Peptic ulcer is a general term for gastric ulcer (GU) and duodenal ulcer (DU), so named because ulcer formation is associated with the digestive action of gastric acid/pepsin. Clinical manifestations include chronic, periodic, rhythmic abdominal pain with other gastrointestinal symptoms such as increased salivation, heartburn, regurgitation, belching, belching, nausea, and vomiting. Patients with peptic ulcers should avoid mental stimulation, overwork, irregular life, irregular diet, smoking and alcohol abuse.
Gastric ulcers tend to occur in middle-aged and elderly people, while duodenal ulcers are predominantly found in young and middle-aged people. The proportion of men suffering from peptic ulcers is higher than that of women. Duodenal ulcers are more common than gastric ulcers, and according to statistics, the former accounts for about 70%, the latter for about 25%, and the compound ulcers that coexist with both account for about 5%. In recent years, the number of people suffering from duodenal ulcers has increased in cities. The secretion of gastric acid increases when meat is consumed compared to the consumption of sugary substances such as cereals. When excess stomach acid persists for a long time and accumulates in the duodenal bulb (the entrance to the duodenum), it tends to damage the mucosa leading to duodenal ulcers.
1. Helicobacter pylori infection.
HP infection is the main cause of chronic gastritis and is an important cause of peptic ulcers.
2. Delayed gastric emptying and bile reflux.
This degenerative change in the gastric sinus and pyloric region in gastric ulcer disease can render the contraction of the gastric sinus ineffective, thus affecting the forward propulsion of the food chyme. Delayed gastric emptying may be a factor in the pathogenesis of gastric ulcer disease.
Certain components of duodenal contents, such as bile acids and lysolecithin, can damage the gastric epithelium. Reflux of duodenal contents into the stomach can cause chronic inflammation of the gastric mucosa. The damaged gastric mucosa is more susceptible to damage by acid and pepsin.
With gastric ulcer, the concentration of bile acid conjugates in gastric juice is significantly higher than that of normal controls during fasting, leading to the assumption that bile reflux into the stomach may play an important role in the pathogenesis of gastric ulcer disease.
3. Drug factors.
Certain antipyretic and analgesic drugs, anticancer drugs, such as anti-inflammatory pain, pautazone, aspirin, adrenocorticotropic hormones, fluorouracil, methotrexate, etc. have been classified as ulcerogenic factors.
4, environmental factors.
Smoking can stimulate increased secretion of gastric acid, cause vasoconstriction, and inhibit the secretion of pancreatic juice and bile and weaken its ability to neutralize gastric acid in the duodenum, leading to persistent acidification of the duodenum; tobacco nicotine can reduce the tone of the pyloric sphincter, affecting its closing function and leading to bile reflux and destruction of the gastric mucosal barrier. The incidence of peptic ulcers is significantly higher in smokers than in controls. The healing rate of ulcers was also significantly lower in the former than in the latter under the same effective drug therapy. Therefore, long-term heavy smoking is not conducive to ulcer healing and can lead to recurrence.
Food can cause physical and chemical damage to the gastric mucosa. Overeating or irregular eating may disrupt the rhythm of gastric secretion. According to clinical observation, coffee, strong tea, strong alcohol, spicy seasonings, kimchi and other foods, as well as paranoia, eating too fast, too hot, too cold, overeating and other bad eating habits, may be the relevant factors for the occurrence of the disease.
5, mental factors.
According to the modern psycho-social-biomedical model view, peptic ulcer belongs to one of the typical psychosomatic disease categories. Psychological factors can affect the secretion of gastric juice.
What are the characteristics of abdominal pain in peptic ulcer disease?
(1) Chronic recurrence: peptic ulcer is prone to recurrence after healing, mostly stating that the pain in the upper abdomen is recurrent, with an average duration of 5-8 years.
(2) Periodic attacks: In autumn and winter when the climate changes suddenly and in the early spring of the following year, there is a high incidence of ulcer disease.
(3) Rhythmic pain: It is a typical physical feature of epigastric pain in peptic ulcer patients, and it is mostly present when there is no complication. Gastric ulcers heal duodenal ulcers pain rhythmically different, according to this feature sometimes history can be differential diagnosis, usually two two features are.
Complications.
Upper gastrointestinal bleeding: the most common complication, with a higher rate of bleeding complicating duodenal ulcers than gastric ulcers; perforation; gastric outlet obstruction.
Carcinoma: Some patients who were diagnosed with gastric ulcer at the first visit were eventually diagnosed with gastric cancer, which is due to the difficulty of screening benign malignant gastric ulcers, so the importance of reviewing gastroscopy after 2 months of regular treatment is emphasized.
Treatment strategy.
1. 8 weeks of treatment for gastric ulcer and 4-6 weeks for duodenal ulcer.
2. hp must be eradicated for combined hp infection.
How to prevent recurrence?
1.Remove risk factors of recurrence Avoid taking NSAID drugs and quit smoking.
2. Eradicate H. pylori.