【正文】 ?A regular diet, avoidance of strong tea, coffee, alcohol and smoking；?Discontinuance of NSAIDs and other gastric mucosal harmful drugs.（II）Medical Treatment?Reducing levels of acid?Enhancing mucosal defense?Eradication of H. Pylori1. Drugs that Reducing levels of acidity?Alkali drugs (Antacids, neutralization)?Antimuscarine drugs?Antigastrin drugs?H2 receptor antagonists (H2RA)7 / 24?Proton pump inhibitor (PPI)⑴ antacidsAffect：Alkali drugs Neutralization of gastric acidDrugs：Alumimum hydroxide Magnesium hydroxideDirection： qid，after meal and before sleepingSide effects: more。 Operation should be performed.4．Carcinogenesis GUabout 1%~2% DUNegative association exists VI. Diagnosis and differentiation （I）DiagnosisHistory：Chronicity Episodicity RhythmicityManifestations：Symptoms SignsDepend on: Radiography Endoscopy （II） differentiation 1．Functional dyspepsia 2．Chronic cholecystitis and gallstone 3．ZE syndrome 4．Gastric cancer1. Functional dyspepsia, FDDefinition: With dyspepsia, but has not have ulcer and other structural diseases.Characters: ①Female is more mon ②Dyspepsia ③Xray, Endoscopy2 . Chronic cholecystitis and gallstone⑴ Manifestations： Pain, Fever, Jaundice；⑵ Diagnosis： Bultrasound, ERCP syndrome?Hypersecretion of gastrin by pancreatic nonβ cell tumors leads to hypersecretion of gastric acid.?Characters: Multiple ulcerations in some atypical location.?Acid secretory testing BAO＞15mmol/h　 MAO＞60mmol/h　　　BAO / MAO＞60% Serum Gastrin ＞ 500pg/ml4 . gastric cancer5 Radiography6 Endoscopy and biopsyDifferentiation of GU amp。 GU→Duodenal, intestine DU→Common bile duct3．Pyloric obstruction?DU、Pyloric channel ulcer?① Temporary(Functional) obstruction: Edema and smooth muscle spasm around an active ulcer。 Resulting in acute diffuse peritonitis.② Chronic perating ulcer Erosion into and confinement by a solid an ( pancreas, liver, spleen)。 Bottom is covered with fibrous exudate.H（healing stage） Inflammation, Edema around ulcer。?Difficult to cure by antacid treatment；?Both endoscopy and radiography may miss.IV. Laboratory studies（I）HP TestRequire samples of gastric mucosa: Rapid urease test Histologic examination Smear stain CultureDo not require samples of gastric mucosa: PCR test 13Cor 14CUBT Serum IgG antibody（II）acid secretory testing1 . Value: Differential diagnosis of gastric cancer2 . Meaning:?PU： DU↑，GUN or ↓? Gastric cancer：↓↓ or without?ZE syndrome： BAO15mmol/L MAO60mmol/L BAO/MAO60%（III） Serum Gastrin?PU：↑，No clinical meaning?ZE syndrome ：↑↑↑， 500pg/ml（IV ）Radiography⑴Direct sign： crater — Diagnosis⑵Indirect sign: Tenderness Spastic notch Duodenal excitation — May be（V ）Eendoscopy and Biopsy1 . Meaning ① Diagnosis ② HP test ③ Differential diagnosis of benign and malignancy ulcer2 . Endoscopic EX of PU1. Location： DU：Anterior wall of duodenal bulb GU：Lesser curvature of gastric antrum, gastric angle2. Number： Single or multiple3. Size amp。 Shape： Round or oval in shape Often ＜4. Characteristic of PU：Have smooth, regular, rounded edges.With a flat, smooth ulcer base often filled with exudate.Hyperemia and edema around ulcer.Folds radiating to ulcer margin.5. Course： 4 8 weeksIV. Clinical ManifestationCharacteristic of Manifestation 1. Chronic course (Chronicity) 2. Periodic recurrence (Episodicity) 3. Rhythm pain (Rhythmicity)（I） symptoms1. epigastric pain① Location： Epigastrium② Character：Burning (Heart burn), Gnawing (Hunger pain), Hungerlike disfort.③ Degree：Mild to moderate④ Rhythmicity ： DU: Hunger pain ,Middle night pain. Painfoodrelief GU : Soon after meals food Pain relief⑤ Aggravating or Alleviating Factors Aggravate：Emotional stress, NSAIDs Relieved：Ingestion of food or antacids2. Dyspepsia : Nausea, Vomiting, Anorexia, Bloating, belching.（II） signsActive stage：Epigastric tenderness (a nonspecific finding)Remission stage：No signs（III）Atypical Ulcer Ulcer: 15%35% of PU patients Deadlyplications More frequent in elderly patients 2. Elderly Ulcer：Atypical of symptoms3. Multiple Ulcer：5% of PU4. Pyloric Channel Ulcer：Like DU5. Postbulbar Duodenal Ulcer：In the 3cm distal to the pylorus, easily to bleeding.1. Elderly Ulcer?Incidence increased resent years；?Atypical or silent of symptoms?Like gastric cancer： Anorexia, Weight loss , Anemia?High position or giant ulcer are mon.2. Pyloric Channel Ulcer?Like DU，Pain after meals；?Difficult to cure by antacid treatment；?Vomiting；?A higher rate of plication: Bleeding, Obstruction , Perforation3. Postbulbar Duodenal Ulcer?In the distal to the pylorus。 Peptic?Nonsteroidal antiinflammatory drugs（NSAIDs ）?Geic factors?Abnormal motor function?Stress and psychologic factors?Others：smoking,food and drink,infection of virus. helicobacter pylori ， Hp The main causes of PU （no Hp，no ulcer）⑴ Proof of a causal role for Hp① The majority of PU patients are infected DU 90%～100% ， GU 80%～90%② infected are easily lead to PU（15%20% ）③ Cure of infection reduces ulcer recurrence ④ HP is the main causal factor of chronic gastritis, all PU coexist with HPassociated antral gastritis. ⑵Pathogenic mechanisms of Hp on gastrointestinal mucosa A. Promote Colonization Motility