Peptic ulcer

Introduction to peptic ulcer Gastrointestinal ulcers mainly refer to chronic ulcers that occur in the stomach and duodenum. They can also occur in the lower esophagus, around the gastric jejunal anastomosis, and in the MECKEL chamber containing the ectopic gastric mucosa. The formation of these ulcers is related to the digestion of gastric acid and pepsin, so it is called peptic ulcer. The total incidence of this disease accounts for 5-10% of the population. Duodenal bulb ulcers are more common than gastric ulcers. They are more common in young adults. Men are more than women, and children can also develop diseases. The proportion of elderly patients is also increasing year by year. Increased. The average age of patients with gastric ulcer is higher than that of patients with duodenal ulcer. Recent studies have found that the formation of ulcers is associated with the presence of Helicobacter pylori (HP). The vast majority (more than 95%) of the disease is located in the stomach and duodenum, so it is also called gastric duodenal ulcer. In-depth research shows that gastric ulcer disease and duodenal ulcer disease have obvious differences in etiology and pathogenesis, not the same disease, but the epidemiology, clinical manifestations and drug treatment responses are similar. So, it is customary to put them together. basic knowledge Sickness ratio: 0.1% Susceptible people: more young and young Mode of infection: non-infectious Complications: stomach bleeding

Cause of digestive ulcer

Genetic factors (20%):

In gastric ulcers, especially among relatives of males, the incidence rate is higher than that of the average person. Sometimes, several generations of families have peptic ulcers, and the twins who are separated from each other have occasional cases of this disease. It was discovered that revealing the disease may be related to heredity.

Environmental factors (20%):

The incidence of this disease has significant geographical differences. For example, in the United States, Britain and other countries, duodenal ulcer is more common than gastric ulcer, while in Japan, the incidence of gastric ulcer is higher than that of duodenal bulb. The incidence of ulcers is high. Changes in the climate season are also significantly associated with the onset of gastric ulcers, which occur in the late fall and early spring.

Dietary factors (15%):

Food can cause physical or chemical damage to the gastric mucosa. According to reports in the literature, there is a kind of kimchi in Japan that can cause severe antral sinusitis, which may be a causative factor of gastric ulcer. Whether alcohol has any effect on the etiology of this disease is still inconclusive, but most people think that the wine cellar is susceptible to this disease. In addition, malnutrition, binge drinking, and binge eating can induce gastric ulcer disease.

Emotional factors (15%):

Continued strong mental stress and anxiety, depression and other emotions, long-term excessive mental work, lack of proper adjustment and rest, have an impact on the onset and severity of gastric ulcer.

Smoking factor (10%):

Smoking is a condition for the formation of gastric ulcers and exacerbates existing ulcers, which has been accepted by most people.

Drug factors (10%):

Some drugs such as aspirin, indomethacin, phenylbutazone, and glucocorticoids have been classified as ulcerative substances. Among them, aspirin is the most important ulcer-producing drug. Many antipyretic analgesics and drugs for treating colds contain aspirin, which can cause stomach ulcers when taken for a long time.

Certain disease factors (5%):

Such as gastrinoma, primary hyperparathyroidism, emphysema, cirrhosis, renal insufficiency and excessive intestinal resection are prone to ulcer disease, which has been paid more and more attention in China. For example, patients with emphysema may be caused by a decrease in the acid resistance of the local mucosa. Gastrinoma is undoubtedly due to the secretion of a large amount of gastrin to stimulate parietal cells, causing a large amount of gastric acid secretion and damage the gastric mucosa, leading to gastric ulcer. form.

Gastrointestinal ulcer prevention

It is important to remove and avoid the factors that cause the onset of peptic ulcer, such as mental stimulation, overwork, irregular life, irregular diet, smoking and alcohol abuse. Peptic ulcer can achieve symptom relief and ulcer healing after drug treatment. It is still necessary to continue to give a maintenance dose of drug for 1 to 2 years, which is of positive significance for preventing ulcer recurrence. HP-related gastroduodenal ulcer, in the application of lowering gastric acid drugs, while giving effective antibacterial drugs, eradication of HP infection is also an important part of preventing ulcer recurrence. In addition, gastrinoma or multiple endocrine neoplasia, hyperparathyroidism, Meckel diverticulum, Barrett's esophagus and other diseases can often be associated with peptic ulcer, should be treated in time.

Prognosis

Peptic ulcer is a chronic disease with a tendency to recurrent episodes. The duration of the disease can be as long as one or twenty years or longer; however, it is not a minority after repeated episodes. Many patients, despite repeated episodes, then have no complications at all; many patients have milder symptoms without being noticed or cured without medication. Thus, in most patients, the disease is a pathological process with a good prognosis. However, if the elderly patients have a large amount of bleeding, the condition is often more dangerous, and the mortality rate can be as high as 30% without proper treatment. A large amount of bleeding and perforation occurs after the ball is ulcerated. Peptic ulcer complicated by pyloric obstruction, massive bleeding, the chance of pyloric obstruction and massive bleeding later increased. A small number of patients with gastric ulcer can develop cancer, and the prognosis is obviously worse.

Gastrointestinal ulcer complications Complications, stomach bleeding

1. Bleeding: a common complication of digestive ulcers. Bleeding is caused by erosion and rupture of blood vessels by ulcers. When the capillaries are damaged, occult blood is found only during stool examination; when the larger blood vessels are damaged, black stools and hematemesis appear. Generally, the symptoms are aggravated before the bleeding, and the upper abdominal pain is relieved or disappeared after the bleeding.

2. Perforation: Acute gastric perforation may occur when the ulcer reaches the serosa layer, and the contents overflow into the abdominal cavity, resulting in acute diffuse peritonitis. Sudden abdominal pain, nausea, vomiting, abdominal plate, obvious tenderness and rebound tenderness, liver dullness and bowel sounds disappeared, abdominal fluoroscopy see free gas under the armpit, some patients in shock state.

3. Pyloric obstruction: pyloric ulcer can cause pyloric sphincter spasm, congestion and edema around the ulcer, obstructing the occlusion of the pyloric aisle, resulting in temporary pyloric obstruction. After the ulcer heals, persistent organic pyloric stenosis is caused by scar formation or adhesion of surrounding tissues. It is characterized by prolonged gastric emptying time, upper abdominal pain, fullness discomfort, postprandial aggravation, often accompanied by gastric peristaltic waves, peristaltic sounds, and shaking water sounds; late no peristaltic waves but visible enlarged stomach contours, often vomiting a lot. After the vomiting, the above symptoms are alleviated or relieved, and the vomit is often a food for a meal.

4. Malignant transformation: Helicobacter pylori is associated with intestinal adenocarcinoma of the stomach and antrum, but not with the cancer of the gastric cardia. The possibility of gastric cancer in patients with Helicobacter pylori infection is 3-6 times that of non-infected patients. Gastric lymphoma, gastric mucosa-associated lymphoid tissue (MALT) lymphoma is also associated with this infection.

5. Recurrence: After a traditional anti-ulcer treatment, the annual recurrence rate of gastric and duodenal ulcers is >60%. Long-term use of H2 antagonists or proton pump inhibitors can reduce the risk of recurrence of ulcer disease. It is related to the dose of the antacid used. After treatment with anti-Helicobacter pylori, the recurrence rate of ulcer disease is significantly reduced (<10%). The most common cause of recurrent peptic ulcer is the eradication of Helicobacter pylori. For patients with recurrence, persistent infections that may be present should be identified. If the infection is present, anti-Helicobacter pylori treatment should be performed again.

Symptoms of digestive ulcers Common symptoms Neurological symptoms , hernia, upper abdominal pain, heartburn, nausea and vomiting, insomnia

1. Chronic, periodic, rhythmic mid-abdominal pain: The common clinical manifestations of digestive ulcers are abdominal pain limited to the upper abdomen, which can be summarized as limitations, slowness and rhythm. The localized pain of gastric ulcer is mostly in the middle or left of the sword; the onset is slow, the course of disease is several years or decades, the pain is more than 1/2 to 2 hours after the meal, and the stomach is discharged after 1-2 hours. After the empty relief, the law is eating pain relief. When the ulcer is deep, especially perforated, the pain can involve the back. Duodenal bulb ulcers begin to show upper abdominal pain 1 to 3 hours after breakfast. If you do not take the medicine or eat it, it will last until after lunch. It hurts 2 to 4 hours after eating, and it is necessary to eat to ease. Its regular pain eating relief. About half of the patients have midnight pain and the patient can often wake up. Rhythmic pain lasts for a few weeks and can occur repeatedly with relief for several months. The disease is a periodic episode, which is related to the season, with the most in late autumn and early winter, followed by spring, and rare in summer. It is also related to mental emotions, treatment reactions, and so on. The nature of the pain is often dull pain, burning pain, dull pain, hunger pain or severe pain, which can be alleviated by alkaline drugs. Pain can be atypical when a particular type of ulcer, such as a pyloric canal ulcer, a gastric fundus ulcer, a giant ulcer, a multiple ulcer, a complex ulcer, or a complication.

2. In addition to pain, there are often other gastrointestinal symptoms, such as hernia, acid reflux, heartburn, nausea, vomiting, etc. Vomiting and nausea mostly reflect the high degree of activity of the ulcer.

3. Systemic symptoms: Patients may have manifestations of neurosis such as insomnia, which may affect the diet and may cause weight loss and anemia.

4. There is generally no obvious signs during the remission period. The tenderness of gastric ulcer in active period is often in the middle or upper abdomen; the duodenal bulb ulcer is often in the right side; the posterior wall penetrating ulcer is on the 11th and 12th thoracic vertebrae in the back.

Examination of digestive ulcers

First, X-ray barium meal inspection

It is one of the important methods. In particular, the application of hernia double contrast angiography and duodenal hypotension angiography further improves the accuracy of diagnosis. There are two kinds of X-ray signs of ulcers: direct and indirect. The shadow of the ulcer is a sign of ulcer. The gastric ulcer is mostly outside the small curved side. The shadow of the anterior and posterior wall of the ball often has a shadow of increased circular density. The moonlight is shallow or transparent, and sometimes the signs of wrinkles are visible. Indirect signs are caused by inflammation, spasms or scars around the ulcers. Localized deformation, irritation, spasm and local tender points can be seen during barium meal examination. Indirect signs are limited in specificity, duodenal inflammation or peripheral organs (such as gallbladder). Inflammation can also cause the above indirect signs, and clinical attention should be paid to the identification.

Second, endoscopy

Fiber and electronic stomach, duodenoscopic surgery can not only clearly and directly observe the changes of the stomach and duodenal mucosa and the size and shape of the ulcer. It can also be used to directly examine the cells or clamp the tissue for pathological examination. Accurate diagnosis of peptic ulcer and differential diagnosis of benign malignant ulcers, in addition, dynamic observation of the active period of the ulcer and healing process. Observe the effects of drug treatment.

Endoscopic ulcers can be divided into three periods: 1. ActiveStage: the ulcer is garden or elliptical, the bottom is flat, covered with white or yellow-white thick moss, the edge is smooth, and the edge of the ulcer is filled with redness and edema. However, the mucosa is smooth, and the surrounding wrinkles are concentrated after the inflammation subsides. 2, Healing stage (Healingstage): ulcers shrink, shallow, around the congestion and edema redness subsided, wrinkles concentrated, bottom exudation reduced, the surface is gray and thin moss. 3. ScarringStage: The thin white moss disappears at the bottom, and the ulcer surface is the red epithelium where the scar is healed. Afterwards, no traces or white scars and wrinkles are left to indicate that the ulcer is completely healed. The above three types can be divided into A1 and A2; H2 and subtypes such as S1 and S2.

Third, gastric juice analysis

Gastric acid secretion in patients with gastric ulcer is normal or slightly lower than normal, and patients with duodenal ulcer are more likely to be more obvious at night and on an empty stomach. The results of general gastric juice analysis can not really reflect the gastric mucosal acid secretion ability, and now use pentapeptide gastrin or increase histamine gastric acid secretion test to determine the basic gastric acid excretion (BAO) and maximum gastric acid and peak excretion (MAO and PAO). It has great diagnostic or reference value for the following conditions: 1 Excluding peptic ulcer caused by gastrinoma, such as BAO exceeding 15mmol / hour, MAO exceeding 60mmol / hour, or BAO / MAO ratio greater than 60%, suggesting gastrin Diagnosis of the tumor. 2 difference gastric ulcer is benign or malignant, refer to MAO results, such as true gastric acid deficiency, should be highly suspected of tumor ulcers. 3 symptoms typical, MAO more than 40mmol / hour, suggesting active duodenal ulcer.

Fourth, fecal occult blood test

During the active period of ulcer, the fecal occult blood test was positive, and after active treatment, it turned over in 1-2 weeks.

According to the chronic course of the disease, periodic episodes and rhythmic upper abdominal pain and other typical manifestations, a general diagnosis can be made. However, the definitive diagnosis of peptic ulcer, especially those with atypical symptoms, can be established by X-ray and/or endoscopy.

Diagnosis and diagnosis of digestive tract ulcer

Diagnose based on

1. Chronic, rhythmic, and periodic mid-abdominal pain.

2. There may be symptoms of acid reflux, hernia, nausea, vomiting and other indigestion.

3. Gastroscope or upper gastrointestinal barium meal examination (GI) can be found in the shadow.

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