Gastric ulcer is a common and frequent disease, and it is estimated that about one in ten people have suffered from it. Patients with this disease often experience burning, distending or dull pain in the upper abdomen and symptoms such as acid reflux and belching. Gastric ulcers that continue to develop can cause complications such as gastric bleeding, gastric perforation, and pyloric obstruction, and when these complications occur, surgery to remove most of the stomach is often the treatment of choice. In recent years, with the development of anti-ulcer drugs, the above complications of peptic ulcer have been greatly reduced. Therefore, the number of people who need partial gastrectomy for gastric ulcer is decreasing. However, some people are still prone to recurrence after medication, and the ulcer symptoms are recurrent and do not heal over the years, so shouldn’t it be time to take up the butcher’s knife? The first two aspects to note before you start: 1. The general healing cycle of gastric ulcers is 6 to 8 weeks. Many patients buy their own drugs, eat a week or two, the pain situation can basically be improved, at this point, most patients choose to stop the drug. At this point, most patients choose to stop taking the medication, but the gastric ulcer is not cured, the ulcer surface still exists, and it is easy to recur when encountering suitable conditions. 2, most of the gastric ulcer is bacterial infection. According to statistics, more than half of the patients suffer from gastric ulcer due to H. pylori infection. Therefore, the treatment of gastric ulcer should be antibacterial first, then treatment, not just for ulcer treatment. In collaboration with gastroenterologists from 27 countries and regions around the world, large-scale observations showed that after the ulcer healed, if H. pylori was not eradicated and allowed to continue to “do evil”, 58% of patients relapsed after 1 year; if it was completely eradicated, only 2.6% relapsed after 1 year, a difference of 22 times. If the above two cases are avoided, and the ulcer is still not cured after several courses of regular medication under the doctor’s guidance, in order to avoid excessive prolongation of medical treatment and increase the risk of serious complications such as perforation and bleeding, and the gastric mucosa is repeatedly broken and irritated, it may become malignant, and then a painful decision should be made to “cut the stomach”. The prognosis of resection after cancer is very different from that of cutting before cancer. The cancer of gastric ulcer is not easy to be detected, and it often occurs quietly without obvious symptoms, so it should be noticed. Clinical studies have found that about 5% of gastric ulcer patients will eventually develop gastric cancer. The main reason why gastric ulcers become cancerous is that the ulcer surface does not heal for a long time, resulting in repeated destruction of epithelial cells at the edge of the ulcer. So, what are the signs that a patient’s gastric ulcer has become cancerous? Change of pain pattern Gastric ulcer is characterized by regular pain in the upper abdomen, which is burning-like or dull. The typical pain of gastric ulcer is satiety pain, which appears half an hour to two hours after meal and disappears before the next meal, and the pain comes again after eating, forming a regular pattern of eating-pain-relief. If the pain loses the above regularity, has irregular episodes or becomes persistent pain, or the nature of pain has changed significantly, it may be a precursor of malignant change and should be further diagnosed in hospital in time to avoid delaying the condition. Although gastric ulcers are prone to recurrent attacks, the symptoms can usually be relieved after taking anti-ulcer drugs. If the effect of anti-ulcer medication is not obvious or even ineffective after taking it for a period of time, it should be suspected to be a precursor of cancer. Persistent black stools Black stools can be seen after eating large amounts of blood clots from animals such as pigs, sheep and chickens, or after taking certain astringent antidiarrheal and gastric mucosa-protective drugs such as Gastrin and Lodex. However, the occult blood test should be consistently negative for black stools caused by diet or medication. If a patient with gastric ulcer has unexplained black stool or a persistently positive fecal occult blood test, he should be alerted to the possibility of malignant transformation of gastric ulcer. Gradual physical wasting Most patients with gastric ulcer are physically wasted, but in good spirits and with a bright gaze. If they are over 40 years old and have symptoms such as loss of appetite, aversion to meat, nausea, vomiting, vomiting of interstitial food or dark red food, obvious emaciation and fatigue in a short period of time, cancer may have occurred. If cancer occurs, the ulcer lesion will become bigger and harder, and even form a “leathery stomach”. If the above situation occurs, especially for ulcers older than 45 years old, we should be vigilant and go to the hospital for barium X-ray or gastroscopy in time. Gastroscopy is currently the most ideal means to confirm the diagnosis of gastric disease, which can detect small, superficial ulcers and observe their evolution, and can not only identify benign and malignant ulcers under the naked eye, but also perform biopsy or exfoliative cell examination after flushing and brushing, which has a definite significance for the diagnosis of malignant gastric ulcers. Therefore, if it is difficult to characterize the gastric disease, you may want to do a gastroscopy.