Intestinal ulcer is a disease that causes intestinal mucosal defects, bleeding or even ulceration due to various reasons
Symptoms include irregular abdominal pain, diarrhea, blood or mucus in the stool, and acute and severe symptoms.
The cause of the disease is related to infection, stress, autoimmune factors, lifestyle habits and medications.
Treatment mainly includes general treatment, medication and surgery.
What is intestinal ulcer?
Definition
Intestinal ulcer is a disease in which the intestinal mucosa is defective, bleeding or even ulcerated due to various reasons.
Common ones include intestinal diseases such as Crohn’s disease and intestinal tuberculosis, and rheumatic immune diseases such as Behçet’s syndrome (leukemia).
The main symptoms include abdominal pain, bloating, diarrhea, fever, blood and mucus in the stool, a feeling of urgency during defecation, abdominal mass, and weight loss.
Incidence
There are no statistics on the overall incidence of the disease in China.
It can occur at any age.
There is no significant gender difference.
Questions you may be concerned about
What are the most feared foods for intestinal ulcers?
When intestinal ulcers occur, you should avoid stimulating foods such as coffee and strong tea, quit smoking and drinking, and pay attention to eating regularly.
Spicy and irritating foods such as chili pepper, hot sauce, and chili sticks should also be avoided, and too rough and hard foods such as nuts should also be avoided in order to avoid mechanical damage to the intestinal mucosa.
Usual life should pay attention to should not be strenuous exercise, avoid excessive tension and exertion, when the ulcer is active, pay attention to more rest.
What are the symptoms of intestinal ulcer?
The main symptoms of intestinal ulcers include abdominal pain, abdominal distension, diarrhea, fever, mucous bloody stools, feeling of incomplete bowel movement, abdominal mass may be present, weight loss and other symptoms.
Intestinal ulcers can also be accompanied by eye pain, photophobia, tearing, vision loss and other manifestations of iridocyclitis, arthritis manifestations such as joint pain, swelling, limited mobility; scleral yellowing of the skin, edema of the lower extremities, itchy skin and other manifestations of liver dysfunction.
If treatment is not timely, complications such as blood in the stool, intestinal stenosis and intestinal perforation can occur.
What is the most effective medicine for intestinal ulcer?
Intestinal ulcers should be treated with medications chosen according to different causes, and are usually treated with macrolide antibiotics, bifidobacteria, montelukast, and other medications.
Macrolide antibiotics include erythromycin, clarithromycin, roxithromycin, and azithromycin.
Bifidobacterium bifidum directly replenishes normal physiological bacteria; montelukast has a covering ability on the mucosa of the digestive tract, which helps to repair and improve the defense function of the mucosal barrier.
Etiology
Causes of disease
Many factors can lead to intestinal ulcers, among which there are disease factors, which can also be caused by lifestyle habits and medications.
Disease factors
Intestinal diseases: Crohn’s disease, ulcerative colitis and other intestinal diseases can damage the intestinal mucosa.
Infectious diseases: Bacterial dysentery, intestinal tuberculosis, and intestinal infectious diseases such as enteric typhus can also cause intestinal ulcers, which may be caused by direct attack of disease-causing microorganisms on the intestinal tissues. One of the causes of peptic ulcers is Helicobacter pylori.
Stress disease: when the human body is in a state of stress such as extensive burns, hemorrhage, etc., resulting in direct or indirect damage to the intestinal mucosa causing intestinal stress ulcers.
Rheumatic immune disease: rheumatic immune disease due to autoimmune factors can damage the intestinal mucosa, so that intestinal ulcers.
Drug factors
Long-term use of non-steroidal anti-inflammatory drugs can cause localized damage to the intestinal tract, resulting in intestinal ulcers.
Predisposing factors
Diet: Long-term dietary irregularities, such as overeating, can trigger intestinal ulcers.
Work and rest: Long-term irregularities in work and rest, such as frequent late nights and lack of sleep, can cause intestinal ulcers.
Alcohol: long-term alcohol consumption can also cause intestinal ulcers.
Psychological stress: Long-term high tension is also easy to cause intestinal ulcers.
Pathogenesis
The normal metabolism of intestinal cells is affected by the irritation of the intestinal wall.
If the irritating factors persist, the intestinal cells may suffer from nutritional disorders.
In the long run, the barrier effect of the intestinal wall is weakened, causing the intestinal mucosa to be more susceptible to irritation by celiac disease mixed with digestive juices, which eventually leads to intestinal ulcers.
Symptoms
Main Symptoms
Abdominal pain, bloating and diarrhea.
Fever.
Blood and mucus in the feces.
Desire to defecate, but no fecal matter is passed, yet the bowel movement always feels incomplete (urgency and heaviness).
Abdominal masses may be present.
Weight loss.
Other symptoms
Iridocyclitis: eye pain, photophobia, tearing, loss of vision, etc.
Arthritis: joint pain and swelling as well as limitation of movement, etc.
Hepatic dysfunction: yellowing of the skin and sclera, edema of the lower extremities, and itching of the skin.
Complications
The development of one disease causes the development of another disease or symptom, which is called a complication of the former.
If the treatment is not timely and standardized, intestinal ulcers can have complications such as blood in profuse diarrhea, intestinal stenosis, and intestinal perforation.
Massive diarrhea with blood in stool
Blood in stool is one of the main clinical manifestations of ulcerative colitis, and the amount of blood in stool is also an indicator of the severity of the disease, but sometimes it is difficult to absolutely quantify.
The large amount of blood in stool here refers to a large amount of intestinal bleeding in a short period of time, accompanied by increased pulse rate or even intestinal perforation.
Intestinal stenosis
It mostly occurs in patients with extensive lesions and a continuous course of the disease lasting for more than 5 to 25 years.
Its site mostly occurs in the left half of the colon, sigmoid colon or rectum.
The cause is thickening of the muscular layer of the mucosa or obstruction of the intestinal lumen by pseudo-polyps.
It is asymptomatic in mild cases, but can cause partial intestinal obstruction in severe cases.
Intestinal perforation
Mostly a complication of toxic intestinal dilatation, it can also occur in severe forms.
Corticosteroid application is considered one of the possible risk factors for intestinal perforation.
Consultation
Department of Medicine
Gastroenterology
Prompt medical attention is recommended in the event of unexplained abdominal pain, diarrhea, blood or mucus in the stools, and a feeling of urgency.
Preparation
Information on how to get to the doctor: registration, preparation of documents, and frequently asked questions.
Tips for seeking medical care
You can record the symptoms you have experienced and their duration for the doctor’s reference.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Are there any symptoms such as abdominal pain, diarrhea, mucous blood stools, etc.?
When did these symptoms appear?
If diarrhea is present, how many times per day are the stools?
What color are the stools? What is the shape of the stool?
Is there any bloating and what conditions relieve it?
Are there any symptoms such as fever, lethargy, or fatigue?
Under what conditions do the symptoms worsen?
Medical History Checklist
Have you had any intestinal diseases in the past?
Has there been any related examination or treatment?
Any history of drug allergy, etc.?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Immunosuppressive and biological agents: azathioprine, cyclosporine, infliximab
Diagnosis
Disease Diagnosis
The doctor will make a diagnosis based on the medical history and a combination of physical examination, laboratory tests, imaging tests, and endoscopy.
Medical History
These are crucial to the diagnosis of the disease and determining the cause, so your doctor will ask about the following medical history.
Any history of Crohn’s disease, ulcerative colitis, tuberculosis, or rheumatologic diseases.
Any recent consumption of unclean food, etc.
History of relevant medications.
Any lifestyle habits such as alcohol consumption.
Clinical manifestations
Symptoms: Irregular abdominal pain, diarrhea, blood or mucus in the stool, acute and severe symptoms.
Signs: Physical examination by the doctor through vision, palpation, percussion and auscultation can find out whether there is a mass in the abdomen, whether there is pressure pain, etc., which is diagnostic for the disease.
Laboratory Tests
Blood tests
Changes in the white blood cell count can determine the presence of enteric typhus, ulcerative colitis and other diseases. It is crucial for the diagnosis and etiologic determination of intestinal ulcer.
If there is a decrease in the blood white blood cell count and a decrease or disappearance of eosinophils, it can assist in the diagnosis of enteric typhoid fever.
There is no need to fast and abstain from food and water before the blood test, you can have a normal diet, but you need to abstain from alcohol.
Fertilizer test
A test tube agglutination reaction used to detect Salmonella infection.
The test can diagnose the presence of typhoid fever and paratyphoid fever, and is crucial for the diagnosis and etiology of intestinal ulcers.
Fertilizer test needs to be observed dynamically and no conclusion can be drawn from just one test report.
Helicobacter pylori test
There are mainly urea breath test (¹³C, ¹⁴C breath test), blood antibody test and fecal antigen test.
The results can help the doctor determine whether H. pylori infection is present, and if so, can guide the doctor in confirming the diagnosis of peptic ulcer.
Imaging examination
Methods: Abdominal X-rays and CT examinations are mainly performed.
Function: X-ray and CT examination can be used to determine the location of the lesion, and other malignant diseases that cause abdominal pain can also be ruled out.
Fasting is generally not required before the examination, so normal diet is allowed; metal objects in the abdomen, such as belts, need to be removed before the examination; children or critically ill patients need to be accompanied by a person.
Endoscopy
Purpose: Endoscopy can visualize the intestinal mucosa and can confirm the diagnosis of intestinal ulcers.
Characteristics: Endoscopy is safe and reliable, and mucosal tissue can also be taken under the microscope for testing.
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Precautions
Start eating semi-liquid or low residue diet, such as milk, porridge, noodles, thin rice, etc., and avoid eating vegetables, fruits and other foods containing more fiber 1~3 days before the endoscopy.
Fasting is required on the day of examination; before the examination, take oral laxatives as prescribed by the doctor for bowel cleansing until the discharge is light yellow, non-slaggy watery stool.
Before the examination, please bring the electrocardiogram, previous colonoscopy results and relevant information such as pathological diagnosis and imaging examination.
For normal colonoscopy without colonoscopic treatment, you can eat after the abdominal distension disappears about 2 hours after the examination.
Painless colonoscopy needs to be accompanied by a family member, and after the examination, you should lie down and rest, and get up and move around only after you are completely awakened, and don’t drive on the day of the examination.
Differential Diagnosis
Gastric ulcer
Similarity: both can have rhythmic pain in the upper abdomen and abdominal distension.
Differences: Gastric ulcers are more common in middle-aged and elderly people, while duodenal ulcers are more common in young adults; gastric ulcers are painful after eating, while duodenal ulcers are painful only when hungry. It can be differentiated with the help of endoscopy.
Treatment
Aims and principles of treatment
The treatment of intestinal spasms is aimed at preventing complications such as intestinal perforation and reducing the frequency of recurrent episodes.
In severe cases or if symptoms are not relieved after treatment, medication, surgery and Chinese medicine may be used.
Treatment
General treatment
Eat regularly and quantitatively.
Stop smoking and drinking.
Avoid excessive tension and anxiety.
Strenuous activities are not advisable and more rest is needed.
Medication
Macrolide antibiotics
Commonly used for the treatment of infections with aerobic Gram-positive bacteria, Gram-negative bacilli and anaerobic cocci.
Commonly used drugs include erythromycin, clarithromycin, roxithromycin, azithromycin, madithromycin and spiramycin.
It is contraindicated for people who are allergic to macrolide antibiotics, and caution is needed for pregnant and lactating women.
Bifidobacterium bifidum
Bifidobacterium bifidum can directly replenish normal physiological bacteria for the treatment of diarrhea, chronic diarrhea and constipation caused by intestinal flora imbalance.
Bifidobacterium bifidum is a live bacterial preparation, and its combination with some drugs may cause interaction and affect the efficacy of the drugs. Try to avoid antacids, antibacterial drugs when used in combination, so as not to weaken the efficacy of this drug; bismuth, tannins, medicinal charcoal, tinctures, etc. can inhibit, adsorb or kill bifidobacteria.
Montmorillonite powder
The main drug ingredient is montmorillonite, which has the ability to cover the mucous membrane of the digestive tract and repair and improve the defense function of the mucous membrane barrier against the attacking factors both qualitatively and quantitatively by combining with the mucous glycoproteins with each other.
It is recommended to be taken on an empty stomach, usually 2 hours before a meal, and it is also recommended to abstain from drinking and eating for 2 hours after taking the medicine.
Surgery
Surgery may be required in the following cases of intestinal ulcers.
The ulcer cannot be healed by repeated treatment with medication over a long period of time.
Complicated intestinal polyps can be removed by enteroscopy.
In severe cases of intestinal ulcers, surgical removal of part of the bowel may be considered.
Intestinal ulcers cause serious complications such as bleeding and perforation.
Prognosis
Cure
In untreated cases, normal life and study may be affected by irregular abdominal pain, diarrhea, blood or mucus in feces, and urgency.
The condition can be relieved with active and scientific treatment. However, certain intestinal ulcers are difficult to cure and tend to recur after control.
Harmfulness
Affecting life
If the ulcer is serious, frequent bloody stools with high fever and abdominal pain will occur, which will seriously affect daily life.
Weight loss
People with chronic intestinal ulcers will lose significant weight.
Physical and mental pain
During disease activity, severe tenderness in the lower abdomen and acute abdominal symptoms may occur, causing great physical and mental pain.
Daily routine
Daily Management
Dietary management
Strictly prohibit alcohol and all beverages with alcohol.
Avoid overeating and eat regularly.
Work and rest management
Do not stay up late and get enough sleep.
If surgical treatment is performed, bed rest is required as prescribed by the doctor.
Psychological management
Keep in a good mood and avoid bad emotions.
Follow-up
Importance of follow-up examinations: Regular follow-up examinations help to detect complications in a timely manner, which is crucial to the effectiveness of the treatment.
Timing of follow-up: Follow the doctor’s instructions for regular follow-up; if you have symptoms such as irregular abdominal pain, diarrhea, blood or mucus in the stool, or a feeling of urgency, it is recommended that you consult the doctor in time.
Tests to be done at follow-up: People with intestinal ulcers may need endoscopy and imaging tests at follow-up.
Prevention
Treatment of chronic diseases of the intestines such as Crohn’s disease and ulcerative colitis.
Treatment of bacillary dysentery, intestinal tuberculosis, and intestinal infectious diseases such as enteric typhus.
Avoid stressful conditions such as massive burns and hemorrhage.
Treat autoimmune diseases.
Use non-steroidal anti-inflammatory drugs such as ibuprofen with caution.
Pay attention to healthy lifestyle, reasonable diet and appropriate exercise.