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Abstract: The patient was a 27-year-old man who presented to the clinic with 4 black stools in 3 days. The routine blood count indicated decreased hemoglobin, and gastroscopy suggested duodenal bulb ulcer, which was considered as upper gastrointestinal bleeding and duodenal bulb ulcer with bleeding. The patient’s symptoms and biochemical parameters improved after treatment with gastroscopic tissue adhesive therapy and symptomatic treatment such as suppression of gastric acid and protection of gastric mucosa.
Basic information】Male, 27 years old
Type of disease】Upper gastrointestinal bleeding
Hospital】Xinhua Hospital, Shanghai Jiaotong University School of Medicine
Date of consultation】February 2022
Treatment plan】Gastroscopic tissue adhesive treatment + medication (sodium eprazole for injection, snake venom hemagglutinase injection, teprenone capsule, amoxicillin capsule, bismuth citrate potassium capsule, metronidazole tablet, eprazole enteric solution tablet)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
The patient is a 27-year-old young man who has been working in the IT industry for 2 years, with irregular diet and frequent late night work. This time, he visited the clinic because of black stool 4 times in 3 days. The patient had black stool 4 times in 3 days, the stool was not formed, the volume was about 200ml each time, accompanied by weakness, dizziness, no vomiting of blood, syncope, chest pain, shortness of breath, etc. Emergency blood tests showed that hemoglobin was 76g/L, white blood cell count was 3.54×10^9/L, platelet count was 337×10^9/L, liver and kidney function, coagulation routine and electrolytes were basically normal. Further improvement of emergency gastroscopy showed an ulcer of about 0.5 cm in diameter in the duodenal bulb, and a bare thrombotic head was seen. Treatment with cyanoacrylate tissue gel injection was given. This led to the diagnosis of duodenal bulb ulcer with erosive gastritis, which in turn caused upper gastrointestinal bleeding, duodenal bulb ulcer with bleeding, and moderate anemia.
(Blood count)
II. Treatment history
The cause of upper gastrointestinal bleeding was clear, and the patient was considered to have a duodenal bulb ulcer with bleeding, so the patient was treated with gastroscopic tissue gelation, instructed to fast, given intravenous injection of sodium eprazole for injection to suppress gastric acid and control bleeding, and given intravenous injection of snake venom hemagglutinase to suppress bleeding, together with teprenone capsules, amoxicillin capsules, bismuth citrate potassium capsules, and metronidazole tablets taken orally. The patient was also instructed to rest in bed and to closely test the blood count. If the bleeding could not be controlled and the hemoglobin continued to drop, blood transfusion support was needed if necessary. The patient initially did not know enough about his disease and thought he was young and would not have any major problems. The patient was explained the seriousness of upper gastrointestinal bleeding and that if the bleeding could not be controlled by medication, surgical treatment would be considered. Later, the patient began to pay attention to it and actively cooperated with the treatment.
III. Treatment effect
The patient was treated with eprazole and teprenone capsules, and the symptoms of weakness and dizziness improved significantly, and no more black stools were seen, and the condition gradually improved. On the 7th day of treatment, the patient’s stool turned yellow, and there was no abdominal pain or vomiting after eating, so the patient was discharged from the hospital with medications including anti-pyloric snail drugs, including Eprazole enteric tablets, amoxicillin capsules, bismuth citrate potassium capsules and metronidazole tablets. The patient’s gastroscopy was repeated 1 month later and the duodenal bulb ulcer healed well.
IV. Notes
We are glad that the patient has basically recovered from the disease. Since duodenal bulb ulcers tend to occur in young people, especially in individuals with high work pressure, frequent late nights, and irregular diet. Therefore, the patient should be advised to avoid spicy and stimulating diet after discharge, and to eat light, easy-to-digest soft food, three regular meals, regular rationing; do not stay up late, go to bed early and get up early, and develop good habits in life. If you have any discomfort such as vague pain, acid reflux and bloating in the upper and middle abdomen, you should consult a doctor promptly and improve gastroscopy if necessary to check for related diseases. If black stool or vomiting blood occurs, suggesting gastrointestinal bleeding, seek immediate emergency medical attention. If there is severe pain in the abdomen, it may also be an ulcer perforation, which also requires immediate emergency medical attention.
V. Personal insight
Upper gastrointestinal bleeding is a common disease in gastroenterology, and ulcer bleeding accounts for about half of the causes of bleeding. The upper duodenal bulb ulcer with bleeding is mostly seen in young people, and this patient’s upper duodenal bulb ulcer with gastrointestinal bleeding is mainly related to poor diet and irregular life style. Bleeding is a serious complication of ulcer, treatment is based on proton pump inhibitors and protection of gastric mucosa, while H. pylori needs to be screened and if necessary, sterilization treatment is needed. If the situation is serious, gastroscopic hemostatic treatment or even surgical treatment needs to be considered. Prevention emphasizes a regular diet and a good lifestyle.