Symptom >> Internal Medicine >> Gastroenterology

Ulcer pain

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The pain of gastric ulcer is a pain of visceral nature. The location of the body surface is not accurate. At the same time, the pain is not severe and can be tolerated. It is characterized by burning pain, pain and discomfort. The active period is rhythmic, manifested as postprandial pain, with periodic and seasonal characteristics as the pathology develops. Ulcers near the cardia can also manifest as a burning sensation in the back of the chest and pain in the left chest. When the ulcer penetrates, it manifests as aggravation of pain, radiation to the back or back pain, and nighttime pain. When the nature of the pain changes and the rhythm changes, you should be alert to the possibility of malignant transformation.

Cause

Cause

Gastric ulcer is a multifactorial disease with complex etiology that has not been fully understood so far and is a combination of factors.

1. Genetic factors: gastric ulcer sometimes has a family history, especially in children with ulcers, family history can account for 25% to 60%. In addition, people with type A blood are more susceptible to this disease than people with other blood types.

2. Chemical factors: long-term consumption of alcohol or long-term use of aspirin, corticosteroids and other drugs may cause this disease, in addition to long-term smoking and drinking tea seems to have a certain relationship.

3. Living factors: Patients with ulcer disease seem to be more common in some occupations such as drivers and doctors, and may be related to the law of diet. Work too much can also induce the disease.

4. Mental factors: mental stress or anxiety, sentimentality, excessive mental work is also a predisposing factor for this disease. May be caused by vagus nerve excitement and excessive gastric acid secretion.

5. Infectious factors: The effect of Helicobacter pylori (HP) on the occurrence of gastric ulcer is still difficult to explain, because only a small number of HP infected people have gastric ulcer. However, almost all patients with gastric ulcers have chronic active gastritis. HP is the leading cause of the onset and spread of gastritis. When the HP is cleared, the gastritis disappears. Quantitative studies of HP infection have shown that gastric ulcers, especially those located in the upper part of the stomach, often involve severe HP infection.

6. Other factors: The incidence of this disease varies from country to country and from region to region. The incidence rate varies from season to season, indicating that the geographical environment and climate are also important factors. In addition, the disease can also occur on the basis of other primary diseases such as burns, severe traumatic brain injury, gastrinoma, hyperparathyroidism, emphysema, cirrhosis, and renal failure, so-called "secondary ulcer" (secondary Ulcer). This may be related to gastrin, hypercalcemia and excessive vagal nerve excitability.

Examine

an examination

Related inspection

Two-way agar diffusion test blood routine

1. Clinical features: deep abdominal pain 2 hours after a meal, usually no abnormal signs.

2. Auxiliary examination: the diagnosis of gastric ulcer mainly depends on the history of symptoms, gastroscope plus biopsy, barium meal examination. In addition, gastric acid determination, serum gastrin determination, serum calcium determination also have certain diagnostic and differential diagnostic significance. In recent years, with the application of electronic gastroscope, the diagnostic coincidence rate of gastric ulcer is extremely high.

Diagnosis

Differential diagnosis

The diagnosis of gastric ulcer must be differentiated from many diseases in the stomach and stomach.

1. Functional dyspepsia: usually have dyspepsia syndrome, such as acid reflux, hernia, nausea, upper abdominal fullness discomfort, but no positive findings in gastroscopy and barium meal examination, is functional.

2. Chronic stomach, duodenitis: There is chronic irregular upper abdominal pain, gastroscopy can identify, more than chronic antral sinusitis and duodenal inflammation but no ulcers.

3. Gastrinoma: Also known as Zhuo-Ai syndrome, it is caused by the secretion of a large amount of gastrin from pancreatic cells. The diagnosis points are: 1BAO>15mmol/h, BAO/MAO>0.6; 2X line examination shows atypical location ulcer, especially multiple ulcer; 3 refractory ulcer, easy to relapse; 4 with diarrhea; 5 serum gastrin increase >200pg/ml (usually >500pg/ml).

4. Gastric ulcer malignant or gastric cancer: The most important differential diagnosis method is gastroscope plus biopsy and barium meal examination. Biopsy is needed during gastroscopy to confirm benign and malignant. Gastric ulcers require gastroscopy plus biopsy for continuous follow-up observation.

5. Gastric mucosal prolapse: intermittent upper abdominal pain, antacid can not be relieved, and changing position such as left lateral position may be relieved. Gastroscope and barium meal can be identified. X-ray barium meal examination can show that the duodenal bulb has a "sweet-like" or "parachute-like" defect shadow.

6. Others: In addition, hemorrhagic esophagogastric rupture caused by portal hypertension should be differentiated. Concurrent perforation should also be differentiated from various common acute abdomen, such as pancreatitis, appendicitis, biliary tract disease, intestinal obstruction and so on.