What Is a Bleeding Peptic Ulcer?

Peptic ulcer mainly refers to chronic ulcers that occur in the stomach and duodenum. It is a common and common disease. There are various factors for the formation of ulcers, among which the digestive effect of acidic gastric juice on the mucosa is the basic factor for ulcer formation, hence the name. Wherever acidic gastric fluid contacts, such as the lower part of the esophagus, the anastomosis after gastrointestinal anastomosis, the jejunum, and Meckel's diverticulum with ectopic gastric mucosa, most ulcers occur in the duodenum and stomach. Duodenal ulcer.

Basic Information

nickname

Gastric and duodenal ulcers

English name

pepticulcer

Visiting department

Gastroenterology

Common causes

Related to hyperacidity, Helicobacter pylori infection, and weakened gastric mucosal protection

Common symptoms

Epigastric pain, acid reflux, heartburn, etc.

Causes of peptic ulcer

Recent experiments and clinical studies have shown that factors such as excessive gastric acid secretion, Helicobacter pylori infection, and weakened gastric mucosal protection are the main causes of peptic ulcer. Delayed gastric emptying and bile reflux, the role of gastrointestinal peptides, genetic factors, drug factors, environmental factors, and mental factors are all related to the occurrence of peptic ulcers.

Clinical manifestations of peptic ulcer

1. Peptic ulcer pain characteristics

(1) Long-term. Because the ulcer can heal by itself, but it relapses after healing, so it often has the characteristics of long-term recurrent episodes of epigastric pain. The entire course of disease is an average of 6 to 7 years, and some can be as long as one or two decades.

(2) Periodic epigastric pain is a recurrent episode, which is one of the characteristics of this ulcer, especially duodenal ulcer is more prominent. The epigastric pain can last for days, weeks, or longer, followed by a longer period of relief. It can occur all year round, but the author is more common in spring and autumn.

(3) The relationship between rhythmic ulcer pain and diet has obvious correlation and rhythmicity. During the day, from 3am to breakfast, gastric acid secretion is the lowest, so pain rarely occurs during this time. The pain of duodenal ulcers occurs between meals, and continues unabated until the meals are eaten or taken after taking antacids. Some patients with duodenal ulcer may suffer from midnight pain due to higher gastric acid at night, especially those who have eaten before bedtime. The occurrence of gastric ulcer pain is more irregular, often occurring within 1 hour after a meal, and gradually relieved after 1 to 2 hours, until the above rhythm appears again after eating and eating.

(4) Pain in the duodenal ulcer occurs in the mid-upper abdomen, or above the umbilicus, or to the right of the umbilicus; gastric ulcer pain is also mostly in the mid-upper abdomen, but slightly higher Or below the xiphoid and below the xiphoid. The pain range is about several centimeters in diameter. Because the location of cavity visceral pain on the body surface is generally not very precise, the pain site may not accurately reflect the anatomical location of the ulcer.

(5) The nature of the pain is mostly dull, burning or hunger-like pain, which is generally mild and tolerable. Persistent severe pain indicates ulcer penetration or perforation.

(6) Affecting factors Pain is often induced or exacerbated by factors such as mental stimulation, excessive fatigue, careless diet, drug effects, and climate change; it can be caused by rest, eating, taking antacids, pressing the painful part with your hands, and vomiting. Lighten or alleviate.

2. Other symptoms and signs of peptic ulcer

(1) Other symptoms In addition to middle and upper abdominal pain, this disease may also have other gastrointestinal symptoms such as increased secretion of saliva, heartburn, nausea, gallate, belching, nausea, and vomiting. Appetite remains normal, but I may be afraid of eating due to the onset of pain after eating, resulting in weight loss. Systemic symptoms can be manifested as neurosis such as insomnia, or symptoms of autonomic disorders such as bradycardia and sweating.

(2) During the onset of signs of ulcers, there may be limited tenderness in the mid-upper abdomen, to a lesser extent, and most of the tenderness sites are basically consistent with the location of the ulcer.

Peptic Ulcer Examination

Endoscopy

Whether the choice of fiber gastroscopy or electronic gastroscopy is the main method for the diagnosis of peptic ulcer. Under direct endoscopic vision, peptic ulcers are usually round, oval, or linear, with sharp edges, basically smooth, covered by gray-white or gray-yellow moss, and the surrounding mucosa is congested, edema, and slightly raised.

2. X-ray barium meal inspection

The main X-ray image of peptic ulcer is the niche or diaphragm, which means that the barium suspension fills the concave part of the ulcer. In frontal view, the shadow is round or oval, with neat edges. A circular, translucent area is formed by inflammatory edema around the ulcer.

3. Detection of HP infection

The detection methods for HP infection can be roughly divided into four categories: Check HP directly from gastric mucosa tissue, including bacterial culture, tissue smear, or section staining for microscopy; urease test, respiration test, and urea nitrogen test in gastric juice The gastric urease activity was measured; anti-HP antibodies were serologically examined; HP-DNA was measured using polymerase chain reaction (PCR) technology. Bacterial culture is the most reliable way to diagnose HP infection.

4. Gastric fluid analysis

The average basal acid output (BAO) of normal men and women was 2.5 and 1.3 mmol / h, (0 to 6 mmol / h), and the average BAO of men and women with duodenal ulcers was 5.0 and 3.0 mmol / h, respectively. . When BAO> 10mmol / h, it often indicates the possibility of gastrinoma. After pentagastrin was injected at 6 g / kg, the maximum acid excretion (MAO) in duodenal ulcers often exceeded 40 mmol / h. Due to the analysis of gastric juice of various gastric diseases, the amplitude of gastric acid overlaps with that of normal people, and the diagnosis of ulcer disease is for reference only.

Diagnosis of peptic ulcer

The diagnosis of peptic ulcer mainly depends on emergency endoscopy, which is characterized by ulcers that occur in the upper gastric body and present as multiple superficial irregular ulcers with a diameter of 0.5 to 1.0 cm or more. No scar left after the ulcer healed.

Differential diagnosis of peptic ulcer

Gastric cancer

The identification of benign gastric ulcers and malignant ulcers is very important. The main points of their identification are shown in Table 18-10. Differentiating between the two is sometimes difficult. Special attention should be paid to the following situations: middle-aged and elderly people with mid-upper abdominal pain, bleeding, or anemia in the near future; clinical manifestations of patients with gastric ulcer have changed significantly or anti-ulcer drug treatment is ineffective; biopsy or atypical pathology Proliferators. Clinically, patients with gastric ulcer should be followed up with regular endoscopy under active medical treatment, and closely observed until the ulcer heals.

2. Chronic gastritis

The disease also has chronic upper abdominal discomfort or pain, and its symptoms may be similar to peptic ulcers, but the periodicity and rhythm of the attacks are generally not typical. Gastroscopy is the main method of identification.

3. Gastric neurosis

The disease may have upper abdominal discomfort, nausea and vomiting, or resembles a peptic ulcer, but it is often accompanied by obvious systemic neurological symptoms, and mood swings are closely related to the onset. Endoscopy and X-ray examination showed no obvious abnormalities.

4. Cholecystitis gallstone disease

More common in middle-aged women, often with intermittent, episodic right upper quadrant pain, often radiating to the right scapular region, may have biliary colic, fever, jaundice, Murphy sign. Eating greasy food can often be induced. B-ultrasound can make a diagnosis.

5. Gastrinoma

This disease is also known as Zollinger-Ellison syndrome. It has refractory multiple ulcers or ectopic ulcers. It is easy to relapse after subtotal gastrectomy, and it is often accompanied by diarrhea and significant weight loss. The patient's pancreas had a non-beta cell tumor or gastric antrum G cell proliferation, serum gastrin levels increased, and gastric juice and gastric acid secretion increased significantly.

Peptic Ulcer Treatment

Life

Peptic ulcer belongs to the category of typical psychosomatic diseases. Psycho-social causes play an important role in the pathogenesis. Therefore, optimistic mood, regular life, and avoiding excessive stress and fatigue are very important in the onset or remission of the disease. important. When the ulcer is active and the symptoms are severe, rest in bed for a few days or even 1 to 2 weeks.

2. Diet

Before the advent of H2 receptor antagonists, diet therapy was the sole or main treatment for peptic ulcers. In 1901, Lenhartz pointed out that eating less and eating more was good for patients. Since then, Sippy diet therapy has been introduced and has been used clinically for decades. The Sippy diet mainly consists of milk, eggs, and cream, and later includes some "soft" non-irritating foods. The principle is that these foods can permanently dilute and neutralize stomach acid. Take the following views on the diet of patients with peptic ulcer: chew slowly and avoid fast food, chewing can increase saliva secretion, which can dilute and neutralize gastric acid, and may have the effect of improving the mucosal barrier; regular eating regularly In order to maintain the rhythm of normal digestive activities; In the acute active period, it is advisable to eat less and eat more meals, eating 4 to 5 times a day, but after the symptoms are controlled, should be encouraged to return to 3 meals a day as usual; Diet should pay attention to nutrition, but there is no need to specify special recipes; avoid snacks between meals, should not eat before bedtime; in the acute activity period, you should quit smoking and avoid irritating flavors such as coffee, strong tea, thick broth and hot and sour vinegar Products or spicy drinks, and drugs that damage the gastric mucosa; diet is not full to prevent excessive expansion of the gastric antrum and increase gastrin secretion.

3. Sedation

For a small number of patients with symptoms of anxiety, tension, insomnia, etc., some sedatives or tranquilizers can be used for a short time.

4. Avoid applying ulcer-causing drugs

Patients should be discouraged from discontinuing related drugs that induce or cause exacerbations of ulcer disease or emit blood, including: salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs); adrenal corticosteroids; reserpine equality. If the above drugs must be used for rheumatism or rheumatoid diseases, enteric-solvent or small-dose intermittent application should be used as much as possible. At the same time, sufficient antacid treatment and strengthening of the mucosal protective agent are performed.

Peptic Ulcer Prevention

The formation and development of peptic ulcer are related to the digestion of gastric acid and pepsin in gastric juice. Therefore, it is forbidden to go to work on an empty stomach and go to bed on an empty stomach. It is not difficult to heal the ulcer to the scar stage in a short time (2 to 4 weeks), but the key is to prevent the ulcer from recurring. Repeated ulcers are more harmful. Quitting bad habits, reducing the irritation of tobacco, alcohol, spicy, strong tea, coffee and certain drugs are of great significance for healing of ulcers and preventing recurrence.