What Is the Difference Between Gastritis and an Ulcer?

In a broad sense, gastric ulcer refers to ulcers that occur in the corners of the stomach, gastric antrum, cardia, and hiatal hernia, and is a type of peptic ulcer. Peptic ulcer is a common gastrointestinal disease that can occur in the esophagus, stomach, or duodenum, or near the gastro-jejunostomy or in the Meckel diverticulum containing gastric mucosa, because gastric ulcers and duodenum Intestinal ulcers are the most common, so peptic ulcers are commonly referred to as gastric ulcers and duodenal ulcers. It is called peptic ulcer because it was thought that gastric ulcer and duodenal ulcer were formed by gastric acid and pepsin digestion of the mucosa itself. In fact, gastric acid and pepsin are only one of the main reasons for ulcer formation. There are other reasons why peptic ulcers can form. Because the etiology and clinical symptoms of gastric ulcer and duodenal ulcer have many similarities, it is sometimes difficult to distinguish between gastric ulcer and duodenal ulcer, so it is often diagnosed as peptic ulcer or gastric or duodenal ulcer. If it is clear that the ulcer is in the stomach or duodenum, it can be directly diagnosed as a gastric ulcer or duodenal ulcer.

Basic Information

English name: stomach ulcer
Visiting department: Gastroenterology
Multiple groups: Middle-aged and elderly people, long-term overtime workers, and people with poor diet

Common causes: Helicobacter pylori infection, effects of drugs, diet, genetic factors, etc.
Common symptoms: Epigastric pain
Contagious: no

Causes of gastric ulcer

Helicobacter pylori infection

Marshall and Warren were awarded the 2005 Nobel Prize in Medicine for successfully cultivating H. pylori in 1983 and proposing that their infection plays a role in the pathogenesis of peptic ulcer. Numerous studies have fully proved that Helicobacter pylori infection is the main cause of peptic ulcer.

2. Drugs and dietary factors

Long-term use of aspirin, corticosteroids and other drugs can easily cause this disease. In addition, long-term smoking, long-term drinking and drinking strong tea, coffee also seem to have a certain relationship.

Drugs that can cause stomach ulcers:

(1) A variety of aspirin preparations: long-term or large doses can cause stomach pain and discomfort, severe cases may have vomiting blood, melena, etc. Gastroscopy can find gastric mucosa inflammation, erosion and ulcer formation.

(2) Hormone replacement drugs: Indomethacin and Baotaisong are hormone replacement drugs, which directly damage the gastric mucosa and can cause acute gastric ulcers.

(3) Antipyretic and analgesics: such as APC, paracetamol, Qutong tablets, and cold medicines.

(4) Drugs for treating coronary heart disease: such as sodium alginate (PSS), persantin, and reserpine, can also cause gastric ulcers and even gastric bleeding.

(5) Anti-inflammatory drugs: Macrolide antibiotics, such as erythromycin and acetylspiramycin, can easily cause stomach discomfort.

(6) Anticancer drugs and others: Various types of chemotherapy drugs often cause gastrointestinal irritation.

3. Stomach acid and pepsin

The final formation of peptic ulcer is due to the digestion of gastric acid and pepsin, which is the decisive factor for the occurrence of ulcers.

4. Stress mental factors

Acute stress can cause stress ulcers. People with chronic stress, anxiety, or mood swings are prone to stomach ulcers.

5. Genetic factors

In some rare genetic syndromes, such as multiple endocrine adenoma type I and systemic mastocytosis, gastric ulcers are part of their clinical manifestations.

6. Abnormal gastric movement

Some patients with gastric ulcer have gastric dyskinesias, such as increased gastric acid secretion caused by delayed gastric emptying, and bile, pancreatic juice, and lysolecithin caused by duodenum-gastric reflux on gastric mucosa.

7. Other factors

Local infections such as type I herpes simplex virus may be related. Cytomegalovirus infection may also be involved in patients with kidney transplantation or immunodeficiency.

Clinical manifestations of gastric ulcer

Upper abdominal pain is the main symptom of the disease. Mostly located in the upper abdomen, can also appear in the left upper abdomen or behind the sternum and xiphoid. Often presents as dull, dull, sore, burning pain. The pain of gastric ulcer usually occurs within 1 hour after a meal, and gradually relieves after 1 to 2 hours, and the above rhythm is repeated after eating and eating. Some patients may be asymptomatic or have complications such as bleeding and perforation as the first symptoms.

Gastric ulcer examination

Endoscopy

Endoscopic ulcers can be divided into three stages: active stage: the base of the ulcer is covered with white or yellow-white thick moss, the surrounding mucosa is congested and edema (A1), or the peripheral mucosa is congested and edema begins to subside, and regenerating epithelium appears around The resulting red halo (A2). Healing period: The ulcer shrinks and becomes shallower, the moss becomes thinner, the red halo formed by the surrounding regenerating epithelium surrounds the ulcer, the mucosal folds are concentrated towards the ulcer (H1), or the ulcer surface is almost covered by the regenerating epithelium, and the mucosal folds are more concentrated towards the ulcer ( H2). Scar stage: The white moss at the base of the ulcer disappeared, showing red scars (S1), and finally turned into white scars (S2).

2. X-ray barium meal inspection

There are direct signs of dark shadow and mucosal fold concentration. Indirect signs such as simple spasms and irritations. Imaging features:

(1) The shadow is a direct sign of peptic ulcer. At the tangential position, the shadows protrude from the contour of the inner wall of the stomach and are papillary or semicircular; in the upright position, the shadows are round or oval, and their edges are smooth and neat.

(2) The tangent line of mucous membrane around the shadow, the transparent thin line shadow of 1 ~ 2mm is displayed at the junction of the shadow and the stomach.

(3) "Narrow neck sign" tangent position, the mouth of the shadow and the gastric cavity at the junction of 0.5 ~ 1cm narrower than the diameter of the shadow, called "neck neck sign".

(4) The "collar sign" has a smooth and thin linear density-reducing area at the mouth of the Yingying, such as a collar worn on the neck.

(5) The "sun halo sign" around the shadow is in the right position. There is a wide and narrow translucent band around the shadow, and the edges are smooth.

(6) The mucosal fold correction centered on the shadow is distributed radially, and its periphery gradually becomes thinner and disappears, which is another sign of chronic ulcer.

(7) Other X-ray signs of gastric ulcer Finger-shaped notch on the large curved side of the stomach; Shortening of the small curved side of the stomach; Widening of the gastric angle notch; Obstruction of the pyloric duct with gastric retention.

Gastric ulcer diagnosis

The diagnosis of gastric ulcer mainly relies on the typical periodic epigastric pain, X-ray barium meal examination, and endoscopy.

Differential diagnosis of gastric ulcer

Identification of gastric ulcer and duodenal ulcer: Duodenal ulcer is more common in peptic ulcer; gastric ulcer pain is more common after meals, duodenal ulcer is more common before meals and more common at night.

Gastric ulcer complications

Upper gastrointestinal bleeding

Upper gastrointestinal bleeding is the most common complication of peptic ulcers, with 20% to 30% of patients with ulcers having a history of bleeding. According to statistics, among the various causes of upper gastrointestinal bleeding, ulcers account for about 50%, ranking first. Most peptic ulcers and bleeding can stop on their own. Gastric bleeding easily occurs within 1 to 2 years after the appearance of ulcers.

2. Ulcer perforation

Peptic ulcer perforation can be clinically divided into acute, subacute and chronic. Gastric ulcer perforation is mostly in middle-aged and older people over 50 years old.

3. pyloric obstruction

In recent years, due to the widespread application of various effective anti-ulcer drugs, such complications have been significantly reduced. There are two types of pyloric obstruction: organic and functional. The former is due to chronic ulcers caused by submucosal fibrosis, resulting in scarring stenosis, ineffective medical treatment, often requiring surgical treatment; the latter due to congestive edema and pyloric reflex spasm due to inflammation around the ulcer tissue, medical treatment is effective.

4. Cancerous

Whether chronic gastric ulcers become cancerous is still controversial. Most scholars believe that gastric ulcers are cancerous, and the canceration rate is estimated to be 1% to 7%. Gastric ulcers often occur at the edge of ulcers.

Gastric Ulcer Treatment

1. Generally used according to the principle of treatment of peptic ulcer

First apply drugs that reduce damage: such as antacids, anticholinergics, H ₂ receptor antagonists, propyl glutamine, prostaglandin E ₂ synthetic agents and omeprazole, etc., while giving gastric mucosa protection Drugs: such as sucralfate, bismuth, gampere acid (gastroketone) and so on. Complete eradication of Hp, because Hp infection is currently considered to be related to the disease, so active treatment is required.

2. Upper gastrointestinal bleeding caused by gastric ulcer

Can manifest as vomiting or blood in the stool. You should go to the hospital immediately. The main hemostatic measures are: H ₂ -receptor antagonist or proton pump inhibitor (PPI), which can increase and maintain gastric pH; endoscopic hemostasis; surgical treatment; interventional treatment.

Gastric ulcer diet recommendations

Patients with gastric ulcer need to pay attention to diet:

Eat foods without mechanical and chemical stimuli, low dietary fiber, and easy digestion.
Avoid eating raw potatoes, vegetables and fruits with a lot of crude fiber, gravy soup that can easily stimulate gastric acid secretion, indigestible glutinous rice and nuts, strong seasonings, strong tea, coffee, wine, etc.
Eat less and eat more, 5 to 6 meals a day. In the cooking method, it should be chopped, softened, or made into mud.