<h1 class="pgc-h-arrow-right" data-track="1" > recurrent episodes of epigastric pain may be peptic ulcer</h1>
With the accelerated pace of contemporary life, work pressure ensues, and many office workers eat irregularly due to busy work, which is easy to suffer from peptic ulcer in the long run.
Peptic ulcer (PU), usually due to the role of gastric acid and pepsin in the digestive tract, ulcer damage can generally reach deep into the mucosal muscle layer. PU is characterized by the appearance of open sores on the inner wall of the digestive tract, often forming duodenal ulcers (DU), gastric ulcers (GU), the ratio of the two is about 3:1.
If epigastric pain with recurrent periodic episodes occurs, the onset of pain can last for days, weeks, or even longer, and the pain has a clear correlation and rhythm with eating, suggesting that PU may already be present. The pain is usually dull, burning, or starving, and is usually mild, with persistent, severe pain suggesting ulcer penetration or perforation.
<h1 class="pgc-h-arrow-right" data-track="10" > 1 in 10 people have suffered from peptic ulcer in their lifetime</h1>
It is generally believed that about 10% of the population has suffered from peptic ulcer (PU) in their lifetime. The disease is mostly 20 to 50 years old, and the ratio of males to females is about 2 to 5:1. PU is very closely related to Helicobacter pylori (Hp) infection, with hp infection rates of more than 90% in duodenal ulcer (DU) patients and Hp positive rates of 60% to 90% in patients with gastric ulcer (GU).
In addition, the common causes of PU are the widespread use of nonsteroidal drugs (such as ibuprofen, aspirin, etc.), gastric acid, pepsin erosion, etc.
Many patients are relieved by medication, usually 4 to 6 weeks for DU and 6 to 8 weeks for GU. If not treated, it is easy to relapse, and its natural recurrence rate in 1 year can be as high as 60% to 80%. Complementary therapy for maintaining acid suppressants (H2 receptor antagonists, proton pump inhibitors (PPIs), etc.) and eradication of Hp can be more effective in preventing ulcer recurrence and reducing complications.
For PU caused by Hp infection, successful Hp radical treatment can not only promote ulcer healing, but also reduce its recurrence rate to 3% to 7%, thereby greatly curing ulcers. Due to the gradual decline in the eradication rate of previous eradication Hp therapy, the current bismuth quadruple "proton pump inhibitor + bismuth agent + 2 antibiotics" is the main empiric eradication hp treatment regimen.
<h1 class="pgc-h-arrow-right" data-track="20" > a new direction for hp eradication therapy— potassium-ion competitive acid blockers</h1>
Potassium ion competitive acid blocker (P-CAB) is a new drug that has a powerful and long-lasting inhibitory effect on gastric acid secretion. Compared with PPI, P-CAB has the advantages of fast onset of action (full effect of the first dose), long-lasting acid suppression (good acid suppression at night), and convenient to take (no need to take it before meals).
In 2015, funola fumarate tablets (P-CAB) were launched in Japan for the treatment of acid-related diseases such as reflux esophagitis and peptic ulcer. The 2020 edition of the Japanese Society of Gastroenterology (JSGE) Clinical Practice Guidelines for Peptic Ulcer recommends Vonorasine as a first-line eradication treatment for Hp (recommended intensity: strong; 100% agree; evidence grade: A). Among all oral drugs for the treatment of gastric and duodenal ulcers, the current share of vonorasin sales volume has reached 15.3%, and the share of sales amount has reached 28.1%.
At present, only 3 P-CAB drugs have been approved for marketing in the world, and funoracin fumarate tablets became the first P-CAB approved to enter the Chinese market at the end of 2019 for the treatment of reflux esophagitis, and are constantly submitting marketing applications for new indications. P-CAB can be regarded as a convenient and effective acid inhibitor with potential advantages, but whether P-CAB drugs are suitable and safe, or even lifelong use, still needs to be re-evaluated after clinical phase IV marketing.
<h1 class="pgc-h-arrow-right" Data-track="28" > why do common and curable peptic ulcers affect underwriting outcomes? </h1>
In general, the outcome of the PU underwriting depends on the patient's surgery and complications. Most PUs heal without complications, but in some cases life-threatening complications such as bleeding, perforation, etc., may occur, or even become cancerous. When ulcers are complicated by bleeding, perforation, etc., it is usually in the course of treatment, so the underwriting will extend the treatment to observe the effect of treatment, but if bleeding occurs repeatedly, it will be denied. The underwriting results of specific bleeding, perforation, etc. should also be determined in conjunction with factors such as pu's medical history time, extent, location, and erosion of blood vessels.
PU is the most common cause of upper gastrointestinal bleeding, accounting for about 50% to 70% of the causes of non-varices rupture bleeding; when the ulcer penetrates the stomach and duodenal wall, perforation occurs, about 1/3 to 1/2 of the perforation is associated with taking nonsteroidal drugs, DU can penetrate the common bile duct to form a gallbladder fistula, GU can penetrate the duodenum or transverse colon to form intestinal fistula; when DU recurrent attacks, the duration of the disease is long, the risk of cancer is also higher, and the risk of gastric cancer in Hp-related ulcer patients can increase by 3 to 6 times. Therefore, even if PU is a very common and curable disease, its complications may be life-threatening such as cancerous, so different degrees of PU will be limited when underwriting.
bibliography:
GE Junbo,XU Yongjian,WANG Chen. Internal Medicine[M]. Beijing:People's Medical Publishing House, 2018.
WANG Chuijie,LI Yufeng,HAO Weiwei,et al. Guidelines for the Diagnosis and Treatment of Peptic Ulcer in Common Diseases of the Digestive System (Grassroots Doctor Edition)[J].Chinese Journal of Traditional Chinese Medicine,2019,34(10):4721-4726.
Gastrointestinal Diseases Committee of Chinese Association of Integrative Medicine. Consensus Opinion on the Diagnosis and Treatment of Peptic Ulcer integrative medicine (2017)[J].Chinese Journal of Integrative Medicine and Digestion,2018,26(2):112-120.
Helicobacter pylori and peptic ulcer group of the Gastroenterology Branch of the Chinese Medical Association, etc. Fifth National Consensus Report on the Treatment of Helicobacter pylori Infection[J]. Chinese Journal of Digestion,2017,37(6) 364-378.
Kamada T, Satoh K, Itoh T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2020[J]. J Gastroenterol. 2021,56:303-322.