush cells or take tissue samples for pathological examination under direct vision.

　　3. Gastric juice analysis

　　Gastric ulcer patients have normal or slightly lower than normal gastric acid secretion; duodenal ulcer patients have increased gastric acid secretion, more so at night and during fasting.

　　4. Fecal occult blood test

　　During the active phase of the ulcer, the fecal occult blood test is positive. After active treatment, it often turns negative within 1-2 weeks.

　　Duodenal ulcer should pay attention to the following aspects in diet.

　　1. Eat small and frequent meals, regular and quantitative:Eat 5 to 7 meals a day, and the amount of each meal should not be too much. Eating small and frequent meals can neutralize gastric acid, reduce the stimulation of gastric acid on the ulcer surface, and also provide nutrition, which is conducive to the healing of the ulcer surface, and is more suitable for acute peptic ulcer.

　　2. Avoid刺激性食物: Stimulating foodsMechanical stimulation foods can increase mucosal damage, destroy mucosal barriers, such as coarse grains, celery, chives, snow peas, bamboo shoots, and dried fruits. Chemical stimulation can increase gastric acid secretion, which is unfavorable for ulcer healing, such as coffee, strong tea, strong alcohol, strong meat soup, etc.

　　3. Choose soft and easy-to-digest foods:Choose foods with high nutritional value and soft, easy-to-digest foods such as milk, eggs, soy milk, fish, lean meat, etc.

　　4. Eat more carbohydrates:Carbohydrates have no effect on stimulating or inhibiting gastric acid secretion. Choose easily digestible foods such as congee, noodles, wontons, etc.

　　5. Supply abundant vitamins:Choose foods rich in B vitamins, vitamin A, and vitamin C.

　　The main treatment methods for gastrointestinal ulcers are as follows.

　　1. General Treatment

　　1. Diet should be regular, and eating should not be too fast, avoiding overeating or hunger.

　　2. Abstain from alcohol and smoking is also part of the treatment.

　　3. Non-steroidal anti-inflammatory drugs that can damage the gastric mucosa, such as aspirin, indomethacin, and phenylbutazone, should be avoided.

　　4. Stabilize emotions and relieve anxiety.

　　2. Drug Treatment

　　1. Antacids:Antacids mainly include sodium bicarbonate, calcium carbonate, aluminum hydroxide, subcarbonate bismuth. Commonly used compound preparations include Wanshuiping, magnesium aluminum complex, Wanyangning, Ledewei, compound calcium bismuth magnesium, etc.

　　2. Gastric Acid Secretion Inhibitors:Commonly used gastric acid secretion inhibitors include belladonna, atropine, scopolamine, piprazine, cimetidine, famotidine, Losec, etc.

　　3. Drugs to Strengthen Protective Factors:Commonly used drugs to strengthen protective factors include sucralfate, trivalent potassium dicitrate bismuth complex, and gastrokin.

　　4. Antibiotic Treatment:Since Helicobacter pylori may be related to the onset of peptic ulcer, antibiotic agents such as Tetracycline should be taken.

　　3. Surgical Treatment

　　The surgical indication is: intractable ulcers that do not heal after strict internal medicine treatment, gastric ulcers suspected of being malignant, or those with severe complications that cannot be treated effectively with internal medicine.