Practice diagnosis and treatment of gastrointestinal ulcers

2021-03-25 12:00 AM

pylori ulcers: These are all gastrointestinal ulcers that test shows the presence of this bacterium.

An ulcer is an indentation in the skin or mucous membranes formed by the destruction of the epithelium. The ulcer, which looks like a crater, can be shallow or deep, but both cause inflammation and pain. In fact, about one-fifth of the total number of cases of ulcers in the body as peptic ulcer, including cases of ulcers and duodenal (90%), ulceration of the oesophagus (about 5%), or stomach ulcers (accounting for about 5%).

From about the 1980s onwards, gastrointestinal ulcers were still considered chronic cases, almost impossible to cure. Therefore, patients have to eat snacks, take antacids ... Men aged 45 to 65 often suffer from gastrointestinal ulcers more than twice as often as women. It is also known that strong emotions and stress often cause or worsen sores. Since the discovery of Helicobacter pylori (or H. pylori ) as a specific cause of ulcers, overall improvement in the treatment of gastrointestinal ulcers has improved. Because there are many cases that can be treated with radical instead of frequent recurrence as before. The presence of bacteriaH. pylori accounts for 70% (stomach ulcers) to 90% (duodenal ulcers) of the total number of gastrointestinal ulcers.

Reason

The causes of gastrointestinal ulcers are complex. The H. pylori bacteria play an important, but not all, role. There are many other factors involved in gastrointestinal ulcers. However, the diagnosis can often be distinguished into two groups:

Ulcers caused by bacteria H. pylori : is all peptic ulcer cases that tests showed the presence of this bacterium. However, this does not rule out the possibility of a combination of some other causes. It is also important to know that many people are infected with H. pylori bacteria (about half of the world's population), but not all people have gastrointestinal ulcers. Many people are healthy even though their bodies carry the H. pylori bacteria. Therefore, a definitive diagnosis is only made when ulcers are accompanied by the presence of bacteria.

Ulcers of other causes: To date, the following causes are known to be involved in the creation of ulcers. They can act independently, or in combination with many causes, or in combination with cases of H. pylori bacteria. Therefore, these causes should also be considered in cases where H. pylori has been identified.

Frequent use of aspirin or non-steroidal anti-inflammatory drugs, such as ibuprofen or naprosin ... strongly reduces the gastric mucosa's resistance to acid and pepsin. In fact, when taken with coffee will increase the harmful effects of drugs.

Alcohol such as alcohol, beer ... also reduces the resistance of the stomach lining to acids and pepsin . Even the amount of alcohol found in many medicines used to treat the disease.

Smoking breaks the stomach lining. Smokers have a 50% higher risk of stomach or duodenal ulcers than nonsmokers. For smokers, the ulcers also take a long time to heal.

Family history of gastrointestinal ulcers.

Diagnose

Diagnosis is based on the symptoms present and the relevant information provided by the patient.

Attention should be paid to:

The location of the pain site, symptoms of pain and its association with meals.

Calculate the period of pain and when it occurs, such as when the patient has to wake up during the night ...

Associated manifestations such as nausea or vomiting, loss of appetite ...

What special diets are patients applying, such as dieting, vegetarian ...

Level of use of alcohol, beer ... or tobacco addiction.

Signs of weight loss in recent times.

Other symptoms such as gas, heartburn, heartburn (heartburn is very sharp, feeling of discomfort like burning the throat) ...

Testing for H. pylori should be done for all confirmed cases of ulcers, because the results will determine the treatment.

Treatment

The drugs acid is used for cases of suspected ulcers (because of pain) but not enough to determine. The drug has a neutralizing effect to reduce the acidity in gastric juice, thereby helping to alleviate the pain.

Mild ulcers can start with an H2-receptor antagonist, such as cimetidine 800mg or ranitidin 300mg, continuous nocturnal use for 6 weeks for patients with normal duodenal ulcer, 8 weeks for those people who smoke or have ulcers caused by taking nonsteroidal anti-inflammatory drugs, and 12 weeks for people with stomach ulcers.

If symptoms persist after 4 weeks of treatment, the dose should be doubled.

If the effect is still ineffective, consider replacing it with a proton pump inhibitor such as omeprazole 20mg daily for 4 weeks for duodenal ulcers and 8 weeks for peptic ulcers. The dose may be doubled in severe cases.

Maintenance therapy with H2-receptor antagonists, such as cimetidine 400mg or ranitidine 150mg nocturnal, is indicated for the following subjects to limit the rate of recurrence:

Ulcers have happened more than 2 times a year.

An ulcer history of complications.

Are taking nonsteroidal anti-inflammatory drugs or anticoagulants.

The elderly or those in poor health.

For cases of ulcers caused by H. pylori bacteria, it is necessary to use antibiotics with sufficient doses of radical treatment to avoid relapse. Eradication therapy reduces the risk of recurrence over 2 years from 100% to 5%.

Once the ulcer and the presence of the H. pylori bacteria have been identified, a combination of 2 antibiotics and neutralizing acid bismuth ( Pepto Bismol ) should be treated. There are many different types of H. pylori bacteria, so the use of two antibiotics at the same time increases the ability to kill bacteria. Some drugs such as metronidazole ( Clont, Entizol, Orvagil ...) and tetracycline ( Tetracyn, Hostacyclin, Polfamycin ...) work very well, unless the patient has previously used metronidazole . In this case, it is possible to replace metronidazole with clarithromycin.

Treatment with omeprazole 40mg per day, combined with amoxicillin 500mg, 3 times a day, and metronidazole 400mg, 3 times daily, continuously for 2 weeks.

Maintenance therapy with high-dose H2-receptor antagonists, such as cimetidine 800mg or ranitidine 300mg nocturnal, is indicated for the following subjects:

Relapse because of low dose treatment (6 weeks).

Ulcers are complicated by low (long-term) maintenance.

For cases of ulcers caused by H. pylori bacteria, it is necessary to use antibiotics with sufficient doses of radical treatment to avoid relapse. Eradication therapy reduces the risk of recurrence over 2 years from 100% to 5%.

Once the ulcer and the presence of the H. pylori bacteria have been identified, a combination of 2 antibiotics and neutralizing acid bismuth ( Pepto Bismol ) should be treated. There are many different types of H. pylori bacteria, so the use of two antibiotics at the same time increases the ability to kill bacteria. Some drugs such as metronidazole ( Clont, Entizol, Orvagil ...) and tetracycline ( Tetracyn, Hostacyclin, Polfamycin ...) work very well, unless the patient has previously used metronidazole. In this case, it is possible to replace metronidazole with clarithromycin.

Treatment with omeprazole 40mg per day, combined with amoxicillin 500mg, 3 times a day, and metronidazole 400mg, 3 times daily, continuously for 2 weeks.

Subsequent recurrences may require treatment with H2 receptor antagonists.