Peptic Ulcer Health Education Q&A
1. Can peptic ulcers be prevented?
Peptic ulcer can be effectively prevented, mainly in the following aspects.
(1) Prevention of diet management: regular diet, avoid overeating, avoid spicy and stimulating, cold and hard, greasy food, avoid strong tea, coffee, orange juice and other drinks that stimulate gastric acid secretion, quit smoking and alcohol.
(2) Prevention of environmental adaptation: have adequate knowledge and psychological preparation for the work and living environment, and improve the ability to adapt to the environment.
(3) Prevention of sleep quality adjustment: develop a good biological clock, ensure sleep quality, and medication intervention if necessary.
(4) Prevention of mental and psychological adjustment: good at adjusting mood, relieving psychological burden and relieving anxiety.
(5) Prevention of drug application: if there is discomfort or previous history of peptic ulcer, apply acid suppressant PPI or gastric mucosal protector prophylactically in the good season (such as autumn and winter, winter and spring), especially for those who have a history of ulcer, and eradicate H. pylori infection.
(6) Standardized treatment, timely consultation and treatment according to treatment norms.
2.What is peptic ulcer?
Peptic ulcer (PU) refers to an ulcer caused by digestion of the gastrointestinal mucosa by gastric acid/pepsin under the action of various pathogenic factors, and the lesion reaches deep into the mucosal muscle layer. Peptic ulcer is one of the most common digestive diseases, and it is believed that about 10% of the population has peptic ulcer in their lifetime. The disease can be seen at any age, with the majority being 20-50 years old, with more men than women (2-5:1), and the ratio of duodenal ulcers to gastric ulcers is 3:1 clinically.
3.What are the symptoms and manifestations of peptic ulcer or physical discomfort?
The clinical manifestations of this disease vary, and some patients may be asymptomatic or have bleeding, perforation and other complications as the first symptoms.
(1) Pain is the main symptom of the disease. Patients mainly present with hidden pain, dull pain, distension, burning pain or hunger-like pain in the upper abdomen, which is usually tolerable, and ulcers in the posterior wall of the gastroduodenum may radiate to the back. The pain of typical DU is often rhythmic and periodic, and is relieved by eating or taking antacids.
The pain of DU often occurs between meals and continues unabated until relieved by the next meal or antacids. Nocturnal pain symptoms are rare.
2) The periodicity of pain is especially prominent in DU. Epigastric pain episodes can last for days, weeks or months, followed by a longer period of remission, and then recur. Ulcers can recur throughout the year, but are more common in the colder seasons from late autumn to early spring.
(2) In addition to epigastric pain, peptic ulcers may also have dyspeptic symptoms such as acid reflux, belching, heartburn, epigastric fullness, nausea, vomiting, and loss of appetite, but these symptoms are lacking in specificity. Some of these symptoms may be associated with concomitant chronic gastritis. Longer duration of the disease can be due to pain or other indigestion symptoms affect the intake of food and weight loss; but there are a few patients with duodenal bulb ulcer because of eating can make the pain temporarily reduced, frequent eating to weight gain.
4.What factors can cause peptic ulcer?
The pathogenesis of PU is mainly related to the imbalance between the damage factors of gastroduodenal mucosa and the factors of mucosal self defense-repair, among which abnormal secretion of gastric acid, H. pylori infection and the widespread use of NSAID, a non-steroidal anti-inflammatory drug, are the most common causes of PU. Next, smoking, dietary factors, genetics, abnormal gastroduodenal motility, stress and psychological factors also play a role in peptic ulcers.
5.Why do peptic ulcers occur?
(1) Helicobacter pylori (H. pylori) infection: H. pylori, by virtue of its virulence factor, colonizes the gastric-type mucosa (stomach and duodenum with gastric metabolism), induces local inflammation and immune response, and impairs the local mucosal defense/repair mechanism; on the other hand, H. pylori infection increases the secretion of gastrin and gastric acid, which enhances the invasive factors. These two synergistic effects cause damage to the gastroduodenal mucosa and ulcer formation.
(2) abnormal gastric acid secretion: in conditions such as gastrinoma or H. pylori infection, there is increased gastric acid secretion and increased pepsin activity, which increases the invasive effect on the gastric mucosa because of its ability to explain protein molecules.
(3) The wide application of non-steroidal anti-inflammatory drugs NSAID: commonly used in anti-inflammatory and analgesic, rheumatic diseases, osteoarthritis, cardiovascular diseases, etc. On the one hand, NSAID drugs have a direct damaging effect on the gastric mucosa, and secondly, they inhibit cyclooxygenase (COX), so that the endogenous prostaglandins (PG) with cytoprotective effect in the gastrointestinal mucosa, especially PGE1, PGE2 and PGI2 synthesis in the gastrointestinal mucosa, thus weakening the defense of the gastroduodenal mucosa against gastric acid/pepsin.
(4) Abnormal gastroduodenal motility: some DU patients have faster than normal gastric emptying, especially liquid emptying. Accelerated gastric liquid emptying increases the acid load on the duodenal bulb and makes the mucosa vulnerable to injury.
(5) Stress and psychological factors: people with chronic mental stress, anxiety or mood swings are prone to peptic ulcers, and these factors can affect the regulation of gastroduodenal secretion, movement and mucosal blood flow through the vagus nerve mechanism, which can lead to the occurrence of PU.
(6) Smoking and poor dietary habits: both can stimulate gastric acid secretion and increase the incidence of peptic ulcer.
6.How to diagnose peptic ulcer? How to self-judge whether there is peptic ulcer?
Peptic ulcer diagnosis: typical periodic and rhythmic epigastric pain is the main clue to the diagnosis of peptic ulcer. gu abdominal pain is mostly seen about half an hour after meals, while DU often occurs on an empty stomach. Those with ulcer symptoms do not necessarily have peptic ulcers, while a significant proportion of peptic ulcer patients often have atypical epigastric pain, and some patients may have no pain symptoms. Therefore, it is difficult to make a reliable diagnosis based solely on medical history. Therefore, the diagnosis needs to be confirmed by gastroscopy or barium meal imaging of the digestive tract.
7.Which diseases are peptic ulcer confused with or need to be differentiated from?
The main clinical manifestation of this disease is epigastric pain, so it needs to be differentiated from other diseases with epigastric pain symptoms.
(1) Functional dyspepsia: The main manifestations are postprandial epigastric fullness, belching, acid reflux, nausea and loss of appetite, etc. Sometimes the symptoms are similar to peptic ulcer. Gastroscopy can help to differentiate.
(2) Cholecystitis and cholelithiasis: They are mostly seen in middle-aged women, and often present with intermittent, episodic right upper abdominal pain, often radiating to the right scapular region, and may have accompanying symptoms such as fever and jaundice. For atypical patients, identification requires the help of B-type ultrasonography or endoscopic retrograde cholangiography.
(3) Gastric cancer GU is difficult to differentiate from gastric cancer symptomatically, and must rely on barium meal examination and endoscopy, especially the latter can take tissue for pathological examination under direct vision. endoscopic and X-ray manifestations of type III (depressed type) early gastric cancer are easily confused with benign gastric ulcer, and biopsy can help clarify. It should be emphasized that: firstly, for those who suspect malignant ulcer and have a negative biopsy, gastroscopy must be reviewed and biopsied again within a short period of time. Second, ulcer shrinkage or partial healing after treatment with powerful acid-suppressing drugs is not a reliable basis for judging benign or malignant ulcers, and follow-up should be strengthened for GU patients.
(4) Gastrinoma, also known as Zollinger-Ellison syndrome, is caused by non-b-cell tumors of the pancreas that secrete large amounts of gastrin. Ultrasonography (including ultrasound endoscopy), CT, MRI, selective angiography, etc. can help to localize the diagnosis of gastrinoma.
8.What tests help to confirm the diagnosis of peptic ulcer?
Gastroscopy and barium meal angiography of the upper gastrointestinal tract are the main methods for peptic ulcer disease. (1) Gastroscopy: Not only can the gastroduodenal mucosa be directly observed and photographed, but also biopsied under direct vision for pathological examination. Its accuracy for the diagnosis of peptic ulcer and the differential diagnosis of benign and malignant ulcer is higher than that of barium meal examination. It must be pointed out that there is no absolute limit to the morphological changes of ulcers for the identification of the nature of lesions, therefore, biopsy should be routinely performed for gastric ulcers, and for atypical or difficult-to-heal ulcers, the etiology should be analyzed and, if necessary, ultrasound endoscopy or mucosal bulk biopsy should be performed to clarify the diagnosis. Active upper gastrointestinal bleeding is a contraindication to barium meal examination, but endoscopy can determine its source and nature. (2) Barium meal X-ray examination: It is suitable for those who are contraindicated to gastroscopy or unwilling to undergo gastroscopy.
9.How to treat peptic ulcer?
The purpose of peptic ulcer treatment is to eliminate the cause, relieve clinical symptoms, promote ulcer healing, prevent recurrence and prevent complications.
(1) General treatment: pay attention to rest, regular diet, quit smoking and alcohol, avoid spicy and stimulating, cold and hard food. A relaxed mental state, optimistic mood, regular life and avoidance of overwork and stress are all conducive to ulcer healing. Those taking non-steroidal anti-inflammatory drugs should stop using them as far as possible, even if they are not used to warn patients to use them with caution in the future.
(2) Drug therapy: Inhibition of gastric acid secretion and gastric mucosa protection therapy are the two main drugs of PU. Acid suppression therapy: It is the most important measure to relieve the symptoms of peptic ulcer and heal the ulcer, and the proton pump inhibitors PPI (omeprazole, rabeprazole, esomeprazole, etc.) are preferred, usually in standard doses, once a day, half an hour before breakfast. Gastric mucosa protection drugs: commonly used are aluminum thioglycollate, colloidal bismuth, magnesium aluminum carbonate tablets (Daxi). Among them, colloidal bismuth has the effect of inhibiting H. pylori and can be used as a component in the combined treatment program of Hp eradication. the course of GU treatment is 6-8 weeks, and the course of DU treatment is 4 weeks.
(3) H. pylori eradication Hp therapy: For patients with Hp-positive peptic ulcer, Hp eradication therapy should be routinely performed. Not only can it promote ulcer healing, but also prevent ulcer recurrence. After the end of Hp eradication therapy, PPI should continue to be applied until the end of the course of treatment. The most commonly recommended treatment regimen for Hp eradication is PPI-based triple therapy (PPI, amoxicillin, clarithromycin) for 10 d. For those who fail to eradicate for the first time, quadruple therapy (PPI, bismuth, two antibiotics) is recommended for 10 d or 14 d. The eradication should be routinely reviewed after eradication therapy, and PPI should be stopped for at least 2 weeks and antibacterial drugs and bismuth for at least 4 weeks before the review. drugs and bismuth for at least 4 weeks before the review. In case of remedial treatment, an interval of 2-3 months is recommended.
(4) NSAID ulcer prevention and treatment: PPI preparations are preferred, which are highly effective in inhibiting gastric acid secretion, dilating gastric mucosal vessels, improving gastric mucosal blood flow, etc., and promoting ulcer healing. The standard measure of H2RA can only effectively prevent the occurrence of NSAID duodenal ulcers, but not gastric ulcers. The literature reports that 20 mg of esomeprazole daily is effective in preventing the recurrence of NSAID ulcers.
10.What are the precautions in peptic ulcer drug treatment and prevention?
(1) Acid-suppressing drugs are preferred to PPI preparations in the drug treatment of peptic ulcer, because the healing rate of H2RA ulcer is lower than that of PPI preparations due to H2 receptor antagonist, and there are occasional adverse reactions.
(2) Patients with NSAID ulcers should suspend or reduce the dose of NSAID medication, and if NSAID treatment is necessary, the combination of acid-suppressing and gastric mucosa-protecting drugs is generally used to prevent stress ulcers.
(3) Maintenance therapy should be given for the following conditions: elderly patients (>60 years old), those with frequent recurrences, those with previous complications, poor working conditions without good medical assurance (exploration, seafarers), etc.
11.What should be the dietary management in the prevention and treatment of peptic ulcer?
(1) Develop good dietary habits, eat regularly, avoid overeating, avoid spicy and stimulating, too cold and too hot, greasy food, avoid strong tea, coffee, orange juice and other drinks that stimulate gastric acid secretion, quit smoking and alcohol, high protein and high nutritious food during ulcer attack, and eat mainly food to protect gastric mucosa, such as milk and eggs.
Pay attention to rest, combine work and rest, keep a happy mood, avoid excessive tension and anxiety. In case of active ulcer with vomiting blood and black stool, hospitalization and bed rest are required. Ensure sleep treatment and pharmacological intervention if necessary.