Duodenal ulcer is a common disease of the gastrointestinal tract. It is generally believed that the spasm of the blood vessels and muscles of the stomach and duodenal wall is caused by the adverse stimulation of the cerebral cortex, which leads to the impairment of the nutrition of the cells of the gastrointestinal wall and the decrease of the resistance of the gastrointestinal mucosa, resulting in the formation of ulcers due to the susceptibility of the gastrointestinal mucosa to digestion by gastric juices, which is now believed to be caused by Campylobacter gastric infection. The ulcers are often single, but there are also multiple ulcers, such as gastric and duodenal bulb ulcers, and when they exist together, they are called compound ulcers.
I. Western medical treatment
The main purpose of drug treatment is to relieve symptoms and promote ulcer healing, and prevent recurrence and complications.
II. General treatment
Patients should abstain from smoking, alcohol and foods and drugs that are irritating to the stomach and intestines, such as coffee, steroid hormones, NSAIDs, etc. During the treatment period, they should have a soft diet, eat less and more meals, live a regular life, and take proper rest.
Third, drug treatment
1, H2 receptor antagonist: is the main drug for the treatment of ulcer disease, and has a better effect on DU treatment. Available mecamidine (cimetidine), ranitidine, famotidine and other drugs. The common usage of cimetidine is: 200mg, 3 times a day, 400mg before bedtime; the healing rate is 70%-80% in 4 weeks, almost 100% in 8 weeks, and the recurrence rate is 44% in one year if the ulcer is healed without maintenance amount to prevent recurrence, and the recurrence rate is more than 50% in one year.
2, H+-K+ATPase (proton pump) inhibitors: Omeprazole (Loxac) as the representative, is the latest and strongest acid-suppressing effect of the drug, and has mucosal protection and anti-H. pylori effect. Omeprazole in the treatment of peptic ulcer not only can rapidly relieve the symptoms of active ulcer to accelerate ulcer healing, but also has a reliable role in long-term treatment to maintain healing. With daily application of 20-60 mg of omeprazole, about 64% of patients had disappearance of symptoms and healing of ulcers after 2 weeks of treatment. Compared with H2 receptor antagonists, the effect of omeprazole on pain relief appeared faster and ulcer healing rate was higher.
3, anti-Helicobacter pylori (Hp) treatment: the main drugs that have a clear inhibitory or killing effect on Hp are bismuth, metronidazole or tinidazole, amoxicillin, clarithromycin, tetracycline, furazolidone, etc. Killing Hp can improve the efficacy of treatment and prevent recurrence. However, there is no single drug that can effectively eradicate Hp, and the eradication rate of diphtheria is not high, so the triple drug is currently advocated.
Fourth, surgical treatment
Most of the gastrectomy and vagotomy can also be used, both types of treatment methods can achieve good results.
V. Indications for surgical treatment
The indications for surgical treatment of DU are mainly two types: Type I: the occurrence of serious complications of DU, such as acute perforation, hemorrhage and scarring pyloric obstruction; Type II: the ineffectiveness of medical treatment or some special types of ulcers.
1.Acute perforation generally refers to acute free perforation, and surgical treatment is required in the following cases.
(1) perforation after a full stomach.
(2) More peritoneal exudate, late consultation and limited or diffuse purulent peritonitis.
(3) Poor general condition or manifestations of shock.
(4) Long history of ulceration with intractable pain and frequent episodes.
(5) with complications such as pyloric obstruction and bleeding.
If ulcer disease with hemorrhage has been diagnosed, it is usually treated by internal medicine first.
Surgical treatment should be considered in the following cases.
(1) rapid bleeding, critical situation, bleeding soon after the occurrence of shock.
(2) The blood transfusion is 600ml-900ml within 6-8 hours, but the vital signs do not improve or once improve, but after stopping the blood transfusion or slowing down the blood transfusion, it deteriorates rapidly, or the blood transfusion is more than 1000ml within 24 hours to maintain the blood pressure.
(3) Those whose bleeding does not stop with medical treatment, or whose bleeding is temporarily stopped and soon relapses.
(4) Those who are older than 60 years old and have sclerosis of the blood vessels, and it is estimated that it is difficult to stop the bleeding.
(5) Those who also have ulcer perforation or pyloric obstruction.
(6) active hemorrhage is seen on gastroscopy, and internal treatment is ineffective.
3.Once pyloric obstruction is diagnosed as scarring pyloric obstruction, surgical treatment should be performed after adequate preoperative preparation.
4.Ineffective medical treatment or some special types of ulcers, DU with ineffective medical treatment refers to the persistent non-remission of ulcer symptoms or recurrent attacks affecting patients’ daily life and work after strict drug treatment. In terms of pathological changes, it is roughly equivalent to chronic penetrating ulcers, or ulcers located behind the duodenal bulb, or ulcers caused by gastrinomas, multiple endocrine adenomas, etc.