| Background and objectives:Peptic ulcer(PU)is one of the most common chronic gastrointestinal diseases,and it is also a common and frequently-occurring disease in humans.PU often recurs,causing physical and mental pain,affecting the quality of life,and increasing the economic burden.It can also cause ulcer bleeding,perforation and pyloric obstruction,which can endanger the life of the patient in severe cases.In recent years,the clinical diagnosis and treatment of PU has made great progress.The wide application of endoscopes has made it easy to use PU diagnosis.The advent of proton pump inhibitors(PPI)has made PU have good short-term curative effects,and Helicobacter pylori(Hp)eradication can be achieved to a certain extent.Reduce the recurrence,but does not completely change the clinical condition of PU,the incidence is still high,recurrence and concurrent bleeding and perforation are still common.Therefore,it is still necessary to in-depth study the law of occurrence and development of PU in the era of endoscopy,PPI,and Hp to control PU more effectively.To this end,this study will conduct a systematic retrospective analysis of various clinical data of PU hospitalized patients in the past 8 years,summarize their clinical characteristics and changing trends,and provide a scientific basis for more effective diagnosis and treatment of PU.Methods:1.Research subjects: PU patients hospitalized in the Third Affiliated Hospital of Nanchang University from March 2012 to February 2020,including gastric ulcer(GU),duodenal ulcer(DU),compound ulcer(CU),and with or without complications(ulcer bleeding,pyloric obstruction,or ulcer perforation).The diagnosis is confirmed based on the results of gastroscopy or surgery within 2 weeks before and after admission.2.Data collection: Retrieve the patients diagnosed as PU during the above period from the medical record room,and collect the information on the first page of the medical record.According to the diagnostic criteria,inclusion criteria and exclusion criteria,qualified research subjects were screened,medical records were retrieved and clinical data of patients were collected,including clinical symptoms,etiology and triggers,complications,gastroscopy data,etc.All information is saved to Excel sheet,and data is cleaned and coded.3.Research contents:(1)Analysis of clinical characteristics: The PU patients were grouped according to different indicators,and the differences in clinical characteristics between the groups were compared,including demographic characteristics,clinical symptoms and signs,etiology and triggers,complications,endoscopic ulcer characteristics,and treatment methods.(2)Health economics related analysis: statistical analysis of the distribution of PU patients’ admission time,influencing factors of hospitalization days,and clinical characteristics of multiple hospitalized patients.(3)Change trend analysis: According to the annual statistics of the abovementioned various clinical characteristics,hospital admission time,hospitalization days,etc.of PU patients,compare the differences between the years,observe and analyze the change trend.4.Statistical processing: Measurement data are expressed in the form of mean ±standard deviation(Mean ± SD),the difference between two groups is compared by t test,and the difference between three groups and above is compared by one-way analysis of variance.The enumeration data was expressed by rate,and the difference between groups was compared by chi-square test.Whether a single set of data is randomly distributed adopts the run-length test.P<0.05 indicates that the difference is statistically significant.Use SPSS 22.0 software to complete the above statistical analysis.Results:A total of 2993 PU patients were retrieved,of which 2266 eligible PU patients were included in the analysis,aged from 10 to 93 years old,with an average age of51.6±16.7 years,including 1615 males,651 females,689 gastric ulcers,and 1447 duodenal ulcers,130 cases of compound ulcers.The specific statistical analysis results are as follows:1.Demographic characteristics of hospitalized patients with peptic ulcer:gradually increase after the age of 20,reach a peak at the age of 50 to 60,and then gradually decrease;duodenal ulcers increase rapidly after the age of 20,and gastric ulcers increase rapidly after the age of 40.However,the peak ages of the two are the same;there are more men than women,and the younger the male is,the greater the proportion of men and women(P<0.001);female patients are different from male patients,and there is no difference in the peak age of duodenal ulcer and gastric ulcer.2.Clinical manifestations of hospitalized patients with peptic ulcer: Upper abdominal pain,anorexia,nausea,and vomiting are more common than symptoms such as acid reflux,belching,and heartburn.Except for anorexia symptoms,the positive rate of the other symptoms is less than 50%.There is no significant difference in the positive rate between ulcer and compound ulcer;32.6% of female patients have rhythmic epigastric pain,which is significantly more than that of men;there are certain differences in clinical symptoms between different age groups;the positive rate of epigastric tenderness is 47.5%.3.The etiology and incentives of hospitalized patients with peptic ulcer:Helicobacter pylori(Hp)infection rate was 74%,gastric ulcer was 10% lower than duodenal ulcer(P<0.001),and the positive rate of Hp decreased with age(P<0.05),and there was no significant difference in infection rate between men and women;The positive rates of blood type A and B in GU patients were 28.9% and 26.0%,respectively,which were significantly higher than that of DU(P < 0.001).The positive rate of blood type O in DU patients was 43.4%,which was significantly higher than that of GU(P<0.001);NSAIDs are an important predisposing factor for middle-aged and elderly patients.The proportion of women is more than that of men,and drinking is an important predisposing factor for young and middle-aged patients.4.Ulcer complications in hospitalized patients with peptic ulcer: 61.1% of patients were admitted to the hospital due to ulcer complications.Ulceration and bleeding were the most(45.8%),followed by perforation(10.7%).Complications caused by DU accounted for 71%;young people were more likely to have ulcer bleeding and perforation(P<0.001);patients with bleeding and perforation have a higher rate of Hp infection(P<0.05);The incidence of complications in patients with blood type AB is 69.3%,and the incidence of bleeding is 54.3%,which is higher than that of other blood types;those who take NSAIDs are more likely to develop complications.5.The characteristics of endoscopic ulcers in hospitalized patients with peptic ulcer: the duodenum and gastric antrum are the most common(77.7%)of the endoscopic ulcers,and they are mainly round(68.1%)with a length of less than 1cm.Mainly(71.3%);irregular ulcers in the stomach fundus,linear and circular ulcers in the cardia,cream spot ulcers in the duodenum,and large ulcers in the gastric ulcer(P<0.001)Gastric ulcers are more common in middle-aged and elderly people,and duodenal ulcers are more common in middle-aged and young people(P<0.001);the area of ulcers in middle-aged and young people is smaller than that in middle-aged and old people(P<0.05);female ulcers are smaller than that of men(P<0.001);Hp infection and blood type There is no obvious relationship with the size and shape of the ulcer;the incidence of bleeding from ulcers with a long diameter of 0.6 to 1.0 cm was 58.1%,which was significantly higher than that of other groups.The incidence of perforation of ulcers with a long diameter of 1.6 to 2.0 cm was the highest.6.The main treatment methods for hospitalized patients with peptic ulcer:the main treatment method is medication(85.7%),especially for middle-aged and elderly people;endoscopic hemostasis treatment was 4.3%,more elderly patients than other age groups(P<0.001);most of the perforated ulcers were repaired surgically,and subtotal gastrectomy was rarely performed(P<0.001);more men than women were treated with endoscopic and surgical treatment(P<0.001).7.Admission time for inpatients with peptic ulcer: the peak of admission is winter and spring(the highest in March),and the trough in summer(the lowest in August);the number of admissions in different months and seasons is between GU,DU and CU,and in different age groups There is no difference between men and women;ulcer bleeding in summer is lower than other seasons(P<0.05),ulcer perforation and pyloric obstruction are most common in spring;simple drug therapy is most commonly used in summer,and endoscopic hemostasis is more frequent in autumn and winter than other seasons(P <0.001);more ulcers are repaired by open surgery in spring than under laparoscopic repair.8.The length of hospital stay for patients with peptic ulcer: Age,certain clinical manifestations(non-rhythmic epigastric pain,dyspepsia symptoms,epigastric tenderness),ulcer size,and the presence or absence of complications are significantly related to the length of hospital stay(P< 0.05);the hospital stay for gastric ulcer was longer than duodenal ulcer(P<0.001).9.Relevant factors for patients with multiple hospitalizations for peptic ulcer: Multiple hospitalizations for patients are mainly related to old age and complications,which are not related to other factors investigated in this study.10.Trend of changes in hospitalized patients with peptic ulcer: The number of hospitalized patients with peptic ulcer is increasing year by year,mainly due to the significant increase in winter cases(P<0.001);there is no difference in the age and gender composition of patients between each year;there is no rhythm The proportion of patients with epigastric pain,anorexia,belching,and epigastric tenderness showed an increasing trend(P<0.001);Helicobacter pylori-negative cases showed a significant increase(P<0.001);the proportion of patients with blood types A and B showed an increasing trend(P<0.001);the proportion of patients taking non-steroidal anti-inflammatory drugs showed a significant increasing trend(P<0.001);gastric body,gastric angle,and gastric antrum ulcers all showed an upward trend,duodenal ulcer showed a parabolic change trend,compound Sexual ulcers seem to have risen sharply recently(P<0.001);ulcers below 20 cm show a "bimodal" rise,while large ulcers first rise and then fall;atypical ulcers(linear,frosty,ring-shaped ulcers)show an upward trend(P< 0.001),while typical ulcers(circular,irregular)have no obvious changes;ulcer patients with compound complications have an accelerated upward trend,pyloric obstruction has an upward trend,ulcer bleeding has a slight upward trend,and ulcer perforation has a downward trend(P<0.001);the number of days of hospital stay within 1 week showed an increasing trend,those with 1 to 2 weeks showed a bimodal increase trend,and those with more than 2 weeks showed a trend of first rising and then decreasing;the number of hospitalized patients showed a rapid upward trend and stabilized at a relatively high level.Conclusions:1.The proportion of peptic ulcer hospitalized patients with ulcer subtypes is significantly different.Duodenal ulcers are the most common and have obvious demographic characteristics.The patients are the most in 40-60 years old,and there are more men than women.2.The clinical manifestations of hospitalized patients with peptic ulcer are atypical and are related to age and gender.In terms of a single symptom,more than half of the patients have no symptoms.Female patients have more rhythmic epigastric pain than men.There are clinical symptoms in different age groups.Certain differences;about half of patients have upper abdominal tenderness,especially gastric ulcers and young and middle-aged patients.3.The incidence and complications of peptic ulcer hospitalized patients are related to Helicobacter pylori,blood type,taking NSAIDs and drinking.The Hp of gastric ulcer is 10% lower than that of duodenal ulcer.The positive rate of Hp decreases with age.A,People with blood type B have more GU than DU,and those with O blood have more DU than GU;taking NSAIDs is an important predisposing factor for middle-aged and elderly patients,especially women,and drinking is an important predisposing factor for young and middle-aged patients,especially men.More than half of the patients were admitted to the hospital due to ulcer complications.Ulcers and bleeding were the most common,mainly caused by duodenal ulcers.Young men were more likely to have ulcer bleeding and perforation.Patients with complications had a higher rate of Hp infection,and AB blood accounted for higher than that,more people taking NSAIDs.4.The position,shape and size of the endoscopic ulcer in hospitalized patients with peptic ulcer are related to age,sex and complications.Gastric ulcer is more common in middle-aged and elderly patients,duodenal ulcer is more common in middle-aged and young people,and ulcer in middle-aged and young people The area is smaller than that of middle-aged and elderly people.Female ulcers are smaller than males.Ulcer bleeding is more common in ulcers within 1 cm,and ulcer perforation is more common in ulcers within 1 cm.5.The main treatment method for hospitalized patients with peptic ulcer is medication alone.A small number of bleeding patients receive endoscopic treatment.Patients with perforation generally undergo surgical repair,rarely undergoing subtotal gastrectomy.Endoscopic and surgical treatments are mostly performed by men.For women.6.The peak of admission for patients with peptic ulcer is in winter and spring(the highest in March),and the trough in summer(the lowest in August).Ulcer bleeding in summer is lower than other seasons.Ulcer perforation and pyloric obstruction are most common in spring.Endoscopic hemostasis in autumn more in winter than in other seasons;ulcers are repaired more frequently than under laparoscopic surgery in spring.7.Peptic ulcer hospitalized patients are older,have certain clinical manifestations(non-rhythmic epigastric pain,dyspeptic symptoms,epigastric tenderness),large ulcers,longer hospital stays for complications,and longer hospital stays for gastric ulcers than duodenal ulcers.Multiple hospitalizations are mainly related to old age and complications.8.The number of hospitalizations of peptic ulcer patients is increasing year by year.The number of cases in winter has increased significantly,and the proportion of Helicobacter pylori-negative patients taking non-steroidal anti-inflammatory drugs has a significant increase;gastric ulcers are all on the rise,duodenum Ulcers show a parabolic change trend: ulcers below 2cm show a "bimodal" rise,while large ulcers first rise and then fall;atypical ulcers(linear,frosty,ring-shaped ulcers)show an upward trend;patients with ulcers with compound complications There was an accelerating upward trend,pyloric obstruction showed an upward trend,ulcer bleeding showed a slight upward trend,while ulcer perforation showed a downward trend;the number of hospitalization days within 1 week showed an increasing trend;the number of hospitalized patients showed a rapid upward trend. |
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