Peptic ulcer: It mainly refers to chronic ulcers occurring in the stomach and duodenum, and is a multi-infarct and common disease.
Basic etiology: The digestion of mucous membrane by acidic gastric juice is the basic factor of ulcer formation, hence the name.
Main aspects of pathogenesis.
1, excessive secretion of gastric acid (so “acid suppression” is very important.)
2, Helicobacter pylori (HP) infection (so “anti-HP treatment” is necessary);
3, weakened gastric mucosa protection.
Main manifestations
Abdominal pain.
(1) Long-term.
(2) Periodic.
(3) Rhythmical.
The relationship between ulcer pain and diet has a clear correlation and rhythmicity. During the day, the secretion of gastric acid is lowest during the period from 3:00 am to breakfast, so pain rarely occurs during this time. The pain of duodenal ulcers occurs between meals and continues unabated until the next meal or after taking acid-control drugs. In some patients with duodenal ulcers, pain can occur in the middle of the night due to higher gastric acid at night, especially in those who have eaten before going to bed. The occurrence of gastric ulcer pain is more irregular, often occurring within one hour after a meal, gradually relieved after one to two hours, until the above rhythm reappears after the next meal is eaten.
(4) Pain location: The pain of duodenal ulcer is mostly found in the middle and upper abdomen, or above the umbilicus, or to the right above the umbilicus; the location of gastric ulcer pain is also mostly in the middle and upper abdomen, but slightly higher, or to the left of the subxiphoid and subxiphoid. However, the location of the pain does not necessarily reflect the anatomical location of the ulcer.
(5) The nature of pain is mostly dull, burning or hunger-like pain, which is generally mild and tolerable, while persistent severe pain suggests ulcer penetration or perforation.
(6) Affecting factors Pain is often triggered or aggravated by mental stimulation, excessive fatigue, careless diet, drugs, climate change, etc.; it can be alleviated or relieved by rest, eating, taking acid-control drugs, pressing the painful area with hands, vomiting, etc.
Other signs and symptoms
(1) There may be other gastrointestinal symptoms such as increased salivation, heartburn, regurgitation, belching, belching, nausea, vomiting, etc.
(2) Signs During the ulcer attack, there may be limited pressure pain in the middle and upper abdomen, which is not severe, and the site of its pressure pain mostly corresponds to the location of the ulcer basically.
Diagnosis and auxiliary examination.
The diagnosis of peptic ulcer mainly relies on endoscopy (i.e., “gastroscopy”).
1. Endoscopic examination
Directly visible, gold standard, accurate and reliable. Including ordinary gastroscopy (safe, effective, low risk, but there is a certain amount of pain) and painless gastroscopy (first anesthesia loss of consciousness after gastroscopy, less pain, but increased anesthesia risk)
2, the detection of HP infection (commonly used “breath test”, commonly known as “blowing”)
It is recommended that patients with gastric ulcer and chronic gastritis do. Positive patients need drug eradication of H. pylori (HP) treatment.
3.Barium X-ray examination
4.Gastric fluid analysis
It is necessary to do when gastrinoma is considered. When BAO>10mmol/h, it often suggests the possibility of gastrinoma.
Treatment and prevention.
1.Lifestyle change.
Peptic ulcer belongs to the category of typical psychosomatic diseases, and psycho-social factors play an important role in the development of the disease. Therefore, optimism, regular life, and avoidance of excessive stress and strain are important in both the attack and remission periods of the disease. When the ulcer is active and the symptoms are heavy, bed rest for a few days or even 1 to 2 weeks.
2.Diet
The Sippy diet consists of milk, eggs, cream, and “soft” non-stimulating foods. The principle is that these foods can dilute and neutralize stomach acid in a lasting way.
Dietary recommendations for peptic ulcer patients.
① Chew slowly and avoid eating in a hurry. Chewing increases saliva secretion, which dilutes and neutralizes gastric acid and may have the effect of improving the mucosal barrier;
②Eat regularly and regularly to maintain the rhythm of normal digestive activity;
③When the acute activity period, it is appropriate to eat less and more meals, just 4-5 times a day, but once the symptoms are controlled, it should be encouraged to return to the usual 3 meals a day more quickly;
④It is advisable to pay attention to nutrition, but there is no need to specify special recipes;
⑤ Avoid snacking between meals, and do not eat before bedtime;
⑥During the acute activity period, smoking and alcohol should be avoided, as well as stimulating condiments such as coffee, strong tea, strong broth and chili acid vinegar or spicy drinks, and drugs that damage the gastric mucosa;
(7) Do not eat or drink too much to prevent the secretion of gastrin due to excessive expansion of the gastric sinus.
3.Sedation
For a few patients with symptoms of anxiety, tension and insomnia, some sedatives or tranquilizers can be used for a short period of time.
4.Avoid the application of ulcer-causing drugs
Including: salicylates and non-steroidal anti-inflammatory drugs (NSAIDs): such as cold medicine: ibuprofen, etc.; aspirin, etc.
5.Main drug treatment
Adequate acid suppression therapy (e.g. PPI: omeprazole, rabeprazole, lansoprazole, esomeprazole, etc. (any of them is sufficient). If necessary, H2 receptor inhibitors can be added: ranitidine, famotidine, etc.) and strengthen mucosal protective agents (magnesium aluminum carbonate tablets, colloidal pectin bismuth capsules, etc.).
Prevention
The formation and development of peptic ulcer is related to the digestive action of gastric acid and pepsin in gastric juice, so avoid going to work and going to bed on an empty stomach. It is not difficult to make the ulcer heal up to the scarring stage in a short time (2-4 weeks), but the key is to prevent recurrence of the ulcer. Recurrent ulcers are more harmful. Quit bad habits, reduce the stimulation of tobacco, alcohol, spicy, strong tea, coffee and certain drugs, is important for the healing of ulcers and the prevention of recurrence.