Mr. Li sat in front of the doctor and said with a sad face: “I usually have a lot of social functions, my stomach has not been very good. But I’m afraid to go into the hospital, I have a headache when I smell that smell, so I haven’t been checked out. But in the last few days, I wake up at night around three o’clock, and when I wake up, I feel pain in my stomach, my abdomen and back are like pins and needles, and it hurts all the time. But at night when I work late and don’t sleep, it doesn’t hurt, or it doesn’t hurt soon after I get up in the morning. It’s strange, it seems to have something to do with lying down and sleeping. Doctor, what strange disease do I have?” After examination, the doctor reassured him, “Your current presentation is medically known as “nocturnal upper abdominal pain and radiating pain in the lower back”, which is most common in cases of duodenal bulb ulcers and retrobulbar ulcers, retroperitoneal lesions (such as pancreatitis, pancreatic cancer, para-aortic lymphadenitis or tumors, etc.) and Functional abdominal pain, etc. Rarely, it is seen in thoracolumbar vertebral or intraductal lesions, biliary ascariasis, acute inferior wall myocardial infarction, angina pectoris, abdominal aortic aneurysm or rupture of the entrapment, etc. Based on your complaints and examination findings, it can be initially determined that you have ‘duodenal bulb ulcer or retrobulbar ulcer.” This disease is most often seen in young and middle-aged people, and about 10% of the population will develop it at some point in their lives, with a higher prevalence in men than in women, often in the fall and winter or winter and spring, as well as when they are mentally and emotionally ill and overworked. Other manifestations of this disease are: fasting pain, which manifests itself as pain that occurs between meals and continues unabated until relieved after the next meal. Some patients have upper abdominal discomfort or complications such as gastrointestinal bleeding or perforation as the first manifestation, which may be accompanied by belching, acid reflux, epigastric distention, nausea or vomiting. If there is chronic gastrointestinal bleeding, there may be manifestations of chronic anemia, such as dizziness, inability to concentrate, and pallor. ”May I ask the doctor why my pain always occurs in the middle of the night and disappears when I wake up in the morning? Why do the symptoms ease when I adjust my sleeping position?” Mr. Li asked curiously. The doctor told him that the nighttime epigastric pain was related to the patient’s increased ability to secrete gastric acid at night, the enhanced acidity of gastric juice and the increased corrosiveness (stimulation of gastric acid), as well as the increased excitability of the vagus nerve at night, which stimulates the increased secretion of gastric acid, and the disappearance of the buffering effect of food on gastric acid after midnight. As for the relief of symptoms when adjusting the sleeping posture, this is due to the pain in patients with bulbar ulcers, which is mainly related to the stimulation of the ulcer surface by gastric acid and the contraction of smooth muscle. When the sleeping posture is adjusted so that the stomach acid does not reach the lesion or the contracted smooth muscle is slightly relaxed, the symptoms can be temporarily relieved. ”So, what should I do if I have this disease?” Mr. Li continued to ask. The doctor explained that in order to further clarify the diagnosis and guide standardized treatment, gastroscopy and H. pylori testing should be performed, and fasting and postprandial serum gastrin testing should also be performed for multiple bulb or post-bulb ulcers to rule out malignant lesions. The main treatment options are as follows: eradication of H. pylori If H. pylori infection is present, a triple therapy consisting of one proton pump inhibitor (e.g., loxacort, omeprazole, etc.) and two antibiotics sensitive to H. pylori can be used for a shared 1-2 week course of treatment. This is important for the eradication of bulbar ulcers and the prevention of recurrence and complications. After 1 month of discontinuation, it is important to review whether H. pylori has been eradicated. Gastric acid suppression The corresponding drugs are H2 receptor antagonists (e.g., cimetidine, ranitidine, famotidine & nizatidine, etc.) and proton pump inhibitors (e.g., omeprazole, rabeprazole, etc.) for a course of 4-6 weeks for bulbous duodenal ulcers and 12 weeks for postbulbar ulcers, mainly because postbulbar ulcers are less responsive to drugs. The main drugs in this category are cimetidine, ranitidine, famotidine, omeprazole, rabeprazole, etc. Neutralization of gastric acid The corresponding drugs are mainly aluminum hydroxide and magnesium aluminum carbonate and their compound preparations, and such drugs can quickly control the symptoms. Protection of gastric mucosa Commonly used drugs include aluminum thioglycollate, colloidal bismuth and prostaglandin-based preparations (such as misoprostol). Depending on the condition, the doctor will develop a systematic treatment plan with the above treatment options. For example, in the absence of H. pylori infection, it is not necessary to choose debridement treatment, but simply acid suppression or protection of the gastric mucosa. At the same time of treatment, patients should pay attention to diet, combine work and rest, maintain a good psychological state, avoid anxiety, tension, staying up late, insomnia, and if necessary, take appropriate sedative drugs. In case of symptom change or find poor appetite, lethargy, black stool should go to the hospital; regular follow-up after regular treatment; cautious use of aspirin, Protaxon, anti-inflammatory pain and other drugs that have damage to the gastric mucosa. How to eat for ulcer patients? Patients with peptic ulcer should chew and swallow slowly, eat small amounts of multiple meals, eat a light diet, eat less fatty meat, thick soup and other high-fat, high-protein foods, and eat more vegetables, non-acidic fruits, fish, poultry eggs and other fresh foods. Patients should also quit smoking, alcohol, avoid coffee, strong tea and alcoholic beverages, avoid stimulating foods such as too oily, fried, sour and spicy foods, and avoid too cold, too hot, too hard and too acidic foods. When cooking the patient’s food, use less seasoning to reduce chemical stimulation of the digestive tract mucosa.