I. Definition
Peptic ulcer mainly refers to chronic ulcers occurring in the stomach and duodenum, which is a multifaceted and common disease. It is due to the self-digestion of the mucosa by acidic gastric juice and protease, hence the name. It can occur at any site where acidic gastric juices come into contact, such as the lower esophagus, the gastrointestinal anastomosis, the upper jejunum, and Meckel’s diverticulum (Meckel’s diverticulum, located in the distal ileum), which has an ectopic gastric mucosa. Because gastric and duodenal ulcers are the most common, the so-called peptic ulcers are generally referred to as gastric and duodenal ulcers. Treatment is mainly to take drugs that inhibit stomach acid and protect the mucosa.
Second, the etiology
Excessive secretion of gastric acid, infection of Helicobacter pylori and weakened protection of gastric mucosa are the main factors that cause peptic ulcer. 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 ulcer.
III. Clinical manifestations
1.Peptic ulcer pain characteristics
(1) Long-term
Because the ulcer can heal by itself after the occurrence of the ulcer, but every healing and good recurrence, so there is often a long-term recurrence of epigastric pain characteristics. The average duration of the disease is 6 to 7 years, and some can be as long as one or two decades, or even longer.
(2) Periodicity
Epigastric pain is repeatedly periodic, which is one of the characteristics of such ulcers, especially duodenal ulcers are more prominent. Episodes of pain in the middle and upper abdomen may last for a few days, weeks or longer, followed by a longer period of relief. Episodes can occur throughout the year, but are more common in the spring and fall.
(3) Rhythmicity
The relationship between ulcer pain and diet is significantly correlated and rhythmic. During the day, the period from 3:00 a.m. to breakfast has the lowest secretion of gastric acid, so pain rarely occurs during this time. The pain of duodenal ulcers occurs between meals and continues unabated until the next meal or after the administration of acid-control drugs. In some patients with duodenal ulcers, pain can occur in the middle of the night due to higher stomach acid at night, especially in those who have eaten before going to bed. The occurrence of gastric ulcer pain is more irregular, often occurring within one hour after a meal, gradually relieved after one to two hours, until the above rhythm reappears after the next meal.
(4) Pain site
The pain of duodenal ulcer is mostly found in the middle and upper abdomen, or above the umbilicus, or to the right of the umbilicus; the location of the pain of gastric ulcer is also mostly in the middle and upper abdomen, but slightly higher, or to the left of the subxiphoid and subxiphoid processes. The pain is about several centimeters in diameter. Because the localization of pain in the cavernous viscera is generally not very precise on the body surface, the site of pain does not necessarily reflect the anatomical location of the ulcer accurately.
(5) Nature of pain
Mostly dull pain, burning pain or hunger-like pain, generally mild and tolerable, persistent severe pain suggests ulcer penetration or perforation.
(6) Influencing factors
Pain is often triggered or aggravated by mental stimulation, excessive fatigue, careless diet, drug effects, climate change and other factors; it can be alleviated or relieved by rest, eating, taking acid-control drugs, pressing the painful area with hands, vomiting and other methods.
2.Other symptoms and signs of peptic ulcer
(1) Other symptoms
In addition to pain in the upper and middle abdomen, other gastrointestinal symptoms such as increased salivation, heartburn, regurgitation, belching, belching, nausea and vomiting may be present. Appetite is mostly normal, but occasionally there may be fear of eating due to painful episodes after eating, resulting in weight loss. Systemic symptoms may include insomnia and other neurological symptoms, or symptoms of plant nervous system disorders such as slow pulse and excessive sweating.
(2) Physical signs
During the ulcer attack, there may be limited pressure pain in the middle and upper abdomen, which is not severe, and the site of pressure pain mostly corresponds to the location of the ulcer.
IV. Treatment
1.General treatment
Peptic ulcer is a typical psychosomatic disease, and psycho-social factors play an important role in its development. Therefore, optimism, regular life, and avoidance of excessive stress and strain are important in both the attack and remission periods of the disease. When the ulcer is active and the symptoms are heavy, bed rest for a few days or even 1 to 2 weeks.
2. Diet
Before the introduction of H2 receptor antagonists, diet therapy used to be the only or main treatment for peptic ulcers. The following views on the diet of peptic ulcer patients are held: ① chew slowly and avoid eating sharply, chewing can increase saliva secretion, which can dilute and neutralize gastric acid and may have the effect of improving the mucosal barrier; ② eat regularly and regularly to maintain the rhythm of normal digestive activities; ③ when the acute activity period, it is appropriate to eat less and more meals, and 4-5 times a day can be eaten, but once the symptoms are controlled, it should be encouraged to resume more quickly ④It is advisable to pay attention to nutrition, but there is no need to specify special recipes; ⑤Avoid snacking between meals, and do not eat before bedtime; ⑥During the acute activity period, quit smoking and alcohol, and avoid coffee, strong tea, strong broth and chili acid vinegar and other stimulating condiments or spicy beverages, as well as drugs that damage the gastric mucosa; ⑦The diet is not too full, in order to prevent excessive expansion of the gastric sinus and increase the secretion of gastrin.
3.Sedation
For a small number of patients with symptoms such as anxiety, tension and insomnia, some sedatives or tranquilizers can be used for a short period of time.
4.Drug treatment
At present, there are two major categories of drugs used in the market for the treatment of ulcer disease, one is the drug to reduce gastric acid and increase the defense ability of gastroduodenal mucosa, mainly by alkaline antacids, anticholinergics, H2 receptor antagonists, proton pump inhibitors, etc.; the second is the drug to enhance the defense ability of the mucosa, mainly colloidal bismuth, aluminum thioglycollate and prostaglandins and other drugs.
5.Anti-H. pylori treatment
Commonly used quadruple/triple anti-Helicobacter pylori therapy.
6.Surgical treatment
The current clinical criteria for indications for ulcer disease surgery are: (i) a history of ulcers for many years, with gradually worsening symptoms, frequent attacks, longer attacks, severe pain, or excessive restrictions on diet and life, affecting physical nutrition and normal life; (ii) there has been at least one strict medical treatment without symptom reduction, or relapse within a short time after reduction, or barium X-ray examination reveals a large ulcer or penetration into the stomach or signs beyond the wall of the stomach and duodenum; ③ history of perforation and hemorrhage in the past, while the ulcer is still active and there is a possibility of acute complications. The indications for surgery can be relaxed in older patients. ④ If there is a suspicion of malignant transformation of gastric ulcer and it is not easy to identify whether it is benign or malignant ulcer clinically, the indications for surgery for gastric ulcer are wider than those for duodenal ulcer because of the good results of gastric ulcer surgery and the less possibility of recurrence after surgery.