Chancroid

Disease Description (Causes and Symptoms)

• Disease name: Gastric ulcer (Peptic ulcer) — This is a medically widely recognized diagnostic name.
• Definition and pathophysiology: When the defense mechanisms of the gastric mucosa (mucus, neutralizing substances, blood flow, etc.) are damaged or irritation from gastric acid and pepsin increases, a mucosal defect progresses, resulting in an ulcer that extends beyond the mucosal layer into the muscular layer. The main mechanisms include Helicobacter pylori (H. pylori) infection and inhibition of prostaglandin production by nonsteroidal anti-inflammatory drugs (NSAIDs). Smoking interferes with healing by reducing mucosal regeneration and impairing blood flow.
• Main symptoms: Upper abdominal (epigastric) pain (burning sensation and heartburn below the sternum), postprandial pain (usually around 30 minutes after eating), indigestion, nausea and vomiting, decreased appetite and weight loss. If bleeding occurs, hematemesis, melena, and symptoms of anemia (dizziness and fatigue) may develop. If perforation occurs, acute abdominal pain and signs of peritoneal irritation may occur; if gastric outlet obstruction occurs, vomiting and persistent fullness may develop.

Treatment Methods

• Medication treatment (standard)
  • Gastric acid secretion inhibitors: proton pump inhibitors (PPIs; e.g., omeprazole-based drugs) — usually induce ulcer healing with 4–8 weeks of treatment.
  • Mucosal protectants: sucralfate, etc., may be used in combination when necessary.
  • If H. pylori infection is confirmed, eradication therapy: combination of two or more antibiotics and a PPI (generally for 1–2 weeks or according to local guidelines). Confirm whether eradication was successful after treatment (e.g., urea breath test).
• Management related to NSAIDs
  • Discontinue NSAIDs if possible. If long-term use is necessary, consider combining them with a PPI or using an alternative medication (such as acetaminophen).
  • For patients who must continue using NSAIDs, consult about using a mucosal protectant or a lower-risk drug at the lowest effective dose.
• Procedures/Surgery
  • Bleeding: Endoscopic hemostasis (such as clipping, injection, or thermal therapy) is preferred. Surgical treatment may be possible in cases of rebleeding or when bleeding cannot be controlled endoscopically.
  • Perforation: Small perforations may be treated conservatively or with laparoscopic closure; large perforations require surgical closure.
  • Gastric outlet obstruction: Endoscopic dilation or surgical treatment may be necessary.
• Lifestyle management and precautions
  • Stop smoking (to improve the healing rate and prevent recurrence), avoid excessive alcohol consumption, limit irritating foods (spicy and salty foods), and manage stress.
  • Because taking antithrombotic or anticoagulant drugs increases the risk of bleeding, consult the treating physician.
  • If emergency symptoms occur, such as rapid weight loss, persistent vomiting, melena, or possible fainting, immediately visit an emergency room.
• Follow-up and prognosis
  • With appropriate treatment, most ulcers heal within 4–8 weeks. If H. pylori is not treated, the risk of recurrence is high (approximately 50–60%, depending on the source).
  • Complications: Gastrointestinal bleeding, perforation, and gastric outlet obstruction. Gastric ulcers have a low association with cancer (generally reported as less than 1%), but follow-up endoscopy and biopsy are necessary if malignant features are suspected.
  • RAG-based recommendation: If malignant features or warning signs such as weight loss are present, perform follow-up endoscopy after treatment (and biopsy if necessary) to assess the possibility of cancer (e.g., some recommended schedules include follow-up at 2, 6, and 12 months; adjust according to the patient’s condition and diagnostic findings).

Outpatient Visit Checklist (Including Preparation Items and Example Questions)

• Preparation items (brief list)
  • A list of all medications currently being taken (including prescription drugs, OTC drugs, and supplements), and allergy history
  • Previous test results (recent gastroscopy findings and biopsy results, blood tests [CBC], chest/abdominal imaging, etc.)
  • A record of when symptoms began and their characteristics (pain location, frequency, relationship to meals, and relationship to sleep)
  • Whether bleeding symptoms are present (hematemesis or melena), and whether dizziness or fainting has occurred
  • History of smoking, alcohol consumption, and NSAID use (drug name, dose, and duration)
• Information to tell the doctor in advance during the outpatient visit (examples)
  • "My upper abdominal pain has been recurring 30 minutes after meals for the past few days."
  • "I am taking XX (active ingredient) every day as a painkiller."
  • "I have recently lost X kg and my appetite has decreased."

General Example Questions to Ask the Doctor

• What are the side effects of this medication (e.g., a PPI or antibiotic)? How long should I take it, and what precautions should I follow?
• What is the success rate of eradication therapy (for Helicobacter pylori), and how is treatment handled if it fails? When should I be retested?
• I must take NSAIDs. What measures should I take to protect my stomach?
• What is my risk of complications (bleeding, perforation, or obstruction)? What are the emergency symptoms?
• When and how often should I have follow-up tests (endoscopy and blood tests)?

Examples of Disease-Specific Questions (1–2 Tailored to the Condition)

• Related to Helicobacter pylori
  • "If I test positive for H. pylori, which eradication therapy do you recommend in my case? What is the treatment duration and what side effects can I expect? When and with which test will you confirm whether eradication was successful?"
• Related to NSAIDs
  • "I need to continue taking pain medication for arthritis. Which medication (alternative or protectant) do you recommend to reduce the risk of recurrent gastric ulcers, and what special precautions should I take while taking it?"

Note: This information is general medical information. Individual diagnosis and treatment vary depending on consultation with the treating physician and test results. If emergency signs (severe abdominal pain, hematemesis or melena, fainting, etc.) occur, immediately visit an emergency room.