Gastric and duodenal ulcers: causes, diagnosis, and prevention

Author: Li Junxiang, Chief Physician, Oriental Hospital, Beijing University of Chinese Medicine

Reviewer: Yang Yunsheng, Chief Physician, PLA General Hospital

Gastric and duodenal ulcers, here referring to peptic ulcers, have the core pathological mechanism that the gastric or duodenal mucosal layer is eroded by its own digestive juices, leading to local mucosal tissue necrosis and the formation of ulcer lesions.

1. Cause Analysis

The occurrence of gastric and duodenal ulcers is the result of the interaction of multiple factors. First of all, gastric acid and pepsin, as the main components of gastric juice, are the main invasive factors of ulcer formation. In addition, Helicobacter pylori infection is also a recognized pathogenic factor, which can aggravate the damage of gastric acid to the mucosa by destroying the gastric mucosal barrier.

Bile acid reflux, abnormal gastroduodenal motility, long-term use of nonsteroidal anti-inflammatory drugs (such as aspirin), and bad lifestyle habits (such as smoking, drinking, and spicy food) are all important factors that promote the formation of ulcers. Genetic factors may also play a role in the onset of ulcers.

2. Diagnostic Methods

Gastroscopy is the gold standard for the diagnosis of gastric and duodenal ulcers. Through direct observation through the gastroscope, doctors can clearly see the shape, size and location of the ulcer, and can perform pathological confirmation through tissue biopsy. In addition, the detection of Helicobacter pylori is also an indispensable part of the diagnostic process. Commonly used methods include breath test, rapid urease test under gastroscopy, etc.

Figure 1 Original copyright image, no permission to reprint

For patients who are not suitable for or refuse gastroscopy, capsule endoscopy and upper gastrointestinal barium meal radiography can be used as alternatives, but their diagnostic accuracy is relatively low. In addition, routine stool plus occult blood test is important for detecting whether ulcers are accompanied by bleeding. When patients have alarm symptoms (such as sudden weight loss, anemia, black stools, etc.), they should be highly vigilant and undergo gastroscopy in time to rule out the possibility of malignant lesions.

3. Precautions for gastroscopy

Patients who are preparing to undergo gastroscopy need to pay attention to the following matters: First, a series of preoperative examinations are required before the examination, such as blood biochemistry, blood electrolytes, electrocardiogram, chest X-ray, etc. In order to prevent the spread of infectious diseases, hepatitis B, hepatitis C, AIDS, syphilis and other examinations are also required; secondly, they need to fast after 8 pm the day before the examination until the examination is completed to ensure that the stomach is in an empty state for easy observation; finally, if you choose to undergo a painless gastroscopy, a professional anesthesiologist must perform a preoperative evaluation to ensure the safety of anesthesia.

During the gastroscopy, the doctor will give local anesthesia in the throat to reduce discomfort. After the examination, the patient should not eat or drink for a short period of time to avoid choking or aspiration. At the same time, the patient should not drive, work at heights, or operate machinery for several hours after anesthesia, which requires concentration.

Figure 2 Original copyright image, no permission to reprint

4. Prevention strategies

In terms of prevention, it is crucial to maintain good living habits. Quitting smoking and limiting alcohol consumption, avoiding spicy and irritating foods, eating regularly, and exercising moderately can all help reduce the risk of ulcers. In addition, for patients who take nonsteroidal anti-inflammatory drugs for a long time, the condition of the gastric mucosa should be monitored regularly. For high-risk groups with a family history of ulcers, more attention should be paid to dietary hygiene and regular physical examinations to promptly detect and treat potential diseases.