Peptic ulcer is a general term for gastric ulcer (GU) and duodenal ulcer (DU), so named because ulcer formation is associated with the digestive action of gastric acid/pepsin. Clinical manifestations include chronic, periodic, rhythmic abdominal pain with increased salivation, heartburn, regurgitation, belching, belching, nausea, vomiting, and other gastrointestinal symptoms. Patients with peptic ulcers should avoid mental stimulation, overwork, irregular life, irregular diet, smoking and alcohol abuse. Gastric ulcers tend to occur in middle-aged and elderly people, while duodenal ulcers are predominantly found in young and middle-aged people. The proportion of men suffering from peptic ulcers is higher than that of women. Duodenal ulcers are more common than gastric ulcers, according to statistics, the former accounts for about 70%, the latter accounts for about 25%, and the two coexist in about 5% of the compound ulcers. In recent years, the number of people suffering from duodenal ulcers has increased in cities. The secretion of gastric acid increases when meat is consumed compared to the consumption of sugary substances such as cereals. When excess stomach acid persists for a long time and accumulates in the duodenal bulb (the entrance to the duodenum), it tends to damage the mucosa leading to duodenal ulcers. Experimental and clinical studies in recent years have shown that factors such as excessive gastric acid secretion, H. pylori infection and weakened gastric mucosal protection are the main links that cause peptic ulcers. Delayed gastric emptying and bile reflux, the action of gastrointestinal peptides, genetic factors, drug factors, environmental factors and mental factors are all related to the occurrence of peptic ulcers. 1, Helicobacter pylori infection HP infection is the main cause of chronic gastritis and is an important cause of peptic ulcer. 2, delayed gastric emptying and bile reflux This degenerative change in the region of the gastric sinus and pylorus in gastric ulcer disease can render the contraction of the gastric sinus ineffective, thus affecting the forward propulsion of food chyme. Delayed gastric emptying may be a factor in the pathogenesis of gastric ulcer disease. Certain components of duodenal contents, such as bile acids and lysolecithin, can damage the gastric epithelium. Reflux of duodenal contents into the stomach can cause chronic inflammation of the gastric mucosa. The damaged gastric mucosa is more susceptible to damage by acid and pepsin. With gastric ulcer, the concentration of bile acid conjugates in gastric juice is significantly higher than that of normal controls during fasting, leading to the assumption that bile reflux into the stomach may play an important role in the pathogenesis of gastric ulcer disease. 3.Drug factors Certain antipyretic and analgesic drugs, anti-cancer drugs, such as anti-inflammatory pain, pau d’arco, aspirin, adrenal corticosteroids, fluorouracil, methotrexate, etc. have been listed as ulcerogenic factors. 4, environmental factors Smoking can stimulate increased secretion of gastric acid, cause vasoconstriction, and inhibit the secretion of pancreatic juice and bile and weaken its ability to neutralize gastric acid in the duodenum, resulting in continuous acidification of the duodenum; tobacco nicotine can reduce the tone of the pyloric sphincter, affecting its closing function and leading to bile reflux and destruction of the gastric mucosal barrier. The incidence of peptic ulcers is significantly higher in smokers than in controls. The healing rate of ulcers was also significantly lower in the former than in the latter under the same effective drug therapy. Therefore, long-term heavy smoking is not conducive to ulcer healing and can lead to recurrence. Food can cause physical and chemical damage to the gastric mucosa. Overeating or irregular eating may disrupt the rhythm of gastric secretion. According to clinical observation, coffee, strong tea, strong alcohol, spicy seasonings, kimchi and other foods, as well as poor dietary habits such as partial eating, eating too fast, too hot, too cold, overeating, etc., may be relevant factors for the occurrence of this disease. Mental factors According to the modern psycho-social-biomedical model, peptic ulcer belongs to one of the typical psychosomatic disease categories. Psychological factors can affect gastric juice secretion. What are the characteristics of abdominal pain in peptic ulcer disease? (1) Chronic recurrence: peptic ulcer is prone to recurrence after healing, mostly stating that the pain in the upper abdomen is recurrent, with an average duration of 5-8 years. (2) Periodic attacks: In autumn and winter when the climate changes suddenly and in the early spring of the following year, there is a high incidence of ulcer disease. (3) Rhythmic pain: It is a typical physical feature of epigastric pain in peptic ulcer patients, and it is mostly present when there is no complication. Gastric ulcer and duodenal ulcer have different rhythmicity of pain, according to this feature sometimes the history can be differential diagnosis, usually two The two characteristics are: duodenal ulcer pain: eating – comfortable – pain – eating again – comfortable again Gastric ulcer pain: eating – pain – comfortable – eating again – pain again Complications Upper gastrointestinal bleeding The most common complication, duodenal ulcer complication bleeding rate is higher than gastric ulcer Perforation Gastric outlet Obstruction Carcinoma Some patients diagnosed with gastric ulcer at the first visit are eventually diagnosed with gastric cancer. This is because it is difficult to screen benign and malignant gastric ulcers, so the importance of reviewing gastroscopy after 2 months of regular treatment is emphasized. Treatment strategy: 8 weeks for gastric ulcer, 4-6 weeks for duodenal ulcer. Hp must be eradicated for combined hp infection. How to prevent recurrence 1. Remove risk factors for recurrence Avoid taking NSAID drugs and quit smoking. 2. Eradicate H. pylori This article is authorized by Dr. Qing Haitao.