Learn the strategies to keep warm and don't let "chronic stomach problems" take advantage of you

Whenever winter comes, cardiovascular and cerebrovascular diseases will frequently appear, such as common cerebral hemorrhage and myocardial infarction. So, for young people with peptic ulcers, or middle-aged and elderly patients with liver cirrhosis and esophageal varices, will the cold climate aggravate the condition or even increase the risk of bleeding? Dr. Song Jitao, Secretary General of the Gastroenterology Branch of the Heilongjiang Medical Health International Exchange Promotion Association and Chief Physician of the Department of Gastroenterology of the Second Affiliated Hospital of Harbin Medical University, pointed out that according to the results of domestic and foreign studies, as an independent factor in inducing or aggravating peptic ulcer bleeding, rapid climate change can indeed bring certain risks, suggesting that people must change their bad lifestyle habits and pay attention to keeping warm in daily life.

Song Jitao introduced that the most common diseases in gastroenterology include esophageal varicose bleeding (EGVB) and peptic ulcer bleeding. EGVB is a bleeding symptom caused by the rupture of esophageal varicose veins, accounting for about 20% of upper gastrointestinal bleeding. It has always been a common and urgent complication in patients with cirrhosis and one of the common causes of upper gastrointestinal bleeding. Every year, about 7-8% of cirrhosis cases progress to esophageal varices. After a rough meal, blood vessels may rupture, followed by vomiting blood, black stools, etc. For decades, experts and scholars have been constantly exploring the mystery of EGVB and formulating cutting-edge treatment plans and guidelines based on existing mechanisms.

Problems with gastrointestinal bleeding

So, how do the blood vessels lurking in the esophagus and stomach trigger varicose veins? Dr. Song pointed out that when it comes to varicose veins in the esophagus and stomach, we must first explain it from the perspective of the liver and liver cirrhosis. The liver is the largest and most efficient digestive organ in the human body. When taking in nutrients through activities such as eating, the liver recycles blood from the intestines through a special supply channel, the portal vein, and then supplies the recycled blood to the liver lobules (the basic functional unit of the liver) in the liver through countless branching blood vessels; and the liver lobules are composed of countless hepatocytes arranged in an orderly manner. After the blood is processed by the liver, its nutrients are recovered and reused, and metabolic waste is effectively disposed of. The blood is collected by the inferior vena cava and introduced into the systemic circulation.

However, under the attack of various toxic and harmful substances such as viruses and alcohol, human liver cells are often damaged and then necrotic and apoptotic. However, liver cells are indomitable and have a strong will to "regenerate", but they are prone to lose their original order on the road to "resurrection", causing the previously orderly liver lobules to become "pseudo-liver lobules" with disordered structures. The consequence of this "mutated form" is that it blocks the originally unobstructed pipeline, causing the blood flow from the portal vein to the liver to be blocked, the road ahead is blocked, and the portal vein pressure continues to soar. The blood has to "find another way" to relieve the continuously rising portal vein pressure, so the once dormant "collateral circulation" is awakened, and esophageal and gastric varices are formed, thus laying a "mine" for patients to vomit blood.

Compared with EGVB, the harm of peptic ulcer bleeding should not be underestimated. Dr. Song Jitao said that this disease accounts for 60-70% of the causes of upper gastrointestinal bleeding. When the disease occurs, patients often vomit a large amount of dark red blood, accompanied by blood clots; when the amount of bleeding is large, bright red blood will also be seen gushing out, and then black stools will be seen, and anemia, decreased blood volume in the body and even shock will be life-threatening. According to the predecessors' "leaky roof" theory of the digestive tract mucosa, Dr. Song pointed out that gastric and duodenal ulcers will "come uninvited" in the case of infection with Helicobacter pylori, irregular diet, long-term drinking or short-term heavy drinking, and long-term use of aspirin and other non-steroidal anti-inflammatory drugs.

Cold weather can easily trigger chronic diseases

Song Jitao reminded that the above two common digestive system diseases are obviously seasonal and rhythmic, and are easily "driven" by climate change. In a study, scholars from Taiwan pointed out that although the mechanism of the increased incidence of esophageal varicose bleeding caused by climate factors is not yet clear, more human resources are needed to better manage the increased cases of peptic ulcer and esophageal varicose bleeding in February and March.

In 2016, Taiwanese doctors once again published an article pointing out that cold winter weather is associated with a high risk and high incidence of esophageal varicose bleeding, and this conclusion is consistent with studies in Turkey, Japan, France, Tunisia and other countries. In 2020, American scholars published a paper in the Journal of Clinical Digestive Endoscopy and reached the same conclusion, that is, low temperature, as a "pusher", raises the risk and probability of existing or new esophageal varicose bleeding. This may be related to the use of non-steroidal anti-inflammatory drugs in the elderly in winter, drinking white wine to keep warm in cold weather, which increases the liver load, and the cold stimulates the sympathetic nerves, which causes peripheral vasoconstriction, causing a sharp increase in portal vein pressure, which is overwhelmed and finally causes the gastric fundus blood vessels to "explode".

To prevent accidents, please keep the following suggestions in mind

Dr. Song warned that, like hypertension and diabetes, patients with "chronic stomach problems", cirrhosis and portal hypertension should also strengthen chronic disease management and quit bad habits to avoid the sneak attack of critical illness and complications. Specifically, the first one is to "control your mouth" and eat less or no spicy, sour, cold, high-salt, high-fat, fried food; especially in the high-latitude areas in the north, due to the low temperature and short sunshine time, many people will mistakenly believe that drinking high-proof liquor can add calories and resist the cold; but they don't know that under the strong stimulation of alcohol, the continuous damage to the gastric mucosa is huge, which is very likely to evolve into peptic ulcers, and at the same time make the liver overwhelmed, thus causing alcoholic liver disease (alcoholic cirrhosis) or aggravating the original condition. An indisputable fact is that patients with alcoholic cirrhosis often suffer from portal hypertension and esophageal gastric varices "silently". This reminds us that "although good wine is good, don't be greedy."

Second, keep warm and prevent the stomach from getting cold. As the saying goes, "Nine out of ten stomach problems are caused by cold." Dr. Song Jitao explained that when the weather turns cold, the human sympathetic nerves are excited by the cold, which can easily accelerate the contraction of peripheral blood vessels, forcing a large amount of blood to flow from the systemic circulation into the portal vein system of the abdominal cavity in a short period of time. As the portal vein pressure rises, it naturally lays the "foreshadowing" for the rupture and bleeding of esophageal gastric varicose veins. Song Jitao suggested that people with bad stomachs should try not to go out when encountering extreme weather, or wear thicker clothes when going out; do not drink cold water or cold drinks at ordinary times, but drink more jujube water or brown sugar water. Cover the stomach with a hot water bottle every day, boil some hot water to soak your feet at night, and cover the bedding before going to bed. In a word, "showing concern" is beneficial to one's own health, does not give stomach diseases a chance to take advantage, and prevents the resurgence of old diseases.

The third is to use drugs rationally to effectively protect blood vessels. Dr. Song Jitao pointed out that in the high-altitude cold areas in the north, many middle-aged and elderly people often take aspirin and other non-steroidal anti-inflammatory drugs for prevention to resist the sneak attacks of cardiovascular and cerebrovascular diseases. However, long-term use of aspirin can damage the gastrointestinal mucosa and induce bleeding, suggesting that medication should be taken according to doctor's orders. As for "old patients" with cirrhosis and esophageal varices, while taking mucosal protectants to protect the gastrointestinal mucosa, they should also, under the guidance of doctors and pharmacists, appropriately choose some drugs to control portal vein pressure, such as carvedilol, propranolol and other non-selective receptor blockers, which can effectively "reduce" the pressure of collateral circulation in the portal vein system and further reduce the probability of bleeding.

Introduction of Dr. Song Jitao

Chief physician, doctor of medicine. Published 6 SCI papers in the field of digestive endoscopy and 3 papers in national core journals. Specializes in minimally invasive endoscopic diagnosis and treatment of biliary and pancreatic diseases, minimally invasive endoscopic diagnosis and treatment of precancerous lesions and early cancers of the digestive tract, and emergency endoscopic hemostasis for upper gastrointestinal bleeding of various causes. From July to September 2016, he went to the Department of Gastroenterology of Altay Regional Hospital in Xinjiang to participate in the work of aiding Xinjiang, and from February to April 2020, he participated in the work of aiding Hubei to fight the epidemic at Wuhan People's Hospital.

He is currently the Secretary-General of the Gastroenterology Branch of the Heilongjiang Medical Health International Exchange Promotion Association, a member of the Gastroenterology Professional Committee of the Heilongjiang Association of Integrated Traditional Chinese and Western Medicine, a member of the Second Committee of the Gastroenterology Professional Committee of the China Association of Non-public Medical Institutions, and an executive director of the Gastroenterology Specialist Branch of the Harbin Medical Association.