What’s wrong with the stomach pain that keeps coming back?

  Peptic ulcers, mainly chronic ulcers in the stomach and duodenum, are one of the most common and frequent digestive disorders, which are easily diagnosed and treated but also prone to recurrence. There are various reasons for recurrence, such as ulcer not completely healed, premature discontinuation of medication, excessive gastric acid, failure to eradicate Helicobacter pylori (HP), poor quality of ulcer healing, irregular meals, uncontrolled smoking, alcohol and tea, mental tension and overexertion, etc. Among them, poor quality of ulcer healing, failure to eradicate HP infection and excessive gastric acid are the main reasons for recurrence.  After conventional treatment, ulcers healed under the naked eye (gastroscopy) actually have significant histological and ultrastructural abnormalities, which are manifested as low subepithelial mucosal differentiation, cystic dilatation of gastric glands, reduced microvascularity and structural disorder, low functional state of regenerated mucosa, weak microcirculatory state and ability to secrete protective mucus, etc., which lay the foundation for ulcer recurrence. Under the action of HP, gastric acid and other attacking factors as well as bad living habits, ulcers can easily recur again.  Anti-acid and HP eradication, standardized treatment to prevent recurrence Improving the quality of ulcer healing and reducing the damage to the mucosa by HP and gastric acid and other attacking factors are the keys to preventing the recurrence of peptic ulcer. The theory of “no acid, no ulcer” and “no HP, no ulcer” has important guiding significance in the formation and recurrence of peptic ulcer. After peptic ulcer and HP infection are diagnosed, they should be treated actively according to the principle of systematic, whole process and combined medication.  In patients with HP-positive peptic ulcers, HP eradication therapy should be administered first, which helps to significantly reduce the recurrence rate of ulcers. The regimen can be based on the treatment protocol recommended by the Consensus Opinion on H. pylori Issues of the Chinese Medical Association Gastroenterology Branch in 1999, and any of the triple or quadruple therapy can be used flexibly; after the eradication of HP treatment is completed, 2-4 weeks of gastric acid secretion suppression therapy is given.  For patients with HP-negative peptic ulcer, acid suppression therapy can be routinely administered for 4-6 weeks for duodenal ulcer and 6-8 weeks for gastric ulcer. Acid suppressants can be H2 receptor blockers such as ranitidine, or proton pump inhibitors such as omeprazole. After the above treatment, if the gastroscopy is considered healed, maintenance treatment can be carried out to reduce the chance of recurrence, and generally H2-blockers are mostly used, with half of the standard dose taken at bedtime; or proton pump inhibitors are taken orally 2~3 times a week. Depending on the needs of the specific condition, maintenance treatment is given for 3-6 months or even 1-2 years.  While eradicating HP and suppressing gastric acid treatment, together with the use of gastric mucosal protective agents such as teprenone, aluminum thioglycollate and magnesium aluminum carbonate, etc., can cover and protect the wound surface, reduce the damage to the mucosa by attack factors, increase the synthesis of protective mucus, promote the repair of damaged mucosal epithelium and the generation of new blood vessels, thus improving the healing quality and reducing the recurrence of peptic ulcer.  Life conditioning to prevent recurrence In daily life, long-term mental tension, emotional instability and overwork will affect the regulation function of neuro-endocrine-immune, causing vasospasm of gastrointestinal mucosa and mucosal ischemia, which is not conducive to food digestion and healing of ulcer surface.