Asymptomatic ulcer

When we develop ulcers due to drinking less water, there will be obvious symptoms, which everyone is familiar with. However, there is a type of asymptomatic ulcer that everyone may not be familiar with. This type of ulcer is more common in the elderly because the elderly have weakened metabolic capacity. It often occurs in the gastrointestinal tract, affecting the digestive function and thus causing more complications. People with asymptomatic ulcers should eat regularly and avoid overwork.

Asymptomatic ulcer

About 15%-35% of patients with peptic ulcer may have no symptoms. These patients are mostly discovered during endoscopic or X-ray barium meal examinations for other diseases, when complications such as bleeding and perforation occur, or even during autopsy. This type of peptic ulcer can occur at any age, but is more common in the elderly. More than half of recurrent ulcers treated with H2 receptor antagonists are asymptomatic.

Causes

In addition to being frequently exposed to high concentrations of gastric acid, the gastroduodenal mucosa is also attacked by pepsin, microorganisms, bile salts, ethanol, drugs and other harmful substances. But under normal circumstances, the gastric and duodenal mucosa can resist the damaging effects of these invasive factors and maintain the integrity of the mucosa. This is because the gastroduodenal mucosa has a series of defense repair and restoration mechanisms, including mucus/bicarbonate barrier, mucosal barrier, mucosal blood flow, cell renewal, prostaglandins and epidermal growth factor. The occurrence of peptic ulcer is the result of the imbalance between the invasive factors that damage the gastroduodenal mucosa and the mucosa's own defense-repair factors. This balance may be due to an increase in invasive factors, a decrease in defense-repair factors, or both. GU and DU have different pathogenesis. The former is mainly due to the weakening of defense and repair factors, while the latter is mainly due to the enhancement of invasion factors. Peptic ulcer is a disease caused by multiple causes, that is, the causes and pathogenesis may be different among patients, but the clinical manifestations are similar.

Treatment options

The goals of treatment are to eliminate the cause, relieve symptoms, heal ulcers, prevent recurrence, and avoid complications. The causes of peptic ulcer vary from patient to patient, and the pathogenesis is also different. Therefore, the possible pathogenic factors and pathophysiology involved should be analyzed for each case, and appropriate treatment should be given.

General treatment

Life should be regular, work should be a combination of work and rest, excessive fatigue and mental stress should be avoided. If you feel anxious, you should be counseled and given sedatives if necessary. In principle, it is important to eat on time and avoid spicy, salty foods and strong tea, coffee and other beverages. Although milk and bean paste can temporarily dilute stomach acid, the calcium and protein they contain can stimulate gastric acid secretion, so they should not be consumed excessively. If you have a habit of smoking or drinking and confirm that it is related to the onset of ulcers, you should quit immediately. Those who are taking NSAIDs should stop taking them as much as possible; even if the patient is not taking such drugs, they should be warned to use them with caution in the future.

Drug treatment

Before the 1970s, the treatment of this disease mainly relied on antacids and anticholine drugs. The advent of H2RA brought about the first change in treatment. The eradication of Hp advocated in recent years is a major milestone in treatment.

H. pylori eradication therapy

Eradication of Hp can completely achieve the treatment goal for most patients with Hp-related ulcers. The international community has reached a consensus on the treatment of Hp-related ulcers, namely, whether the ulcer is new or recurrent, active or dormant, or with or without a history of complications, anti-Hp treatment should be given.

1. Treatment plan for eradicating Hp Since most antimicrobial drugs have reduced activity in the low pH environment of the intestine and cannot penetrate the mucus layer to reach the bacteria, Hp infection is not easy to eradicate. To date, there is no single drug that can effectively eradicate H. pylori, so a treatment regimen has been developed that combines drugs that inhibit gastric acid secretion, antibacterial drugs, or synergistic colloidal bismuth agents. Treatment options for eradicating H. pylori can generally be divided into two categories: proton pump inhibitor (PPI)-based and colloidal bismuth-based. Triple therapy consists of a PPI or a colloidal bismuth agent plus two of the three antibiotics: clarithromycin (erythromycin), aspirin (or tetracycline), and metronidazole (or tinidazole). The resistance rate of Hp strains to metronidazole is increasing rapidly. Furazolidone has a strong anti-Hp effect, and Hp is not easy to develop drug resistance. Furazolidone can be used instead of metronidazole, with a dosage of 200 mg/d, taken in two doses. H2RA can be used instead of PPI to reduce costs, but the efficacy is also reduced. For patients who fail initial treatment, quadruple therapy consisting of PPI, colloidal bismuth and two antibiotics can be used.

2. There is no consensus on whether anti-ulcer treatment should be continued after the completion of Hp eradication treatment. When the treatment plan is highly effective and the ulcer area is not large, a single anti-Hp treatment for 1-2 weeks can effectively heal the active ulcer. If the efficacy of the H. pylori eradication regimen is slightly lower, the ulcer area is large, the patient's symptoms are not relieved at the end of anti-H. pylori treatment, or there is a recent history of complications such as bleeding, consideration should be given to continuing treatment with gastric acid secretion inhibitors for 2-4 weeks after the end of anti-H. pylori treatment.

3. Follow-up after anti-Hp treatment: After anti-Hp treatment, tests to determine whether Hp has been eradicated should be performed no less than 4 weeks after completion of treatment. Most DU patients treated with highly effective anti-Hp regimens (eradication rate ≥ 90%) do not need to undergo trials to confirm Hp eradication. For patients with refractory ulcers or DU with a history of complications, it is necessary to determine whether Hp has been eradicated. Because GU has the potential risk of malignant transformation, in principle, gastroscopy and Hp reexamination should be performed at an appropriate time after treatment. For patients who still have persistent dyspepsia symptoms after appropriate treatment, it is also necessary to determine whether Hp has been eradicated.