Duodenal bulb ulcer

　　In the gastric cavity, gastric acid and pepsin are important digestive substances in gastric juice. Gastric acid is a strongly acidic substance with strong erosive properties; pepsin has the function of hydrolyzing proteins and can destroy proteins on the gastric wall. However, under the existence of these erosive factors, the gastrointestinal tract can still resist and maintain the integrity of the mucosa and its own function, mainly because the mucosa of the stomach and duodenum still has a series of defense and repair mechanisms. We call the harmful erosive effect of gastric acid and pepsin the damage mechanism, and the defense and repair mechanism of the gastrointestinal tract itself the protective mechanism. It is currently believed that the protective mechanism of normal gastric and duodenal mucosa is sufficient to resist the erosion of gastric acid and pepsin. However, when certain factors damage a link in the protective mechanism, it may lead to the erosion of the mucosa by gastric acid and pepsin, resulting in the formation of ulcers. Excessive gastric acid secretion far exceeding the defensive and repair function of the mucosa may also lead to the occurrence of ulcers. Recent research has shown that Helicobacter pylori and non-steroidal anti-inflammatory drugs are the most common causes of damage to gastrointestinal protective mechanisms and the occurrence of ulcers, and gastric acid plays a key role in the formation of ulcers. In addition, drugs, stress, hormones can also lead to the formation of ulcers, and various psychological factors and poor dietary and lifestyle habits can induce the occurrence of ulcers.

　　1、Bleeding: Bleeding occurs when the ulcer has eroded to a certain degree and reaches the blood vessels around the ulcer, causing vessel rupture. The amount of bleeding and the degree of harm to the patient's life depend on the size of the damaged vessel. When the ulcer damages capillaries, it generally poses little harm to the patient and is not easily discovered, and is only detected during occult blood tests in the stool; while damage to larger vessels may result in vomiting blood or black stools, or even bright red stools. Generally, patients may experience exacerbation of various gastrointestinal symptoms before bleeding, but the pain in the upper abdomen may decrease or even disappear after bleeding stops.

　　2、Perforation: General ulcer injuries occur in the mucosal and muscular layers of the gastrointestinal tract. When the ulcer progresses and reaches the serosal layer of the gastrointestinal tract, only the outermost layer, resembling a thin piece of paper, remains, which can lead to acute gastrointestinal perforation at any time. After perforation, the contents of the gastrointestinal tract flow into the abdominal cavity, causing acute diffuse peritonitis. Symptoms include sudden severe upper abdominal pain, nausea, vomiting, a rigid abdomen with marked tenderness and rebound pain, disappearance of liver dullness and bowel sounds, and free gas under the diaphragm on abdominal X-ray. Some patients may even develop shock. In such a situation, the patient should undergo emergency surgery immediately, otherwise there is a risk of death at any time. Of course, with the improvement of medical conditions and timely medical consultation, the incidence of perforation is not very high. Clinically, it can be divided into acute, subacute, and chronic types, and only acute perforation requires surgical treatment.

　　3、Pyloric obstructionUlcers in the pyloric canal can cause pyloric spasm, congestion and edema of the mucosal tissue around the ulcer, which obstructs the process of pushing food from the stomach to the duodenum, leading to temporary pyloric obstruction. After the ulcer heals, the formation of scars or adhesions around the ulcer can cause a persistent narrowing of the pyloric orifice. This is manifested by prolonged gastric emptying time, upper abdominal pain, fullness, discomfort after meals, which worsens after meals, often accompanied by gastric peristalsis waves, peristaltic sounds, and splash sounds; in the later stage, there are no peristalsis waves but an expanded gastric contour can be seen, often accompanied by large amounts of vomiting, which reduces or relieves the aforementioned symptoms after vomiting. The vomit is usually leftover food from the previous night, with a sour and smelly taste. Pyloric obstruction can be of organic or functional types. The former is due to submucosal fibrosis caused by chronic ulcers, leading to scar narrowing, which is ineffective with medical treatment and often requires surgical treatment. The latter is caused by inflammation around the ulcer, leading to congestion, edema, and reflex spasm of the pyloric sphincter, which is effective with medical treatment.

　　4、CarcinogenesisDiffering from gastric ulcers, most scholars believe that duodenal ulcers generally do not lead to cancer.

　　The typical clinical manifestations of duodenal ulcers include upper abdominal pain and discomfort, and most people will experience various symptoms of dyspepsia. However, some may not have any symptoms until complications occur. The common complications include bleeding and perforation. The common gastrointestinal symptoms and systemic symptoms include belching, acid regurgitation, upper abdominal distension, burning sensation behind the sternum, nausea, vomiting, loss of appetite, etc. Acid regurgitation and burning sensation behind the sternum are due to relaxation of the esophageal sphincter; nausea and vomiting often reflect that the ulcer may be in an active phase. Some patients may have symptoms of autonomic nervous system dysfunction, such as insomnia and excessive sweating.

　　The characteristics of upper abdominal pain in duodenal ulcers are:

　　1, a chronic processMost patients have had a long course of illness, ranging from several years to a decade or even longer, except for a few patients who sought medical attention early on.

　　2、CyclicMost patients experience recurrent episodes of illness, with the onset and remission periods alternating with seasonal changes, mental stress, emotional fluctuations, dietary disorders, or the use of medications related to the onset of the disease. This reflects the repetitive process of the ulcer cycle, which includes acute activity, gradual healing, and scar formation. The onset period can last for several weeks or even months, while the remission period can last for several months or years. The frequency of onset and the duration of the onset and remission periods vary due to individual differences among patients, the progression of the ulcer, the effectiveness of treatment, and measures to consolidate the efficacy.

　　3、RhythmThe pain of duodenal ulcers usually occurs before meals when the stomach is empty or at night. After eating or taking antacid medication, the pain can be slightly relieved. Some special ulcer diseases may not have a clear rhythm of pain, such as elderly ulcers and duodenal bulb post-ulcer. When the rhythm of pain changes suddenly, it should be considered that the condition has developed or complications may occur.

　　4、The location of the painThe duodenal ulcer is located in the middle or slightly to the right of the upper abdomen. The pain range is generally limited, with local tenderness, but the site of pain is not necessarily the location of the ulcer. When the ulcer reaches the serosal layer or is a penetrating ulcer, the pain can spread to other parts of the body such as the chest, upper left abdomen, upper right abdomen, or back.

　　5、The nature and degree of painThe degree of pain tolerance varies from person to person, so there is no objective standard for the degree of pain in ulcer disease, and its nature also depends on the patient's perception. It is usually described as a feeling of hunger, dull pain, belching, pressure, burning pain, or severe pain and pricking.

　　It is important to maintain an optimistic attitude, develop good living habits, have a balanced diet, and actively cooperate with treatment. Only in this way can the occurrence of duodenal ulcers be prevented to the greatest extent. Specifically, the following points should be noted:

　　1.Adjust your mindset, pay attention to rest, and avoid excessive anxiety and fatigue;

　　2.Quit smoking and drinking, maintain regular diet, and avoid overeating;

      3.Avoid eating刺激性 foods such as coffee, strong tea, and chili;

　　4.Reduce the intake of overly sweet and sour foods and fruits, such as chocolate, ice cream, apples, and oranges;

　　5.Reduce the intake of foods that are easy to cause bloating, such as sweet potatoes, lotus root, potatoes, etc. with high starch content.

　　　The diagnosis can be made through the following commonly used examination methods:

　　1. GastroscopyGastroscopy is the main method for diagnosing duodenal ulcers. Although it is named gastroscopy, it can also directly observe and photograph the duodenal mucosa, and can also take biopsies for pathological examination and Helicobacter pylori detection under direct vision. Therefore, it is of great significance for the diagnosis of ulcers. According to the staging method of Katsuhiro Kikuchi of Japan in 1964, duodenal ulcers under endoscopy can be divided into three stages: active stage (A), healing stage (H), and scar stage (S), with each stage divided into two stages. Some patients may not be able to tolerate the process of gastroscopy or have fear, in which case it may be considered to perform gastroscopy under anesthesia (i.e., painless gastroscopy) to alleviate the discomfort of gastroscopy.

　　2. X-ray barium meal examinationX-ray barium meal examination is less accurate than gastroscopy in the diagnosis of ulcers and the differential diagnosis of benign and malignant ulcers in the stomach. It is often used for patients with older age, cardiovascular and cerebrovascular diseases, or those who cannot tolerate gastroscopy due to other reasons. If shadowing is found, it also has diagnostic value.

　　3. Ureaase test or radioactive C13 breath test:The purpose is to detect the presence of Helicobacter pylori infection, mainly used to evaluate the efficacy of Helicobacter pylori eradication treatment.

　　1、Small and frequent meals, timed and quantifiedIt is recommended to have 5 to 7 meals a day, and the amount per meal should not be too much. Small and frequent meals can neutralize gastric acid, reduce the stimulation of gastric acid on the ulcer surface, provide nutrition, and promote the healing of the ulcer surface, which is more suitable for acute peptic ulcers.

　　2、Avoid stimulative foods Avoid foods with excessive mechanical and chemical stimulationMechanical stimulation increases mucosal damage, destroys the mucosal barrier, such as coarse grains, celery, chives, celery, bamboo shoots, and dried fruits, etc. Chemical stimulation increases gastric acid secretion, which is unfavorable for ulcer healing, such as coffee, strong tea, strong alcohol, strong meat soup, etc. Avoid acid-producing foods such as sweet potatoes, potatoes, excessively sweet pastries, and sugar and vinegar foods; gas-producing foods such as raw scallions, garlic, radishes, garlic sprouts, onions, etc.; cold food such as a large amount of cold drinks, cold mixed vegetables, etc.; hard food such as ham, ham, sausages, clam meat, etc.; strong seasonings such as pepper powder, curry powder, mustard, chili oil, etc.

　　3、Choose soft and easily digestible foods　Choose high-nutrient, soft and easily digestible foods such as milk, eggs, soy milk, fish, lean meat, etc. Processed and cooked to become soft and easy to digest, without stimulating the gastrointestinal tract. At the same time, supplement sufficient calories, protein, and vitamins. The nutritional element ratio during semi-liquid diet is 55% carbohydrates, 15% protein, and 30% fat; during liquid diet, it is 60% carbohydrates, 20% protein, and 20% fat. 1. Protein: Protein has a buffering effect on gastric acid, can neutralize gastric acid, but protein digestion in the stomach can also promote gastric acid secretion. Sufficient protein should be provided to meet the body's needs, 1g/kg per day, to promote ulcer repair; if anemia is present, at least 1.5g/kg. 2. Fat is not limited: Fat does not need to be strictly limited as it can inhibit gastric acid secretion. Moderate fat does not stimulate the gastrointestinal mucosa, but too much can promote cholecystokinin secretion, inhibit gastrointestinal motility; food in the stomach is not easily passed into the duodenum, causing bloating pain. Up to 70 to 90g/d can be provided, and easily digestible and absorbable cheese-like fat such as milk, butter, egg yolk, cheese, and a moderate amount of vegetable oil should be chosen.　

      4、Increase carbohydrate intakeIt has no effect on stimulating or inhibiting gastric acid secretion, and can provide 300 to 350g per day. Choose easily digestible foods such as thick porridge, noodles, wontons, etc. Sucrose should not be consumed in large quantities as it can increase gastric acid secretion and cause bloating.

　　5、Supply abundant vitamins　Choose foods rich in B vitamins, vitamin A, and vitamin C; staple foods should be mainly starchy, and fasting should be avoided during bleeding, while liquid diet should be consumed when bleeding stops.

　　6、Cooking methods for ulcers must chop and cook food thoroughly.Food can be cooked by steaming, boiling, blanching, soft braising, stewing, and braising, but should not be processed with methods such as frying, deep-frying, stir-frying, vinegar sauce, and cold dressing.

　　7,Other　When eating, the mood should be comfortable, chew slowly to facilitate digestion. Pay attention to the patient's dietary habits and prepare delicious meals. Provide soft and fibrous foods with less roughage, and pay attention to prevent constipation. Adding a meal before bedtime is especially suitable for duodenal ulcer, which can reduce hunger pain and promote sleep.

　　Ulcer disease mostly belongs to deficiency syndrome, long-term illness, weak physique, pain is fond of warmth and pressing, can be alleviated after eating, less food intake, loose stools, fatigue and weakness, pale complexion, pale tongue, thick and greasy or slippery white tongue coating, weak pulse. The treatment principle is to warm the middle and disperse cold, tonify Qi and nourish Yin, regulate the stomach and harmonize the middle, nourish Yin, and adjust the intestinal and spiritual agent according to the symptoms in clinical practice, and divide the syndrome into cold syndrome, heat syndrome, deficiency of both Qi and Yin, Qi deficiency, etc.
　　1,Deficiency and Cold Syndrome: Due to insufficient congenital endowment, cold and cold diet, fatigue and injury to Yang, leading to disharmony of stomach Qi and hidden pain in the epigastrium, fond of warmth and pressing, slightly reduced after eating, less food intake, digestion is poor, loose stools, belching and acid regurgitation, cold hands and feet, bloated tongue, white tongue coating, deep pulse and weak pulse. Treatment principle: warm the middle and disperse cold, sweet and warm to tonify deficiency.
　　2,Deficiency and Heat Syndrome: Normally weak physique, long-term illness injures Yin, or indulgence in spicy, sweet and greasy foods, drinking into a habit, consumes stomach Yin, epigastrium burning heat and swelling pain, especially in the evening, restless and stuffy epigastrium, less food intake, sour tongue, if spicy food is eaten, the pain is more severe, burning heat and swelling, hand and foot heat, dry mouth and not willing to drink, dry or soft stool, red tongue around the edges, greasy or slippery tongue coating, deep pulse and wiry pulse at the Guan, small and weak pulse. Treatment principle: benefit the stomach and regulate the middle, nourish Yin and produce fluid.
　　3,Syndrome of Both Qi and Yin Deficiency: Long-term illness without relief, the disease has been prolonged for a long time, Yang deficiency in the front, Yin deficiency in the back. Symptoms include external shape, cold limbs, cold hands and feet, while internal epigastrium heat, swelling, burning pain, although fond of warmth and aversion to cold, epigastric swelling and pain, food intake is less, digestion is poor, fatigue and weakness, thirst and dry throat, red eyes and yellow urine, slightly bloated tongue, red tongue coating, deep pulse and virtual wiry pulse. Treatment principle: tonify Qi and nourish Yin, harmonize the middle and stomach.
　　4,Syndrome of Qi Deficiency: Caused by multiple factors, such as emotional injury, overwork, and neglect of physical exercise, leading to illness due to mental and physical exhaustion. The pain in the epigastrium is not severe, but there is a feeling of heavy and stuffy, restless and uncomfortable when hungry, painful and uncomfortable when eating, thin and weak physique, shortness of breath, fatigue, less talkative, tired and willing to lie down, thin tongue, pale tongue coating, soft and weak pulse. Treatment principle: tonify Qi, enhance Yang and benefit the stomach.