Complex ulcer

Introduction Compound ulcer refers to the simultaneous presence of gastric ulcer and duodenal ulcer. Compound ulcers account for about 5% of patients with ulcer disease. Most patients with duodenal ulcer first, resulting in functional pyloric obstruction, can cause delay in emptying, gastric dilatation stimulates secretion of gastrin, so that gastric acid secretion increases and pyloric dysfunction causes duodenal juice to flow back into the stomach. Repeated stimulation of the stomach to form a gastric ulcer. In patients with compound ulcers, the occurrence of gastric ulcers precedes duodenal ulcers, but the proportion is small, and the composite ulcers are more male than female. The incidence of bleeding from this disease is higher, but the rate of malignant transformation is lower.

Cause

Peptic ulcer mainly refers to chronic ulcers that occur in the stomach and duodenum. It is a common and common disease. The formation of ulcers has various factors, and the digestion of mucous membrane by acidic gastric juice is the basic factor of ulcer formation, hence the name. Any part of the acidic gastric contact, such as the lower esophagus, anastomotic postoperative gastrointestinal anastomosis, jejunum, and Meckel's diverticulum with ectopic gastric mucosa. The vast majority of ulcers occur in the duodenum and stomach, so it is also called stomach and duodenal ulcer.

an examination

Related inspection

Direct examination of Helicobacter pylori fiberoptic examination of Helicobacter pylori immunological detection of gastric mucosal biopsy drug vagus nerve block test

First, Helicobacter pylori detection

The diagnosis of Hp infection has become a routine test for peptic ulcer. The methods can be divided into two types: invasive and non-invasive. The former requires gastroscopy and gastric mucosal biopsy, and can simultaneously identify the presence of gastroduodenal diseases. The latter only provides information on the presence or absence of Hp infection. Currently used invasive tests include rapid urease test, histological examination, mucosal smear microscopy, microaerobic culture and polymerase chain reaction (PCS); non-invasive tests mainly include 13C- or 14C-urea Gas test (13C-UBT or 14C-UBT) and serological tests.

The rapid urease test is the preferred method for diagnosing Hp infection in invasive trials, and is simple and inexpensive. Combinatorial examination can directly observe Hp, and special staining such as Warthin-Starry can improve the detection rate compared with conventional HE staining. Staining microscopy after gastric mucosal smear is simple, but when the number of bacteria is small, it is easy to miss diagnosis. The technical requirements and costs of Hp culture and PCR detection are relatively high, mainly for scientific research. The sensitivity and specificity of 13C-UBT or 14C-UBT for detecting Hp infection in non-invasive trials can be used as the first choice for post-treatment treatment. Serological tests for the qualitative detection of anti-Hp antibody IgG should not be the preferred method for post-treatment review. Serological tests for qualitative detection of anti-Hp antibody IgG are not suitable as a confirmation test for whether Hp is eradicated after treatment.

Second, gastric juice analysis

Gastric acid secretion in patients with GU is normal or lower than normal, and some DU patients increase, but there is a great overlap with normal people, so gastric juice analysis is of little value in the diagnosis and differential diagnosis of peptic ulcer. At present, it is mainly used for the auxiliary diagnosis of gastrinoma. If BAO>15mmol/h, MAO>60mmol, BAO/MAO ratio>60%, it suggests the possibility of gastrinoma.

Third, serum gastrin determination

Serum gastrin is slightly higher in peptic ulcer than normal people, but the diagnosis is not significant, so it should not be classified as routine. However, if a gastrinoma is suspected, this test should be performed. Serum gastrin value is generally inversely proportional to gastric acid secretion, low gastric acid, high gastrin; high gastric acid, low gastrin; and gastric augmentation.

Differential diagnosis

Identification with several other common types of ulcers:

1. Multiple ulcers: There is only one ulcer in the general ulcer case. If there are 2 to 3 simultaneous cases, it is called multiple ulcer.

2, huge ulcers: If the ulcer diameter is greater than 2.0 meters, it is called a huge ulcer. The huge ulcer can be complicated by the perforation of the posterior wall of the stomach, the involvement of the pancreas, and often misdiagnosed as pancreatic cancer.

3. Stress ulcer: an ulcer formed by acute injury, hemorrhage, erosion and necrosis of the gastrointestinal mucosa caused by trauma, major surgery, craniocerebral diseases, serious infection or drugs. The disease is more than 10 days after stress, and can occur at any age, without gender differences. Before the onset, there were many medical history such as trauma, major surgery and serious infection. Often there is massive upper gastrointestinal bleeding, hematemesis, melena, sudden onset, often no signs of prodromal and difficult to stop bleeding. In addition, there may be digestive symptoms such as upper abdominal pain, abdominal distension, nausea, vomiting, and acid reflux, but it is milder than general gastric and duodenal ulcer disease. It can be diagnosed by gastroscopy or discouragement. In addition to the treatment of Xu symptomatic treatment, the primary disease should be actively treated.

4, anastomotic ulcer: also known as marginal ulcer, easy to occur after surgery in the stomach or duodenum, mostly located in the anastomosis, rounded to form an oval ulcer, or single or multiple, usually 2-3 years after surgery .

5, pancreatic ulcer: also known as gastric tumor or Zhuo. Ai syndrome is a pancreatic beta cell tumor. Mainly because of the proliferation of G cells in the antrum and duodenum, and the secretion of a large amount of gastrin, causing multiple, refractory peptic ulcer. The main symptoms are the symptoms of refractory peptic ulcer, which lasts for several years to several decades, and can also have fulminant hair. Ulcers are multiple, often occurring in the twelve-pointed, and can also be found in the stomach, esophagus, and ileum. It can be confirmed by gastric acid measurement, serum gastrin measurement, imaging examination, and the like. The preferred treatment for a clear diagnosis is surgical resection.

diagnosis:

Medical history analysis is important, and typical periodic and rhythmic upper abdominal pain is the main clue to the diagnosis of peptic ulcer. However, it must be pointed out that those with ulcer symptoms do not necessarily have peptic ulcers, and the majority of patients with peptic ulcer often have atypical abdominal pain, and some patients may have no pain symptoms. Therefore, relying solely on medical history is difficult to make a reliable diagnosis. The diagnosis depends on X-ray barium meal examination and/or endoscopy, which is especially useful for diagnosis.

First, X-ray barium meal inspection

Air sputum double contrast angiography can better display mucosal images. The X-ray signs of ulcers are direct and indirect: shadow is a direct sign and has a diagnostic value for the diagnosis of ulcers. Benign ulcers protrude from the contours of the stomach and duodenal tincture, and a smooth ring is often found around them, and the peripheral radial mucosa is wrinkled. Indirect signs include local tenderness, lateral scarring of the stomach, duodenal bulb irritation, and ball deformity. Indirect signs only suggest ulcers.

Second, gastroscopy and mucosal biopsy

Gastroscopic examination can not only directly observe and photograph the gastroduodenal mucosa, but also take biopsy for pathology and Hp detection under direct vision. It is more prepared for the diagnosis of peptic ulcer and differential diagnosis of benign and malignant ulcers than X-ray barium meal examination. In the ulcer is too small or too shallow, barium meal examination is difficult to find; the duodenal bulb deformity found in barium meal examination can be difficult to confirm with multiple explanations; active upper gastrointestinal bleeding is a contraindication for barium meal examination, endoscopy can be Determine its source and nature. About 5% of the GU or endoscopically benign GUs are actually malignant, and a few of them appear to be malignant ulcers. It turns out to be benign. It is difficult to identify without biopsy. In addition, endoscopy can also find gastritis and duodenitis accompanying ulcers. Endoscopic peptic ulcers are mostly round or elliptical, even linear, with smooth edges, grayish yellow or white exudate at the bottom, congestive and edema around the mucosa, and sometimes wrinkles to the ulcer. Endoscopic ulcers can be divided into three phases: active phase (A), healing phase (H) and scar phase (S), each of which can be divided into two phases: 1 and 2.

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