I. Etiology of peptic ulcer
1.External factors of the organism
(1) Helicobacter pylori (HP) infection.
(2) NSAIDs drugs.
(3) smoking.
(4) mental.
(5) Diet (alcohol).
2, internal factors of the body
(1) neurological, endocrine, gastrointestinal function.
(2) Legacy.
II. Clinical manifestations of peptic ulcer
Clinical features: chronic process, periodic episodes and rhythmic epigastric pain
Characteristics and mechanism of pain: stimulation of ulcer by gastric acid; spasm of gastric wall, inflammation of ulcer and its surrounding tissues; increase of local muscle tone; decrease of pain threshold.
Similarities and differences between gastric ulcer and duodenal ulcer.
1. complications: bleeding, perforation, pyloric obstruction and carcinogenesis.
2. Laboratory and auxiliary tests: gastric fluid analysis, serum gastrin determination and fecal occult blood test; barium X-ray examination signs.
3. Diagnosis of peptic ulcer
1. Initial diagnosis: history of chronic course, periodic attacks and rhythmic pain, positive tarry black stool or occult blood test.
2.Confirmation of diagnosis: barium X-ray shows ulcer niche, and gastroscopy reveals ulcer lesions.
3. Gold standard: pathological tissue biopsy to determine Hp infection and exclude malignant lesions.
Special form of ulcers
Post-globular ulcer, pyloric duct ulcer, refractory ulcer, giant ulcer, linear ulcer, symmetrical ulcer, Dieulafoy ulcer, anastomotic ulcer, compound ulcer, chronic penetrating ulcer.
Hp detection methods.
1.Urease test.
2, 13C-urea breath test.
3.Histological test.
4.Serological test.
5, molecular biology assay.
6.Bacterial culture.
IV. Complications: bleeding, perforation, pyloric obstruction, carcinoma.
V. Treatment of peptic ulcer
Changes in treatment strategy: HP eradication treatment should be done for Hp-positive gastric or duodenal ulcers, whether initial or recurrent.
Treatment aims: to eliminate the cause, control symptoms, promote healing, prevent recurrence and avoid complications.
Treatment principles: acid suppression, bacteriophage removal, and protection of gastric mucosa.
1.Acid suppression.
(1) H2 receptor antagonists: metformin, ranitidine, famotidine, etc.
(2) proton pump blockers: omeprazole (Losec), lansoprazole (Lansoprazole), pantoprazole, rabeprazole.
2.Debridement: Combination of drugs, choose amoxicillin, metronidazole, furazolidone, tetracycline, gentamicin, clarithromycin, etc.
3, protection of gastric mucosa: colloidal bismuth subcitrate, aluminum thioglycollate, prostaglandin.
Total treatment course
GU: 4-6 weeks for PPI, 6-8 weeks for H2RA.
DU: 2-4 weeks for PPI and 4-6 weeks for H2RA.
Principles of individualized medication
1.Type of ulcer: DU is mainly acid control and pain relief: GU is mainly to protect gastric mucosa.
2, gastric acid secretion: DU high acid, with stronger acid suppressant; GU acid normal or slightly low, weak acid suppressant.
3, HP infection: positive ulcers are treated with antibacterial therapy.
Drug price: First-line drugs are H2 receptor antagonists, metronidazole, dysentery, thiosemicarbazone.
Maintenance therapy for ulcer disease
1.Long-term maintenance therapy: ulcers are maintained with ranitidine (150mg, 1/day) for 2-3 years after healing.
2.Intermittent maintenance therapy: 4-12 weeks of ranitidine (150mg, 2 /day) when the ulcer recurs.
3.Symptomatic self-monitoring therapy: short course of anti-ulcer therapy at the onset of symptoms and discontinue when the symptoms disappear.