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Abstract: Gastric ulcer is a common clinical chronic disease caused by a variety of pathogenic factors, and is an inflammatory and necrotic lesion that can reach deep into or penetrate the muscular layer of the gastric mucosa. Collectively with duodenal ulcer disease, it is referred to as peptic ulcer. The patient in this case is a female, 33 years old, who was admitted to the hospital with gastric distension and discomfort, sometimes with heartburn and acid reflux, and was diagnosed with gastric ulcer by gastroscopy. After medication, the patient’s symptoms were relieved and she was discharged.
Basic information】Female, 33 years old
Disease Type】Gastric ulcer
Hospital】The First Hospital of China Medical University
Date of consultation】October 2021
Treatment plan】Medication (omeprazole enteric capsules, clarithromycin capsules, amoxicillin capsules, bismuth citrate potassium granules, ranitidine hydrochloride capsules, aluminum thioglycollate chewable tablets, magnesium aluminum carbonate chewable tablets)
[Treatment period] 3 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The condition improved and the patient was discharged from the hospital
I. Initial interview
Patient, female, 33 years old. One month ago, the patient developed gastric distension and discomfort with no obvious cause, sometimes heartburn and acid reflux, abdominal pain, diarrhea, constipation, no fever, chills, no nausea, vomiting, no chest tightness, chest pain and other concomitant symptoms, out-of-hospital self-administered gastric medicine, the details are not known, and improved. In the last 2 days, the patient had pain in the stomach after eating, with paroxysmal attacks that lasted 2-3 minutes and could improve on their own. For further diagnosis and treatment, the patient came to the hospital yesterday. Examination: abdomen is flat, symmetrical, no abdominal wall veins are revealed, no gastrointestinal type and spiral waves, abdomen is soft, no obvious pressure pain and rebound pain, no abdominal mass. The liver and spleen were not palpable under the ribs, and Murphy’s sign was negative. There was no percussion pain in the hepatic and renal regions and no mobile turbid sounds. The electrocardiogram showed a normal electrocardiogram. Gastroscopy showed ulcerative lesions of the stomach and a positive test for Helicobacter pylori, and the preliminary diagnosis was gastric ulcer.
II. Treatment history
Since the patient tested positive for H. pylori, the cause of the disease should be removed first and H. pylori eradication treatment should be carried out. The patient was given omeprazole enteric capsules, clarithromycin capsules, amoxicillin capsules, and bismuth citrate potassium granules in a combined treatment plan containing bismuth after communication with the patient. At the same time, to relieve the patient’s discomfort, the patient was given ranitidine hydrochloride capsules to inhibit gastric acid secretion, and chewable aluminum thioglycollate tablets and chewable magnesium aluminum carbonate tablets to protect the gastric mucosa.
III. Treatment effect
After the treatment, the patient’s symptoms of gastric distension, abdominal pain, diarrhea and constipation improved, and he was in good mental condition, slept and ate normally, and had normal bowel movements. One month later, a H. pylori test was performed and the result showed that the patient was negative for H. pylori. The patient had no other uncomfortable symptoms, and was given to stop the drug treatment of omeprazole enteric capsules, clarithromycin capsules, amoxicillin capsules and bismuth citrate potassium granules.
IV. Precautions
The patient was discharged from the hospital after her condition was stabilized, and I was sincerely happy for the patient as her discomfort disappeared and she was in a happy mood at the time of discharge. At the same time, since the patient needs at least 1 month of medication for H. pylori eradication treatment, the patient should pay attention to strictly follow the doctor’s prescription after discharge, and should not stop the medication privately to avoid poor treatment effect. The daily diet should be light, and spicy, stimulating and greasy food, such as chili peppers and fried chicken, should be prohibited.
V. Personal insight
For patients with gastric ulcer with H. pylori infection, in order to achieve ulcer healing, the course of acid-suppressing drugs is usually 4 weeks, and the combination of drugs for H. pylori eradication should be about 1 month. During the first month of medication, attention should be paid to adhering to the medication as prescribed by the doctor to avoid underdosing or omission, as in the patient in this case, after adhering to the medication for 1 month, H. pylori has been eradicated with excellent results. In addition, it should be noted that if the ulcer recurs several times, while removing the common causes, we should further investigate whether there are other causes, and give maintenance treatment, i.e., a longer period of time to take maintenance doses of H,receptor antagonists or PPI drugs, such as Esomeprazole Magnesium Enteric Capsules, the duration of treatment varies from person to person, from 3-6 months for short cases to 1-2 years for long cases, or extend the duration of medication depending on the specific condition.