| Peptic ulcer(PU) is a common disease which can induce to serious complications such as bleeding, perforation and pyloric obstruction. The incidence of PU is variant among different countries and regions, ages, sexes and occupations. Clinical data indicates that PU is very common in army. In this article, the prevalence and risk factors of PU in army in peace time and on the background of war were studied, and the preventing methods were explored.1. The prevalence of symptoms of PU-like in army in peace time and on the backgroud of warWe sampled 6160 servicemen in the four major special troops which were artilleryman, infantryman, armored and coastal defense by the multi-stage laminate whole-group random sampling method. Questionnaire investigation of PU Symptoms and Risk Factors was taken in peace time and after a certain large scale military maneuver, and at the same time, the Psychological Stress Self-Evaluation Test was used to investigate psychological stress. Sc(score) of PU's three major symptoms that were epigastric pain, epigastric distention and sour regurgitation was obtained. Diagnostic criteria of symptoms of PU-like was Sc≥5. Results: The prevalences of upper gastrointestinal symptoms were 44.68% in peace time and 52.25% in the military maneuver(P<0.01). The prevalences of symptoms of PU-like were 18.60% and 22.42%, respectively(P<0.01). Higher prevalence of symptoms of PU-like was found among the soldiers who enlisted for less than 1 year, or served in armored troops, or were from south China. In the military maneuve, the prevalence of symptoms of PU-like increased obviously in groups whose enlisted period was 1, 4, or longer than 5 years(P<0.01), and in the artilleryman and coastal defense troops(P<0.01). The prevalences of psychological stress were 12.27% and 17.56% in peace time and the military maneuver, respectively(P<0.01). Sufferers from psychological stress had higher prevalence of symptoms of PU-like than the normal servicemen(P<0.01). Logistic multiple regression analysis manifested, fighting vehicle driving(OR5.62), smoking(OR3.76), drinking(OR2.75), irregular meal(OR3.18), frequent mental intension(OR3.65), psychological stress(OR3.06), gastropathy family history(OR2.08), acesodyne and anti-inflammatory(OR1.19), being enlisted for less than 1 year(OR2.14) and serving in armored troops(OR1.67) were related with symptoms of PU-like. Conclusion: The prevalence of upper gastrointestinal symptoms in army is high in peace time and increases on the background of war. The prevalences of symptoms of PU-like are 18.60% and 22.42% in peace time and military maneuver, respectively. For servicemen, symptoms of PU-like are closely associated with military training, mental factors, and also related to enlisted periord, arm of the service and the region where the servicemen come from. Psychological stress may contribute to the development of PU in servicemen.2. The prevalence of PU and Hp infection in armyBased on the data of the first part of this article, the objects were divided into three groups by the symptom score: low score group(Sc0-4), middle score group(Sc5-9), and high score group(Sc≥10). 50 servicemen were selected randomly in each group and received gastroscopy. Hp infection was detected by rapid urease tests(RUT) and 14C-urea breath tests(14C-UBT) in all the 150 servimen, and when both results were positive, the serviceman was considered having Hp infection. Another 300 servicemen were randomly sampled from the rest 6010 servicemen, and received 14C-UBT alone. Results: PU was found in 68 servicemen among the 150 servicemen who received gastroscopy, including 7 cases of gastric ulcer(GU), 58 cases of duodenal ulcer(DU), and 3 cases of complex ulcer(CU). Standardizated according to constituent ratio of the symptom score grades, the prevalence of PU was 13.07%. Hp positive rate in servicemen with PU (91.18%) was obviously higher than non-PU servicemen(50.00%)(P<0.01). Hp positive rates were 71.43%, 93.10%, and 100% in GU, DU, and CU, respectively. The concordance rate of two methods of Hp detection was 93.33%. Hp infection rate was 62.67% in army according to the 14C-UBT results of the 300 servicemen. Conclusion: The prevalence of PU is 13.07% in army, higher than normal population. PU in servicemen is mainly DU. Hp infection is widespread in the army, and the infection rate is 62.67%. Hp infection is closely related to PU in servicemen.3. Study on the prevention of PU in army on the backgroud of warA week before a certain military maneuver, 500 servicemen were randomly sampled. All servicemen were randomly divided into five groups: group A(control group, blank capsule, 1 pill, bid, po., 2 weeks); group B(ranitidine hydrochloride capsule, 150mg, bid, po., 2 weeks); group C(omeprazole enteric capsule, 20mg, bid, po., 2 weeks); group D (Hp eradication regimen: omeprazole enteric capsule, 20mg, and clarithromycin capsule, 500mg, and metronidazole tablet, 400mg, bid, po., 1 week; then blank capsule, 1 pill, bid, po., 1 week); group E(learning knowledge about the prevention of PU, psychological training and psycho-behavior therapy). Psychological stress score and PU symptoms score of each group were recorded, and gastroscopy was conducted in the servicemen whose PU symptoms score was more than 5 points, and who had haematemesis, or melena during or after the military maneuver. Results: The incidence of psychological stress was lower in group E than the control group(P<0.05), and than the other preventing groups after the military maneuver, but there was no significant difference between all the preventing groups (P>0.05). The incidence of symptoms of PU-like was lower in all the preventing group than the control group. The incidence of PU that was confirmed by gastroscopy was obviously lower in all the preventing group than the control group, and there was no significant difference between all the preventing groups (P>0.05). Conclusion: H2RA, PPI, Hp eradication regimen can be used to prevent PU in servicemen on the backgroud of war. Preventing psychological stress may reduce the incidence of PU in servicemen.In summary, present study showed that the prevalence of PU is high in army in peace time, and maybe have futher increase on the backgroud of war. PU is closely associated with military training, mental factors, and also related to enlisted periord, arm of the service in army. Hp infection is widespread in the army. H2RA, PPI, Hp eradication regimen and prevention of psychological stress can be used to prevent PU in servicemen on the backgroud of war. |
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