Peptic ulcers are chronic ulcers that occur mainly in the stomach and duodenum, but also in the lower esophagus, around the gastrojejunal anastomosis and in MECKEL diverticula containing ectopic gastric mucosa. The formation of these ulcers is related to the digestive action of gastric acid and pepsin, so they are called peptic ulcers.
The clinical manifestations of peptic ulcer are chronic in course, with periodic episodes alternating with periods of remission during the course of the disease; rhythmic pain. Rhythmical and periodic disappears when there are complications.
1, pain: epigastric pain is the main symptom of peptic ulcer, the nature of pain varies, can be dull pain, burning pain, distension or severe pain, but also can only feel discomfort. The typical one is mild or moderate persistent pain, limited in scope, gastric ulcer is located in the middle or to the left of the subxiphoid process, appearing 0.5-2h after meals; its pattern is eating → pain → relief. The pain of duodenal ulcer is located in the middle or slightly to the right of the epigastric region, and appears 3-4h after meal, and can be relieved by taking acidulants and eating. Its regular pain → eating → relief, generally can have mild pressure pain in the upper abdomen.
2. Other: epigastric fullness, belching, acid reflux, nausea, vomiting, loss of appetite and other digestive symptoms.
3, systemic symptoms: patients may have insomnia and other neurological manifestations, and those with more severe pain and affecting eating may have wasting and anemia.
4. There are generally no obvious signs during the remission period. The pressure point of active gastric ulcer is often in the upper middle abdomen or to the left; in the case of duodenal bulb ulcer, it is often to the right; the posterior wall penetrating ulcer is on both sides of the 11th and 12th thoracic vertebrae in the back.
The main complications are: bleeding, perforation, pyloric obstruction, and cancer.
The aim of treatment therapy is to relieve symptoms, promote ulcer healing, and prevent recurrence and complications.
1.Drug treatment
(1) Drugs to reduce damaging factors.
①Acid control agents: can reduce the acidity in the stomach and duodenum, relieve pain and promote ulcer healing, now rarely used alone.
②Anti-cholinergic drugs: can resist vagus nerve and reduce gastric acid secretion, can release vasospasm and improve mucosal blood flow, can relax smooth muscle to delay gastric emptying, which is conducive to prolonging the effect of acid making drugs and food neutralization of gastric acid, now rarely used.
③H2 receptor antagonist: it can block the binding of histamine and H2 receptor on the wall cell membrane and inhibit the secretion of gastric acid, such as methanechol, ranitidine, etc.
(4) Proton pump inhibitors: strongly inhibit the activity of cation pump (H+/K+-ATPase) and block H+ from being excreted outside the mural cell body, such as omeprazole, dacrypromine, etc.
(2) Drugs to strengthen the protective factors: Combine with the proteins on the ulcer surface to form a protective film to cover the ulcer surface and promote ulcer healing. Commonly used are: aluminum thioglycollate, bismuth tripotassium di-citrate complex, raw gastrone.
(3) Antibacterial therapy: Since H. pylori may be related to the development of peptic ulcer, antibacterial therapy has become a new treatment method. Add antibacterial agents such as dysentery.
2. Indications for surgical treatment.
(1) Massive bleeding is ineffective by emergency medical treatment.
(2) Acute perforation.
(3) Organic pyloric obstruction.
(4) Gastric ulcer suspected to be cancerous.
(5) Gastric ulcers that have been treated with internal medicine and have no effect.
Peptic ulcer? Diet peptic ulcers occur at different sites and symptoms, but the principles of dietary treatment are the same, and the ultimate goal is to promote ulcer healing and prevent recurrence.
1, a small number of meals at regular intervals; 5-7 meals per day, the amount of each meal should not be more.
2.Avoid irritating food mechanical and chemical stimulation too strong food should be avoided, mechanical stimulation increases damage to the mucosa and destroys the mucosal barrier, such as coarse grains, celery, leek, celery, bamboo shoots and dried fruits. Chemical stimulation will increase the secretion of gastric acid, which is detrimental to ulcer healing, such as coffee, strong tea, strong wine, strong broth, etc. Avoid acid-producing foods, such as groundnuts, potatoes, too sweet snacks and sweet and sour foods; gas-producing foods, such as raw onions, raw garlic, raw radishes, garlic, onions, etc.; raw and cold foods, such as a lot of cold drinks, cold dishes, etc.; hard foods, such as bacon, ham, sausages, mussels, etc.; strong condiments, such as pepper, curry powder, mustard, chili oil, etc.
3, choose fine and soft easy to digest food Choose food with high nutritional value, fine and soft easy to digest, such as milk, eggs, soy milk, fish, lean meat, etc.. After processing and cooking to make it soft and easy to digest, no stimulation to the stomach and intestines.
5.Supply rich vitamins Choose foods rich in B vitamins, vitamin A and vitamin C; staple foods are mainly pasta, fasting should be fasted when bleeding, blood stop eating liquid diet.
6, cooking methods ulcer disease eat food must be chopped and cooked; can choose to steam, boil, boil, soft-boiled, braised, stewed and other cooking methods, should not be fried, fried, stir-fried, vinegar, cold and other methods of food processing.
7, other eating should be relaxed, chew and swallow slowly, to facilitate digestion. Take care of the patient’s eating habits and prepare delicious meals. Provide fine, soft, coarse fiber less food, should pay attention to prevent constipation. Extra meals before bedtime are particularly suitable for duodenal ulcers, which can reduce hunger pain and facilitate sleep.