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Peptic ulcer is a very common disease.
Peptic ulcer is a very common disease.
The pathogenesis of peptic ulcer is mainly related to the imbalance between gastric and duodenal mucosal damage factors and mucosal self-defense - repair factors .
At present, the treatment methods for peptic ulcer mainly include eliminating the cause, reducing gastric acid, protecting the gastric mucosa, and eradicating Helicobacter pylori
01acid suppression therapy01acid suppression therapy01acid suppression therapy
Acid suppression therapy is the most important measure to relieve the symptoms of peptic ulcer and heal the ulcer
Acid suppression therapy is the most important measure to relieve the symptoms of peptic ulcer and heal the ulcer
Acid suppression therapy reduces gastric acidity, which is directly related to the healing of ulcers, especially duodenal ulcers
In addition, H2 receptor antagonists can also be used, such as cimetidine, ranitidine, famotidine, roxatidine, etc.
02Anti -Helicobacter pylori treatment02Anti - Helicobacter pylori treatment02Anti -Helicobacter pylori treatment
"The Fifth National Consensus Report on the Management of Helicobacter pylori Infection " recommends the bismuth quadruple regimen as the main empirical treatment regimen for H.
The "Fifth National Consensus Report on the Management of Helicobacter pylori Infection " recommends the bismuth quadruple regimen as the main empirical H.
Note: a standard dose of proton pump inhibitor + standard dose of bismuth ( 2 times a day, orally one hour before meals) + 2 kinds of antibacterial drugs (orally after meals)
Note: a standard dose of proton pump inhibitor + standard dose of bismuth ( 2 times a day, orally one hour before meals) + 2 kinds of antibacterial drugs (orally after meals)
Except that the regimen containing levofloxacin is not used as the initial treatment regimen, the eradication treatment is not divided into first-line or second-line treatment, and the regimen with high efficacy should be used for the initial treatment as much as possible
In addition, the choice of regimen should weigh efficacy, cost, potential adverse effects and drug availability, and make an individualized decision
For peptic ulcers, refractory ulcers, huge ulcers and recurrent ulcers in the elderly, it is recommended to use anti-acid and anti- H.
03 NSAID - Ulcer Treatment 03 NSAID - Ulcer Treatment 03 NSAID -Ulcer Treatment
For the treatment of NSAID- ulcers, discontinuation of NSAIDs is preferred when conditions permit .
For the treatment of NSAID- ulcers, discontinuation of NSAIDs is preferred when conditions permit .
In addition, PPI should be the first choice for drug treatment , which can effectively inhibit gastric acid secretion, significantly improve the patient's gastrointestinal symptoms, prevent gastrointestinal bleeding, and promote ulcer healing .
prevention
Table: NSAID- Ulcer Complication Prevention Recommendations
Table: NSAID- Ulcer Complication Prevention RecommendationsNote: NSAIDs are non-steroidal anti-inflammatory drugs; PPIs are proton pump inhibitors
Note: NSAID is non-steroidal anti-inflammatory drug; PPI is proton pump inhibitor Note: NSAID is non-steroidal anti-inflammatory drug; PPI is proton pump inhibitorIn addition, the treatment of NSAID- ulcer with H.
pylori eradication remains controversial
.
H.
pylori infection increases the risk of NSAID- and aspirin-related gastrointestinal complications, is an independent risk factor, and patients should be examined and eradicated before long-term NSAID and aspirin therapy .
However, the Japanese guidelines for the diagnosis and treatment of peptic ulcers published in 2015 pointed out that for patients already using NSAIDs , the use of PPI drugs to prevent ulcers is more effective than eradication of H.
pylori , and it is believed that eradication of H.
pylori does not accelerate NSAID- Healing of ulcers .
pylori eradication remains controversial
.
H.
pylori infection increases the risk of NSAID- and aspirin-related gastrointestinal complications, is an independent risk factor, and patients should be examined and eradicated before long-term NSAID and aspirin therapy .
However, the Japanese guidelines for the diagnosis and treatment of peptic ulcers published in 2015 pointed out that for patients already using NSAIDs , the use of PPIs to prevent ulcers is better than H.
pylori eradication , and that eradication of H.
pylori does not accelerate NSAIDs - Healing of ulcers .
04 Treatment of peptic ulcer complicated with bleeding
04 Treatment of peptic ulcer complicated with bleeding04 Treatment of peptic ulcer complicated with bleeding04 Treatment of peptic ulcercomplicated with bleedingWhen suspected peptic ulcer complicated with acute bleeding, emergency gastroscopy should be performed within 24 hours as much as possible.
For those with signs of circulatory failure, circulatory failure should be quickly corrected before gastroscopy .
For those with signs of circulatory failure, circulatory failure should be quickly corrected before gastroscopy .
For patients receiving low-dose aspirin therapy for secondary cardiovascular prevention, when peptic ulcer bleeding occurs, the 2021 Chinese expert consensus proposes that whether to stop antiplatelet drugs after gastrointestinal injury occurs should balance the risk of thrombosis and bleeding in patients.
Antiplatelet therapy should be resumed as soon as possible after the bleeding control is stable, but the specific , and specific analysis should still be carried out according to the specific situation of the patient
.
05Treatment of refractory ulcers
05Treatment of refractory ulcer05Treatment of refractory ulcer05Treatment of refractory ulcerRefractory ulcers generally refer to duodenal ulcers that are still unhealed after 8 weeks of regular treatment or 12 weeks of gastric ulcers, accounting for about 5% to 10% of ulcers.
easy to relapse .
easy to relapse .
The treatment of refractory ulcers mainly includes: understanding the patient's compliance with treatment; whether there is a history of taking NSAIDs ; repeating gastroscopy and pathological examinations to exclude ulcers caused by malignant diseases and other causes; detecting H.
pylori ; measuring serum gastrin level, one excludes Zollinger - Ellison syndrome
.
Omeprazole 40mg/d or other corresponding doses of PPI for 8 weeks can heal more than 90% of refractory ulcers, and its efficacy is better than high-dose H2RA and omeprazole
.
pylori ; measuring serum gastrin level, one excludes Zollinger - Ellison syndrome
.
Omeprazole 40mg/d or other corresponding doses of PPI for 8 weeks can heal more than 90% of refractory ulcers, and its efficacy is better than high-dose H2RA and omeprazole
.
In conclusion, the formation and development of peptic ulcer is related to the digestion of gastric acid and pepsin in gastric juice.
It is not difficult to heal the ulcer to the scar stage in a short time, and the key is to prevent the ulcer from recurring
.
In addition to drug treatment, quitting bad living habits is the key link.
Reducing the stimulation of tobacco, alcohol, spicy, strong tea, coffee and certain drugs is of great significance to the healing of ulcers and the prevention of recurrence
.
It is not difficult to heal the ulcer to the scar stage in a short time, and the key is to prevent the ulcer from recurring
.
In addition to drug treatment, quitting bad living habits is the key link.
Reducing the stimulation of tobacco, alcohol, spicy, strong tea, coffee and certain drugs is of great significance to the healing of ulcers and the prevention of recurrence
.
references:
references:1.
Consensus opinion on the diagnosis and treatment of peptic ulcer with integrated traditional Chinese and Western medicine ( 2017 ) [J].
China Journal of Integrated Traditional Chinese and Western Medicine Digestive , 2018,26(2):112-118
Consensus opinion on the diagnosis and treatment of peptic ulcer with integrated traditional Chinese and Western medicine ( 2017 ) [ J ] .
China Journal of Integrated Traditional Chinese and Western Medicine Digestive , 2018 , 26(2 ) : 112-118 Year) [J].
Chinese Journal of Integrative Medicine and Digestion , 2018, 26(2): 112-118
2.
Han Baohai .
Research progress on the relationship between Hp and digestive tract diseases [J].
China Urban and Rural Enterprise Health , 2020, 35(04): 51-4.
Han Baohai .
Research progress on the relationship between Hp and digestive tract diseases [J].
China Urban and Rural Enterprise Health , 2020, 35(04): 51-4.
2.
Han Baohai .
Research progress on the relationship between Hp and digestive tract diseases [J].
China Urban and Rural Enterprise Health , 2020, 35(04): 51-4.
3.
Yan Lingjun, Chen Ying, Chen Fa et al.
Effect of Helicobacter pylori Eradication on Gastric Cancer Prevention: Updated Report from a Randomized Controlled Trial with 26.
5 Years of Follow-up.
[J] .
Gastroenterology, 2022, https:// doi.
org/10.
1053/j.
gastro.
2022.
03.
039
Yan Lingjun, Chen Ying, Chen Fa et al.
Effect of Helicobacter pylori Eradication on Gastric Cancer Prevention: Updated Report from a Randomized Controlled Trial with 26.
5 Years of Follow-up.
[J] .
Gastroenterology, 2022, https:// doi.
org/10.
1053/j.
gastro.
2022.
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039 https://doi.
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039
4.
Yu Jieping , Shen Zhixiang , Luo Hesheng .
Practical Gastroenterology [J].
World Chinese Journal of Digestion , 2007, 8(003):281.
Yu Jieping , Shen Zhixiang , Luo Hesheng .
Practical Gastroenterology [J].
World Chinese Journal of Digestion , 2007, 8(003):281.
4.
Yu Jieping , Shen Zhixiang , Luo Hesheng .
Practical Gastroenterology [J].
World Chinese Journal of Digestion , 2007, 8(003):281.
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